Citation Nr: 21041702 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 18-34 336 DATE: July 9, 2021 REMANDED Entitlement to service connection for a perianal disability (claimed as gangrene surgery), to include as secondary to service-connected hemorrhoids or as due to Gulf War environmental exposures, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1979 to June 2008. This matter comes to the Board of Veterans' Appeals (Board) from a December 2017 rating decision which, in pertinent part, denied entitlement to service connection for gangrene surgery. In March 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In June 2020, the Board remanded the matter for further development. Entitlement to service connection for a perianal disability is remanded. The Veteran asserts that service connection for a perianal disability is warranted due to service in Southwest Asia, to include exposure to environmental hazards or ingestion of contaminated food or water. He also reported that his surgeons informed him that he had campylobacter jejuni. In March 2021, the VA examiner diagnosed the Veteran with status post incision and drainage for perineal abscess. The examiner opined that the Veteran's disability was less likely than not related to service. The examiner stated that perianal abscesses are acute infectious conditions that require immediate treatment and explained that this disability was not related to medical conditions or treatment mentioned in several service treatment notes. The Board cannot make a fully-informed decision at this time because clarification is needed as to the etiology of the infectious process that caused the Veteran's perianal disability. The Board notes that an August 2018 treatment record stated that this disability was secondary to an infection of unclear etiology. While the examiner explained that this disability was not related to medical conditions or treatment mentioned in several service treatment notes, the examiner did not consider any of the theories asserted by the Veteran. On remand, the examiner should explain whether the infectious process is related to campylobacter jejuni, an infection that can result in presumptive service connection. See 38 C.F.R. § 3.317(c). The examiner also should explain whether the infectious process is related to service in Southwest Asia, to include exposure to environmental hazards or ingestion of contaminated food or water. The matter is REMANDED for the following action: Obtain an addendum opinion from the March 2021 VA examiner, if available, or from an appropriate clinician clarifying the etiology of the infectious process of the Veteran's perianal disability. If the examiner believes a new examination is necessary, schedule a new examination. The examiner should opine on whether it is at least as likely as not that the Veteran's perianal disability is related to campylobacter jejuni and, if so, whether it manifested within one year of separation from a qualifying period of service in Southwest Asia. The examiner also should opine on whether it is at least as likely as not that the Veteran's perianal disability is related to service in Southwest Asia, to include exposure to environmental hazards or ingestion of contaminated food or water. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Ormson, 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.