Citation Nr: 21028767 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 17-43 379 DATE: May 12, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for an inguinal hernia is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The appellant served in the Army National Guard from May 1979 to May 1989, including active duty for training (ACDUTRA) from November 1979 to May 1980 and periods of inactive duty training (INACDUTRA). The appellant also had National Guard service from October 1990 to November 1992 but was discharged under other than honorable conditions for Department of Veterans Affairs (VA) purposes; therefore, VA benefits cannot be awarded for the appellant's second period of National Guard service. 38 U.S.C. § 101(18); 38 C.F.R. § 3.12. He appeals a June 2014 rating decision from the Agency of Original Jurisdiction (AOJ) denying entitlement to service connection for a mental health condition and an inguinal hernia. He also appeals a January 2017 rating decision denying entitlement to TDIU. A Board of Veterans' Appeals (Board) hearing was held in March 2020. A transcript is of record. In April 2020, the Board remanded for development of the aforementioned issues and the claim is now back before the Board. The Board apologizes for the delay, but an additional remand is required to ensure compliance with the prior remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The first remand directive requested the AOJ obtain any outstanding VA and/or private treatment records, including psychiatric treatment records from Hamilton Medical Clinic from 1982 to 1984. The most recent VA treatment record on file is from December 2013 and there is no evidence the AOJ attempted to obtain any VA treatment records since that time. Additionally, the AOJ sent only one request to the appellant to obtain psychiatric treatment records from Hamilton Medical Clinic. See May 2020 VA letter. On remand, the AOJ should make reasonable efforts to obtain all relevant treatment records, including providing two requests for his Hamilton Medical Clinic records. See 38 C.F.R. § 3.159(c)(1). Inguinal Hernia In November 2020, a VA examiner opined that the appellant's inguinal hernias were less likely than not related to a claimed in-service injury or event. As rationale, the examiner stated "according to the following service treatment records (STRs) and private treatment records, the appellant's inguinal hernia is not related to his military service." The examiner then proceeded to list three STRs and six private treatment records. The Board finds this opinion inadequate as it merely lists certain facts and a conclusion without a description of the doctor's reasoning or analysis. Without sufficient detail and rationale, the Board's evaluation of the claimed disability cannot be a fully informed one. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Further, the STRs listed do not include the April 1980 separation examination noting the appellant "had a hernia." See April 1980 separation examination report. Finally, the VA examiner's opinion did not consider any of the appellant's lay statements that his hernia symptoms started in-service and have continued to the present, as directed by the April 2020 Board remand instructions. As such a remand is required. TDIU The appellant claims he cannot work due to his inguinal hernias and acquired psychiatric disorder. See February 2014 VA Form 21-8940. Since the decision on the remanded issues discussed herein impact a decision on entitlement to TDIU, the issues are inextricably intertwined. Accordingly, the Board will defer decision on the matter. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain any outstanding and updated relevant VA and/or private treatment records, including, but not limited to, (a). VA treatment records from December 2013 to the present, and (b). psychiatric treatment records from Hamilton Medical Clinic from 1982 to 1984. If any identified records are not obtainable, or none exist, the appellant and his representative should be notified, and the record clearly documented. 2. After the development of #1 above is complete, obtain an opinion from an appropriately qualified clinician, other than the clinician that provided the November 2020 opinion, to determine the nature and etiology of the appellant's claimed inguinal hernias. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the reviewing clinician. The opinion should note a record review took place. After a thorough review of the record, the reviewing clinician should answer the following: Is it at least as likely as not (a 50 percent probability or more) that the appellant's inguinal hernia was the result of a disease or injury incurred during ACDUTRA or an injury incurred during a period of INACDUTRA, to include the continuous heavy lifting required by his MOS of Indirect Fire Infantryman during any period of ACDUTRA and/or INACDUTRA? The reviewing clinician is directed to March 1980 service treatment records for treatment of "hernia at left side, also left testicle is enlarged and has pain. [Claimant] claims he had it since November;" and the April 1980 separation examination noting the appellant "had a hernia." The reviewing clinician is further directed to the appellant's March 2020 Board hearing testimony at p.5, noting "around the end of 1979, going into January of 1980, I was having urinal problems, and I had nights where I was pushing down around my...groin, down in my testicles, they were kind of swollen." The reviewing clinician should also note that the appellant is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the reviewing clinician rejects the appellant's reports of symptomatology, a reason for doing so should also be provided. The reviewing clinician should not mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A full and complete rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the reviewing clinician cannot provide a requested opinion without resorting to mere speculation, it must be stated, and the reviewing clinician must provide the reasons why an opinion would require speculation. 3. After the above has been completed to the extent possible, readjudicate the claim. If any benefit sought remains denied, provide the appellant with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bona, 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.