Citation Nr: 21042760
Decision Date: 07/13/21	Archive Date: 07/13/21

DOCKET NO. 18-42 004
DATE: July 13, 2021

REMANDED

Entitlement to service connection for neuroendocrine tumor, to include as secondary to service-connected Crohn's Disease with Irritable Bowel Disease (IBS) is remanded.

REASONS FOR REMAND

The Veteran served on active duty in the United States Navy from March 1991 to September 1995. 

This appeal was before the Board in January 2020 when it was denied.  The Veteran appealed to the Court of Appeals for Veterans Claims (Court) and the Court issued a Joint Motion for Remand (JMR) in February 2021.  In compliance with the JMR, the Board finds that a remand is necessary.  Stegall v. West, 11 Vet. App. 268 (1998).

Entitlement to service connection for neuroendocrine tumor, to include as secondary to service-connected Crohn's disease is remanded.

In the JMR, the parties agreed that the Board failed to properly address a medical article and the private oncologist's opinion that the tumor location was the cause of his gastrointestinal bleeding as well as that the tumor was the type that can "grow slowly for many years without causing symptoms."  As the Board is precluded from making medical determinations, a medical opinion is required to properly adjudicate the appeal.  Colvin v. Derwinski, 1 Vet. App. 171, 174 (1991).

Accordingly, a remand is necessary.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate clinician, a gastrointestinal oncologist if possible, regarding:

a) whether the Veteran's neuroendocrine tumor is at least as likely as not related to his service, to include the STR entries for repeated abdominal pain and recurrent melaena, recurrent Mallory Weiss tear, and recurrent vomiting (January 1996,March 1995, February 28, no year provided), as well as the private oncologist's opinion that the Veteran's tumor could have grown slowly for many years without causing symptoms;

b) whether it is at least as likely as not that the Veteran's neuroendocrine tumor was proximately due to his service-connected Crohn's disease with IBS or,

c) whether it is at least as likely as not that the Veteran's neuroendocrine tumor was aggravated beyond its natural progression by his service-connected Crohn's disease with IBS, to include whether the location of the neuroendocrine tumor was the cause of his gastrointestinal bleeding. 

In so doing, the examiner must address the application of the research article, submitted by the Veteran's attorney and referenced by the Court, to the Veteran's tumor: "Remarks to Statement of the Case," dated October 3, 2018) (citing Lauranne A.A.P. Derikx, et al., Is the Prevalence of Colonic Neuroendocrine Tumors Increased in Patients with Inflammatory Bowel Disease?, 139 INT'L J. CANCER, 535, 535-42 (2016)), https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.30096

The examiner must also address the August 22, 2016 private treatment record of a nodule in the distal ileum, approximately 40cm proximal to the ileocecal valve, in light of the article's inclusion of the study of tumors in the ileocecal region in patients with IBS.

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. 

 

 

T. REYNOLDS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	L. Nelson

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.