Citation Nr: 21026751 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 14-34 034 DATE: May 3, 2021 REMANDED Entitlement to service connection for a cecal tubulovillous adenoma, originally claimed as a right hemicolectomy, to include as secondary to exposure to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from January 1979 to January 1983, and from August 1984 to August 2000. This matter before the Board of Veterans' Appeals (Board) is on appeal from a March 2012 rating decision and a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky (Agency of Original Jurisdiction (AOJ)). The Veteran testified at a Board hearing before the undersigned in June 2017. A transcript of the proceeding is of record. The record reflects that the Veteran received a letter indicating that he could request a virtual tele-hearing instead of waiting for a travel board hearing. Upon further review, he does not have a pending hearing request. He provided testimony during the June 2017 hearing with a Veterans Law Judge. The transcript of that hearing has been considered as evidence in coming to this decision. This matter was previously before the Board in February 2019. At that time, the Board denied the Veteran's claim. The Veteran subsequently appealed the Board's decision to the Court of Appeals for Veterans' Claims (the Court). The parties filed a Joint Motion for Partial Remand (JMR) which the Court granted, vacating the Board's decision as it pertained to this issue and remanding the claim due to the Board's reliance on a medical opinion that employed a heightened standard to determine whether the Veteran's cecal tubulovillous adenoma was related to service. Following the JMR, this matter appeared back before the Board in January 2020. The Board remanded to obtain an adequate medical opinion that employed the required standard of proof from a colorectal surgeon. However, while several medical opinions were obtained, they were provided by a nurse practitioner and a doctor of occupational medicine. Given the fact that the Court specifically designated nature of the opinion needed, the Board found that such a decision needed to come directly from a colorectal surgeon and no other medical professional. The Board therefore remanded once more in November 2020 to obtain such an opinion from this specific specialist. Upon review of the record, the Board finds that the AOJ has once again failed to substantially comply with the remand directives. The opinions given on remand, while thorough, were provided by a physician's assistant and an occupational medicine medical examiner instead of a colorectal surgeon. For the same reasons stated above, the Board finds that the AOJ has not substantially complied with the remand directive in accordance with Stegall v. West, 11 Vet. App. 268, 271 (1998), and must therefore remand once more. The matters are REMANDED for the following action: 1. The claims folder should be forwarded to a COLORECTAL SURGEON AND NO OTHER SPECIALIST to determine whether the Veteran's cecal tubulovillous adenoma is related to service. The claims file must be made available to and be reviewed by the examiner. The examiner should specifically indicate whether it is at least as likely as not (50 percent or greater probability) that the Veteran's cecal tubulovillous adenoma, which led to right hemicolectomy, first manifested in service, or is causally related to an event in service, to include the presumed exposures at Camp Lejeune? In providing this opinion, the examiner is requested to consider the testimony of the Veteran of being informally told by his treating physician that the tubulovillous adenoma in the cecum, which led to the right hemicolectomy, had to have been present for 5 to 10 years based on the large size in light of the colonoscopy findings obtained in March 2003, June 2005 and July 2008. The examiner should express whether there is any medical reason to accept or reject the Veteran's belief that his tubulovillous adenoma in the cecum had been present in service based upon the theory expressed above. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Thereafter, readjudicate the claim. If any benefit sought on appeal remains denied, furnish the Veteran and his representative, if any, a supplemental statement of the case and an appropriate period of time to respond. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Victoria A. Banis, 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.