Citation Nr: 22016286 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 17-55 867 DATE: March 21, 2022 REMANDED Entitlement to service connection for inguinal hernia, to include as secondary to service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1973 to August 1975. This matter is before the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the claim was remanded by the Board to the agency of original jurisdiction (AOJ) for further development. After accomplishing the above, the AOJ continued to deny the Veteran's claim (as reflected in a March 2020 supplemental statement of the case (SSOC)). Unfortunately, the Veteran's claim must be remanded again. In the April 2019 remand, the AOJ was directed to obtain VA medical opinion regarding whether the Veteran's inguinal hernia was related to his active service and/or secondary to his service-connected back condition. VA medical opinion was obtained in May 2019. The examiner opined that it was less likely than not that the Veteran's inguinal hernia was related to his active service. However, the examiner only addressed direct service connection. An addendum opinion was provided by the May 2019 examiner in February 2020. The examiner opined that the Veteran's inguinal hernia was less likely than not proximately due to his service-connected back condition. As rationale, she stated that there was a "[l]ack of evidence in medical literature that hernia is related to or caused by degenerative arthritis of the spine." However, the Board finds that the examiner's opinion is flawed as she neglected to discuss the specific facts relevant to the Veteran's claims and relied only on the absence of medical literature showing a positive connection. Notably, in its remand, the Board instructed the examiner to consider the Veteran's November 2017 statement indicating a relationship between his groin condition and service-connected back condition. As a result, this opinion is inadequate. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (reliance on the absence of medical literature supporting nexus without discussing the specific facts of the case renders an opinion inadequate). Moreover, the Board affords no probative weight to this opinion as the examiner did not provide an opinion addressing whether the Veteran's condition was aggravated by his service-connected back condition. 38 C.F.R. § 3.310 (b); El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (a medical opinion that does not specifically address aggravation is generally inadequate to decide a secondary service connection claim). As such, there has not been substantial compliance with the Board's April 2019 remand directives. Thus, the Board finds that VA addendum opinion should be obtained with complete rationale as to whether the Veteran's inguinal hernia is related to his active service and/or service-connected back condition. The matter is REMANDED for the following action: 1. Return the claims folder to the VA examiner who provided the May 2019 and February 2020 medical opinions; if the author of the May 2019 and February 2020 medical opinions is not available, request VA medical opinion from an appropriate clinician. 2. The Veteran's entire electronic claims file must be made accessible to the designated professional for review. A detailed rationale for any opinion expressed should be provided. 3. Following the review of the claims file, the medical opinion provider is then requested to respond to the following: (a) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's inguinal hernia is related to service? (b) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's inguinal hernia is proximately due to or caused by his service-connected back disability? (c) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's inguinal hernia has been aggravated (made worse beyond its natural progression) by service-connected back disability? If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Kovacs, 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.