Citation Nr: 21021772 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 16-62 460 DATE: April 14, 2021 REMANDED Entitlement to service connection for hemorrhoids is remanded. Entitlement to service connection for a low back disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1989 to August 1993. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. In February 2020, the Board denied service connection for hemorrhoids and a low back disorder, and the Veteran subsequently appealed such decision to the United States Court of Appeals for Veterans Claims (Court). In December 2020, the Court granted the Veteran’s and the Secretary of VA’s (the parties’) Joint Motion for Remand (JMR), which vacated and remanded the Board’s February 2020 decision for action consistent with the JMR. The claims now return to the Board for further appellate review. 1. Entitlement to service connection for hemorrhoids. In the February 2020 decision, the Board found that the Veteran’s currently diagnosed hemorrhoids were not present in service or for years thereafter, and were not etiologically related to service. In reaching such decision, the Board acknowledged that a January 1991 service treatment record (STR) indicated that the Veteran was treated for complaints of blood in his stools, but found probative the fact that his STRs did not show that he was diagnosed with hemorrhoids during active duty or at discharge. However, in the December 2020 JMR, the parties found that the Board erred in finding that VA satisfied its duty to assist by not obtaining an examination to evaluate the Veteran’s hemorrhoids. Specifically, the parties noted that, while the Board acknowledged the January 1991 STR that demonstrated that the Veteran was treated for complaints of blood in his stool, an additional January 1991 STR showing that he was diagnosed with probable hemorrhoids was not addressed. Based on this evidence, the parties determined that a remand was necessary in order to obtain a VA examination pursuant to McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006) (holding that an examination is necessary if, inter alia, evidence indicates that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or service-connected disability). Therefore, in compliance with the JMR, the Board herein remands the claim for such development. 2. Entitlement to service connection for a low back disorder. In the February 2020 decision, the Board found that a low back disorder was not present in service or for years thereafter, and was not etiologically related to service. In reaching such decision, the Board afforded great probative weight to a June 2013 VA examiner’s opinion that found it was less likely than not that such disorder was incurred in or caused by the claimed in-service injury, event, or illness based primarily on a finding that he suffered an acute injury to the back in July 2002. However, in the December 2020 JMR, the parties found that the Board erred in finding VA’s duty to assist satisfied by the aforementioned June 2013 medical opinion. Specifically, the parties noted that the June 2013 VA examiner did not address evidence that suggested the Veteran had a low back disorder before July 2002. Here, the parties observed that the evidence showed that: (1) in January 2002, the Veteran reported that his low back pain started in service; (2) in June 2011, the Veteran reported he hurt his back in July 1990 while stationed in Germany; (3) a February 2002 VA treatment record reflected that the Veteran sustained an acute right lower lumbar herniated disc during physical training in 1991, and now had chronic low back discogenic syndrome; (4) in April 2002, the Veteran sought emergency care for back pain which he reported began 12 years earlier, and a corresponding MRI showed right central disc herniation compromising cerebrospinal fluid space at L5-S1; and (5) a July 2002 MRI revealed moderate degenerative disc disease at L5-S1 and moderate to large right posterocentral disc extrusion compressing the right S1 nerve root at L5-S1. Consequently, the parties determined that a remand was necessary in order to obtain an addendum opinion that addressed such matters. Therefore, in compliance with the JMR, the Board herein remands the claim for such development. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of his hemorrhoids. The record, to include a copy of this Remand, must be made available to the examiner, and all indicated tests should be performed. Following a review of the record, the examiner should opine whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s hemorrhoids had their onset in, or are otherwise related to, his military service. In offering such opinion, the examiner should consider and comment on the Veteran’s treatment referable to his rectum and anus in service, including the January 1991 STRs showing: (1) treatment for complaints of blood in his stool; and (2) a diagnosis of probable hemorrhoids. A rationale for any opinion offered should be provided. 2. Forward the record, to include a copy of this Remand, to an appropriate VA clinician to obtain an addendum opinion addressing the etiology of the Veteran’s low back disorder. Following a review of the record, the examiner should address the below inquiries: (A) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s low back disorder (diagnosed as lumbosacral lumbar degenerative joint disease, lumbar herniated disc, and chronic low back discogenic syndrome) had its onset in, or is otherwise related to, his military service, to include his in-service treatment for back pain/problems and assessment of low back strain in January 1991? (B) Did arthritis of the low back manifest within one year of the Veteran’s separation from service in August 1993, i.e., by August 1994. If so, please describe the manifestations. In offering such opinions, the examiner should consider and comment on the following evidence: (1) in January 2002, the Veteran reported that his low back pain started in service; (2) in June 2011, the Veteran reported he hurt his back in July 1990 while stationed in Germany; (3) a February 2002 VA treatment record reflected that the Veteran sustained an acute right lower lumbar herniated disc during physical training in 1991, and now had chronic low back discogenic syndrome; (4) in April 2002, the Veteran sought emergency care for back pain which he reported began 12 years earlier, and a corresponding MRI showed right central disc herniation compromising cerebrospinal fluid space at L5-S1; and (5) a July 2002 MRI revealed moderate degenerative disc disease at L5-S1 and moderate to large right posterocentral disc extrusion compressing the right S1 nerve root at L5-S1. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Koria B. Stanton, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.