Citation Nr: 21039661 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 14-10 645A DATE: July 1, 2021 REMANDED Entitlement to service connection for cancerous colon polyps, to include as due to herbicide exposure or in the alternative, as secondary to a service-connected disability, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to July 31, 2014, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1968 to December 1971, including service in the Republic of Vietnam. As a result of his military service, the Veteran received the Combat Action Ribbon and the Purple Heart, in addition to other decorations. This matter comes before the Board of Veterans' Appeals (Board) from an October 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in July 2019 and March 2021, at which times the issues currently on appeal were remanded for additional development. The case has now been returned to the Board for further appellate action. Finally, the Board notes that in a May 2021 letter, the Veteran's appointed attorney attempted to withdraw his representation of the Veteran. After an appeal is certified to the Board, a representative may not withdraw unless good cause is shown on motion. Good cause includes the extended illness or incapacitation of the representative; failure of the appellant to cooperate with proper preparation and presentation of the appeal; or other factors which make the continuation of representation impossible, impractical, or unethical. 38 C.F.R. § 20.608 (b)(2). Here, the attorney has not provided good cause or state any cause for doing so. Therefore, the Board does not recognize the withdrawal and finds that the attorney still represents the Veteran in this appeal. Entitlement to service connection for cancerous colon polyps Although the Board regrets additional delay, remand is necessary to properly comply with the Boards previous remand instructions. See Stegall v. West, 11 Vet. App. 268 (1998). In March 2021, the Board remanded this issue to obtain an opinion to determine if the Veteran's nonsteroidal anti-inflammatory drugs (NSAIDs) use or any other medication use for his service-connected disabilities caused or aggravated his colon polyp disability. Additionally, the Board requested an opinion to determine if any of the Veteran's service-connected disabilities themselves caused or aggravated his disability. In March 2021, a VA medical opinion was obtained. The examiner stated that there was no clinical evidence found for aggravation of cancerous colon polyps after the Veteran's most recent treatment. The examiner commented that there was no evidence of this Veteran was taking the known medications that have been identified as risk factors for developing or aggravating colon polyps. To that end, the examiner indicated that medical literature does relate several medications (NSAIDS) with an increased risk of diverticulitis and diverticular bleeding. The Veteran has been diagnosed with mild diverticulosis without diverticulitis or diverticular bleeding, so it is less likely than not that the NSAIDS caused his diverticulitis. This opinion does not properly address the Veteran's claim. First, the examiner stated that there is no evidence of the Veteran taking the known medications that have been identified as risk factors for colon polyps. As previously stated in the Board's prior remand, the Veteran has been taking NSAIDs, which were identified as a risk factor medication. As such, a new opinion is needed to determine in the Veteran's NSAID use has caused or aggravated his disability. Secondly, the Board requested a medical opinion to determine if any of the Veteran's service-connected disabilities have caused or aggravated his colon disability. Such opinion has not been obtained, so remand is necessary to address this issue. Finally, the examiner should address whether any medications that the Veteran takes for his service-connected disabilities, not just NSAIDs, have caused or aggravated his colon disability. Entitlement to a TDIU prior to July 31, 2014 Finally, because a decision on the remanded issue of service-connection for a colon disability could significantly impact a decision on the issue of TDIU prior to July 31, 2014, the issues are inextricably intertwined. Thus, a remand of the claim for TDIU is required. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to treatment for his colon disability. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to whether any current disability of the colon is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) service-connected disabilities, to include as a result of NSAIDs or any other medications currently taken for his service-connected disabilities. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. 3. Following the completion of the above, the Agency of Original Jurisdiction should consider whether additional development is warranted as a result of the above (e.g., development for entitlement to a TDIU). Christopher J. O'Donnell Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Hofmeister 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.