Citation Nr: 25003167 Decision Date: 03/05/25 Archive Date: 03/05/25 DOCKET NO. 18-35 031 DATE: March 5, 2025 REMANDED Entitlement to service connection for umbilical hernia is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Air Force from February 1994 to February 2014. This appeal comes before the Board of Veterans' Appeals (Board) from a December 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) which, in pertinent part, denied service connection for a partial hernia. The Veteran's notice of disagreement (NOD) was received in January 2015. The RO issued the statement of the case (SOC) in June 2018, and the Veteran's VA Form 9, substantive appeal was received in June 2018. In the VA Form 9, the Veteran requested a hearing before a Veterans Law Judge (VLJ). The Veteran was a no show for a hearing which was scheduled in December 2021. As the Veteran did not provide any good cause explanation for his absence, or request to reschedule the hearing, the hearing request is deemed withdrawn. 38 C.F.R. § 20.704(d). In January 2023 the Board remanded the case to the RO for further development and adjudicative action. In January 2024, the Board denied the claim. The Veteran appealed to the Court of Appeals for Veterans Claims (CAVC or Court). In a November 2024 Order, the Court vacated the Board's January 2024 decision and remanded the matter pursuant to a November 2024 Joint Motion for Remand (JMR). Entitlement to service connection for umbilical hernia is remanded. The Veteran contends that he has an umbilical hernia condition that onset during active service. Service treatment records (STRs) reveal various reports of abdominal pain but no findings or diagnosis of a hernia.?In June 2003, the Veteran reported left lower quadrant abdominal pain for the past 3 days which was assessed as due to constipation. On every other occasion, the Veteran's abdomen was consistently assessed as nontender with no palpable mass or evidence of hernia. See STRs dated in December 2006, September 2008, August 2010, December 2011, September 2012. On separation, the Veteran reported abdominal pain, tightness, and soreness. See November 2013 Report of Medical Assessment. However, notably, when asked to describe changes in his health since his last examination, the Veteran reported multiple issues but did not include abdominal pain. During treatment approximately one week following the separation medical assessment, the Veteran affirmatively denied abdominal pain. See November 2013 service treatment note. Post-service, the Veteran underwent a VA examination in October 2014. The VA examiner concluded that the Veteran had an umbilical hernia which first developed in 2000. The Veteran reported that he developed a hernia during military service which resulted in pain and slight bulging in the lower abdomen. The Veteran reported that he continues to experience pain in the same location with certain physical activities such as heavy lifting but that the hernia no longer bulges out. The VA examiner checked the section for ventral hernia but noted that there was no surgery for the condition and that no hernia was detected on examination. The Veteran was provided another VA examination in November 2023. The VA examiner found that the Veteran has a current diagnosis of an umbilical hernia. The Veteran reported onset in 2011 while participating in morning work while in service. He stated that his symptoms at onset and current symptoms are abdominal pain with physical activity. The VA examiner opined that the Veteran's umbilical hernia was less likely than not incurred in active service or caused by an in-service injury, event or illness. The examiner explained that there is a lack of sufficient evidence to support an ongoing umbilical hernia condition since active service. The examiner noted that STRs dated in August 2011, September 2012, January 2013, and November 2013 revealed no abdominal tenderness or palpable masses and no reports of current abdominal pain. The examiner noted the October 2014 VA examiner's notation that the Veteran had a partial umbilical hernia but stated that this was in error as there is no such diagnosis. The examiner explained that you either have a hernia or do not have a hernia and thus there is no such thing as a partial umbilical hernia. The November 2023 VA opinion is inadequate to decide the claim. The opinion relied solely on an absence of evidence in treatment records to provide a negative nexus to service and failed to address the Veteran's competent reports, including during the November 2023 VA examination, of continuing to experience abdominal pain with physical activity since service. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). Thus, consistent with the November 2024 JMR, remand is necessary to obtain an adequate VA addendum opinion. The matters are REMANDED for the following action: 1. Obtain a medical opinion for the service connection claim for an umbilical hernia from an appropriate medical specialist. Only arrange for the Veteran to undergo an examination if deemed necessary in the judgment of the medical specialist designated to provide the medical opinion. The entire, electronic claims file to include a complete copy of this REMAND must be made available to the designated individual, and the medical opinion report should include discussion of the Veteran's documented history and assertions. If the Veteran is examined, all indicated tests and studies should be accomplished (with all results made available to the examiner prior to the completion of his or her report), and all clinical findings should be reported in detail. The medical professional should address whether the Veteran's current diagnosis of umbilical hernia at least as likely as not (evidence in at least approximate balance) had its onset in or is otherwise related to the Veteran's active military service. In rendering the requested opinion, the medical specialist must consider and discuss all service treatment records and post-service medical and other objective evidence of record. The medical specialist also must consider and discuss all lay assertions, to include any assertions as to in-service events, and as to the nature, onset, and continuity of symptoms. Notably, the absence of documented evidence of a specific disability or associated symptoms during and shortly after service should not, alone, serve as the sole basis for a negative opinion. In this regard, the medical specialist is advised that the Veteran is competent to report his observable symptoms and history, and such reports must be specifically acknowledged and considered in formulating opinions. If lay assertions in any regard are discounted, the medical specialist should clearly so state, and explain why. The medical specialist must provide a complete rationale for his or her opinion(s). If any of the above requested opinions cannot be made without resort to speculation, the specialist must state this and provide a rationale for such conclusion. In remanding this matter, no finding is made, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. Paulette Vance Burton Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M, Victor 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.