Citation Nr: 21031877 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 13-14 154 DATE: May 24, 2021 REMANDED Entitlement to service connection for an inguinal hernia is remanded. REASONS FOR REMAND The appellant is a Veteran who had honorable active service from January 1974 to August 1977; he also had a period of service from August 1977 to November 1982 from which he was discharged under other than honorable conditions. These matters are before the Board of Veterans' Appeals (Board) on appeal from a January 2012 Department of Veterans Affairs (VA) rating decision. In May 2016, a videoconference hearing was held before the undersigned; a transcript of the hearing is in the record. In July 2016, October 2017, and April 2020 the matter was remanded for additional development. Entitlement to service connection for an inguinal hernia The Veteran contends that he developed an inguinal hernia from heavy lifting in service. When the case was returned to the Board following the October 2017 Board remand, it was determined that the record still did not have an adequate examination/opinion addressing the etiology of the claimed inguinal hernia. The Board's April 2020 remand ordered development for an examination to obtain an adequate opinion. On October 2020 VA examination, the Veteran related that when he was examined for employment soon following his discharge from service, he was found to have a dime-sized hernia (but records of the examination were no longer available). He asserted it had to be due to the heavy lifting in which he engaged in the course of his duties in service. On physical examination an inguinal hernia was diagnosed. The examiner opined that the inguinal hernia was less likely than not related to service. The rationale provided was "There are no records found to indicate onset in service. As such no proximal cause relationship can be established based on the medical evidence." That opinion is conclusory and inadequate for rating purposes. It is well-established that the absence of documentation of a disability in service cannot be the sole basis for a finding that the disability is unrelated to service. The provider did not address the alleged theory of entitlement, and the opinion does not discuss the Veteran's reports of a small hernia found on examination soon after service. While the soon after service finding is not documented, the Veteran's report of such is not inherently implausible (and it also quite likely that a report of such a remote examination would now be unavailable). As the October 2020 medical opinion is noncompliant with the Board's remand directives, corrective action is necessary. See Stegall v. West, 11 Vet. App. 268 (1998) The matter is REMANDED for the following: Arrange for the Veteran's claims file to be forwarded to an appropriate clinician for review and an advisory medical opinion regarding the likely etiology of the Veteran's inguinal hernia found on October 2020 VA examination. Noting that the absence of documentation of a disability in service cannot be the sole basis for a finding that the disability is unrelated to service, and considering the Veteran's lay reports that a small hernia was found on an examination for employment soon after service, the consulting provider should: Identify the likely etiology of the Veteran's inguinal hernia. Specifically, is it at least as likely as not (a 50 percent or greater probability) that it is etiologically related directly to the Veteran's service (was incurred therein), to include as due to acknowledged heavy lifting in which he engaged in the course of his duties in service? The opinion must address the theory of entitlement he has raised and reflect consideration of his lay account of an inguinal hernia being found on an examination for employment soon postservice (whether plausible or implausible based on the evidence of record). If the inguinal hernia is determined to be unrelated to the Veteran's service (and heavy lifting therein), identify the etiology for the inguinal hernia that is considered to be more likely based on the evidentiary record (and explain why that is so). All opinions must include rationale that cites to supporting factual data and medical principles. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Camille NeSmith, 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.