PANCREATITIS

REBECCA N. POULSON · 2026 · Case ID: A26040094

MIXED

Summary

The veteran, who served from June 2003 to March 2016, including a deployment to Iraq from March 2011 to August 2011, appeals the denial of an increased rating for partial pancreatectomy with chronic constipation. The veteran was previously granted service connection for this condition and currently holds a 30 percent rating. The appeal stems from a January 2025 supplemental claim rating decision that denied a rating higher than 30 percent. The Board reviewed the evidence under both pre- and post-May 19, 2024, rating criteria for Diagnostic Codes 7319 (irritable colon syndrome) and 7347 (pancreatitis). The veteran reported worsening constipation, going weeks without a bowel movement, and requiring medication. A VA examination in February 2024 diagnosed chronic constipation but found it did not impact work ability. The Board found the veteran's current symptoms, primarily constipation, did not meet the criteria for a higher rating under either diagnostic code, as there was no indication of frequent severe abdominal pain, hospitalization, weight loss, or malnutrition. The Board denied the increased rating, finding the evidence weighed against the claim. The case also involves a remand for hidradenitis suppurativa, claimed as secondary to service-connected allergic rhinitis, due to inadequate medical opinions regarding etiology and aggravation.

Rationale

Veteran's symptoms do not meet criteria for higher rating under Diagnostic Code 7319 (pre- or post-amendment).; Veteran's symptoms do not meet criteria for higher rating under Diagnostic Code 7347 (pre- or post-amendment).; Evidence persuasively weighs against a rating in excess of 30 percent.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250624-581884

Full Decision Text

Citation Nr: A26040094
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250624-581884
DATE: April 29, 2026

ORDER

Entitlement to a rating in excess of 30 percent for partial pancreatectomy with chronic constipation is denied.

REMANDED

Entitlement to service connection for hidradenitis suppurativa (also claimed as cyst/benign growth-skin), to include as secondary to service connected rhinitis, is remanded.

FINDING OF FACT

During the period on appeal, the Veteran's partial pancreatectomy with chronic constipation did not more nearly approximate three or more episodes of abdominal or mid-back pain per year and at least one episode per year requiring hospitalization for management either of complications related to abdominal pain or complications of tube enteral feeding; or frequent attacks of abdominal pain, loss of normal body weight and other findings showing continuing pancreatic insufficiency between acute attacks.

CONCLUSION OF LAW

The criteria for a rating in excess of 30 percent for partial pancreatectomy with chronic constipation have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.114, Diagnostic Code 7319-7347.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 2003 to March 2016, with service in Iraq from March 2011 to August 2011.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

By way of background, service connection for partial pancreatectomy with chronic constipation was granted in an April 2016 rating decision. In December 2023, the Veteran filed a claim seeking service connection for multiple gastrointestinal disabilities. A subsequent May 2024 rating decision denied service connection for chronic constipation, also claimed as colon syndrome, irritable, gastrointestinal problems, and bowel. In June 2024, the Veteran filed VA Form 20-0996 Decision Review Request: Higher-Level Review (HLR), seeking review of the May 2024 rating decision. In September 2024, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development. Thereafter, a January 2025 supplemental claim rating decision denied a rating in excess of 30 percent for partial pancreatectomy with chronic constipation (also claimed as infection due to pancreas duct leak and chills, nightsweat - due to pancreas duct leak) (also claimed as colon syndrome, irritable, gastrointestinal problems and bowel condition), which is the decision on appeal.

In the June 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. The Board notes that the Veteran identified the September 2024 HLR rating decision as the decision she wants to appeal for her constipation claim. That HLR rating decision cannot be appealed as it is not a final decision. However, a subsequent January 2025 rating decision did adjudicate the claim on the merits. As such, the Board will find that decision to be on appeal. Additional issues and rating decision dates were also listed on the June 2025 VA Form 10182; they were addressed in a previous November 2025 Board decision.

Therefore, the Board may only consider the evidence of record at the time of the January 2025 agency of original jurisdiction (AOJ) supplemental claim decision on appeal. 38?C.F.R. § 20.301. If evidence was submitted after the AOJ issued the supplemental claim decision on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300,?20.301, 20.801.

Relevant evidence was submitted outside this evidence window and the Board has not considered it herein. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the
20.300,?20.301, 20.801.

However, because the Board is remanding the claim of service connection for hidradenitis suppurativa, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii).

Increased Ratings

Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) in 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods.

The evaluation of the same disability or same manifestations under various diagnoses is to be avoided. This is otherwise known as pyramiding, which is prohibited. 38 C.F.R. § 4.14. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

The Board is to take due consideration that the beneficial effects of medication are discounted in assessing musculoskeletal ratings as such effects are not contemplated therein and, therefore, taking medication may make a claimant appear less disabled than in reality. Ingram v. Collins, 38 Vet. App. 130 (2025).

In accordance with 38 C.F.R. § 4.114, ratings under Diagnostic Codes 7301 through 7329 inclusive, 7331, 7342, 7345 through 7350 inclusive, 7352, and 7355 through 7357 inclusive will not be combined with each other. Instead, when more than one rating is warranted under those diagnostic codes, assign a single evaluation under the diagnostic code that reflects the predominant disability picture, and elevate it to the next higher evaluation if warranted by the severity of the overall disability.

During the pendency of the appeal, the rating criteria for evaluating digestive disabilities under 38 C.F.R. § 4.114 were amended effective May 19, 2024. 89 Fed. Reg. 19, 735 (Mar. 20, 2024). If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the claimant will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the
89 Fed. Reg. 19, 735 (Mar. 20, 2024). If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the claimant will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claims under the old criteria prior to May 19, 2024 and both the old and new rating criteria from May 19, 2024. The criteria that is more favorable to the Veteran will be applied.

If the evidence for and against a claim is approximately balanced, the claim will be granted. 38 C.F.R. § 4.3. A claim will be denied only if the record persuasively weighs against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3.

Entitlement to a rating in excess of 30 percent for partial pancreatectomy with chronic constipation.

The Veteran contends her partial pancreatectomy with chronic constipation is more severe than the currently assigned 30 percent rating.

As an initial matter, service connection for partial pancreatectomy with chronic constipation was first granted in an April 2016 rating decision. Therefore, the appeal period before the Board stems from the Veteran's December 19, 2023 claim, plus the one-year look-back period. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

The Veteran's partial pancreatectomy with chronic constipation is rated at 30 percent under 38 C.F.R. § 4.114, Diagnostic Code 7319-7347, for pancreatitis. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. In this case, Diagnostic Code 7319 pertains to irritable colon syndrome and Diagnostic Code 7347 pertains to pancreatitis.

Prior to May 19, 2024, Diagnostic Code 7319 provided a noncompensable rating for mild symptoms with disturbances of bowel function with occasional episodes of abdominal distress. It provided a 10 percent rating for moderate symptoms with frequent episodes of bowel disturbance with abdominal distress. A maximum 30 percent rating was provided for severe symptoms with diarrhea, or alternating diarrhea and constipation, with more or less constant episodes of abdominal distress. 38 C.F.R. § 4.114, Diagnostic Code 7319 (2023).

From May 19, 2024, Diagnostic Code 7319 provides a 10 percent rating for abdominal pain related to defecation at least once during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension. A 20 percent rating is warranted for abdominal pain related to defecation for at least three days per month during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension. A maximum 30 percent rating is warranted for abdominal pain related to defecation at least one day per week during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension
previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension. A maximum 30 percent rating is warranted for abdominal pain related to defecation at least one day per week during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension. 38 C.F.R. § 4.114, Diagnostic Code 7319 (2024).

Prior to May 19, 2024, Diagnostic Code 7347 provided a 10 percent rating for pancreatitis with at least one recurring attack of typical severe abdominal pain in the past year. A 30 percent rating was warranted for moderately severe pancreatitis; with at least 4-7 typical attacks of abdominal pain per year with good remission between attacks. A 60 percent rating was warranted for pancreatitis with frequent attacks of abdominal pain, loss of normal body weight and other findings showing continuing pancreatic insufficiency between acute attacks. A maximum 100 percent rating was warranted for pancreatitis with frequently recurrent disabling attacks of abdominal pain with few pain free intermissions and with steatorrhea, malabsorption, diarrhea and severe malnutrition. 38 C.F.R. § 4.114, Diagnostic Code 7347 (2023).

From May 19, 2024, Diagnostic Code 7347 provides a minimum 30 percent rating for pancreatitis with at least one episode per year of abdominal or mid-back pain that requires ongoing outpatient medical treatment for pain, digestive problems, or management of related complications including but not limited to cyst, pseudocyst, intestinal obstruction, or ascites. A 60 percent is warranted for pancreatitis with three or more episodes of abdominal or mid-back pain per year and at least one episode per year requiring hospitalization for management either of complications related to abdominal pain or complications of tube enteral feeding. A maximum 100 percent is warranted for pancreatitis with daily episodes of abdominal or mid-back pain that require three or more hospitalizations per year; and pain management by a physician; and maldigestion and malabsorption requiring dietary restriction and pancreatic enzyme supplementation. 38 C.F.R. § 4.114, Diagnostic Code 7319 (2024).

The terms mild, moderate, and severe are not defined in the rating criteria. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Merriam Webster defines "mild," as relevant to a physical condition, as "not severe" or temperate; with "temperate" being defined as "keeping or held within limits" and "not extreme or excessive." "Moderate" is defined as "tending toward the mean or average amount," "not violent, severe, or intense," and "limited in scope or effect." "Severe" is defined as "very painful or harmful" or "of a great degree." Merriam-Webster's Dictionary (merriam-webster.com/dictionary, accessed April 22, 2026). The term "severe" is used throughout the rating schedule, including in Diagnostic Code 7319, to indicate a very great degree of the specific listed disability, in order to differentiate between lesser (or sometimes greater) cases of that same disability within the specific diagnostic code. Within the context of Diagnostic Code 7319, which establishes a successive, tiered rating structure, it represents the highest or most extreme level of disability.

The introduction to § 4.114 specifies that ratings under Diagnostic Codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. In this case, the Veteran's predominant disabilities are partial pancreatectomy and chronic constipation. Accordingly, her chronic constipation will not be assigned a separate rating.

Turning to the evidence, VA treatment records reveal the Veteran reported constipation in October 2020, she denied abdominal pain. The Veteran has previously been prescribed MiraLax and Colace. In November 2023, the Veteran reported that her constipation had
7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. In this case, the Veteran's predominant disabilities are partial pancreatectomy and chronic constipation. Accordingly, her chronic constipation will not be assigned a separate rating.

There are no private treatment records during the period on appeal that pertain to partial pancreatectomy with chronic constipation.

The Veteran attended a VA intestinal conditions examination in February 2024. She reported the onset of symptoms in 2010. The Veteran reported she suffered severe constipation after her pancreatectomy. She would go weeks without a bowel movement. The constipation has persisted since onset. The Veteran stated that her appetite decreases after going without a bowel movement for a couple weeks because she doesn't "have enough room." When she feels the urge to go, she has to sit on the toilet for 30 mins. She denies straining or difficulty passing stool. The Veteran required continuous medication. She is currently taking a stool softener and MiraLAX. Her signs and symptoms consist only of constipation. She does not have bowel disturbance with abdominal distress, or exacerbations or attacks of the intentional condition. She does not have weight loss or malnutrition attributable to an intestinal condition. The examiner diagnosed chronic constipation and stated the disability does not impact the Veteran's ability to work.

After review of the evidence, the Board finds that the Veteran's partial pancreatectomy with chronic constipation manifests in moderate symptoms with constipation. Constipation is the only symptom reported by the Veteran. Her VA treatment records do not reveal any abdominal complaints, nor did she report such at the February 2024 VA examination.

The Veteran is currently rated at 30 percent under Diagnostic Code 7319-7347. Under the pre- and post-amendment criteria for Diagnostic Code 7319, a 30 percent is the maximum rating available, which the Veteran currently has. Therefore, Diagnostic Code 7319 will not be considered further as it cannot provide the basis for a higher rating.

Under the pre-amendment criteria for Diagnostic Code 7347, for pancreatitis, a 60 percent rating is warranted for pancreatitis with frequent attacks of abdominal pain, loss of normal body weight and other findings showing continuing pancreatic insufficiency between acute attacks. Under the post-amendment criteria for Diagnostic Code 7347, for pancreatitis, a 60 percent rating is warranted for pancreatitis with three or more episodes of abdominal or mid-back pain per year and at least one episode per year requiring hospitalization for management either of complications related to abdominal pain or complications of tube enteral feeding. Here, the Veteran's overall disability picture does not more nearly approximate the criteria for a 60 percent rating under either the pre- or post-amendment rating criteria. There is no indication that the Veteran experiences pancreatitis with three or more episodes of abdominal or mid-back pain per year and at least one episode per year requiring hospitalization for management either of complications related to abdominal pain or complications of tube enteral feeding. There is also no evidence in the record that the Veteran has pancreatitis with episodes of abdominal pain or back pain; she has not lost normal body weight due to the disability; and there are no additional signs or symptoms other than constipation. Therefore, a rating in excess of 30 percent is not warranted under the pre- or post-amendment rating criteria for Diagnostic Code 7347.

The Board has also considered Diagnostic Code 7356, gastrointestinal dysmotility syndrome, which was added as a diagnostic code pursuant to the May 19, 2024 amendments. Under this code, a 30 percent rating is warranted for symptoms of chronic intestinal pseudo-obstruction (CIPO) or symptoms of intestinal motility disorder, including but not limited to, abdominal pain, bloating, feeling of epigastric fullness, dyspepsia, nausea and vomiting, regurgitation, constipation, and diarrhea, managed by ambulatory care; and requiring prescribed dietary management or manipulation. A 30 percent rating is warranted when the disability has symptoms of chronic intestinal pseudo-obstruction (CIPO) or symptoms of intestinal motility disorder, including but not limited to, abdominal pain, bloating, feeling of epigastric fullness, dyspepsia, nausea and vomiting, regurgitation, constipation, and diarrhea, managed by ambulatory care; and requiring prescribed dietary management or manipulation. A 50 percent rating is warranted when the disability requires intermittent tube feeding for nutritional support; with recurrent emergency treatment for episodes of intestinal obstruction or regurgitation due to poor gastric emptying, abdominal pain, recurrent nausea, or recurrent vomiting. An 80 percent rating is warranted when the disability requires complete dependence on total parenteral nutrition (TPN) or continuous tube feeding for nutritional support. The Veteran is currently rated at 30 percent for her disability and she does not have any symptoms contemplated by the 50 percent or 80 percent criteria.

Furthermore, because the above findings are based on procured evidence, including the Veteran's description of her pancreatitis and constipation at its worst, such descriptions can be expected to describe the pain that prompts the Veteran to use her reported medication, not a level of impairment that reflects the beneficial effects of such medication. See Ingram, 38 Vet. App. 130.

In conclusion, the probative evidence of record persuasively weighs against a rating in excess of 30 percent for partial pancreatectomy with chronic constipation under both the pre- and post-amendment rating criteria. As the evidence persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. Accordingly, a rating in excess of 30 percent for partial pancreatectomy with chronic constipation is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, 21 F.4th 776 (2021).

REASONS FOR REMAND

Entitlement to service connection for hidradenitis suppurativa.

The Veteran contends her hidradenitis suppurativa is related to service. Alternatively, she asserts her hidradenitis suppurativa was caused or aggravated by her service-connected allergic rhinitis. See December 2023 VA 21-526EZ; see also September 2024 HLR - Informal Conference.

As an initial matter, the January 2025 rating decision made favorable findings that the Veteran is currently diagnosed with hidradenitis suppurativa; she participated in a toxic exposure risk activity (TERA); service treatment records (STRs) show that she was treated for cysts and a lump under her arm; and the claimed primary disability of allergic rhinitis is service-connected. The Board is bound by these favorable findings, unless rebutted by evidence that identifies a clear and unmistakable error in the favorable finding. See 38 C.F.R. §§ 3.104(c), 20.801(a).

The Veteran's November 2002 enlistment examination does not reveal any skin disabilities other than a scar on her knee and cheek. The accompanying report of medical history does not reveal any skin complaints. STRs reveal the Veteran was treated for polycystic ovarian disease and a lump under her arm. The Veteran's separation examination and report of medical history are not of record; however, her medical evaluation board (MEB) documents do not reveal any skin complaints.

VA treatment records reveal treatment for hidradenitis suppurativa and reflect that the Veteran was referred to a non-VA dermatologist for treatment in March 2024. These private records are not associated with the claims file.

A December 2023 TERA Memorandum notes the Veteran served in Southwest Asia and was exposed to toxins, chemicals, and asbestos in her military occupational specialty (MOS) of Material Management.

The Veteran attended a VA skin examination in February 2024. She reported painful cysts in her axilla and groin, and that they often fill with pus. Shaving contributes to these lesions. Warm compresses and topical medications help. The examiner diagnosed hidradenitis suppurativa and stated the disability does not impact the Veteran's ability to work. The examiner opined that the Veteran's hidradenitis suppurativa was less likely than not related to service. The rationale was that the Veteran was not diagnosed with hidradenitis suppurativa during service and there is no chronicity during or after service. The examiner also listed several medical articles that allegedly support her opinion. The Board finds this opinion inadequate because it is conclusory and is not supported by an adequate rationale. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (an adequate medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record). Significantly, the examiner provides relevant medical literature but fails to explain how that medical literature applies to this specific Veteran.

In April 2024, VA obtained a toxic exposure risk activity (TERA) medical opinion. The examiner opined that the Veteran's hidradenitis suppurativa is less likely than not caused by the TERAs, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. In doing so, the examiner stated that medical literature does not show a true causative relationship between the Veteran's TERAs and her skin disability. In rendering this opinion, the examiner cited to medical literature and explained why it's relevant to this particular Veteran.

Direct and secondary medical opinions were obtained in October 2024. The examiner opined that the Veteran's hidradenitis suppurativa is less likely than not related to service. The rationale was that the Veteran was not diagnosed with hidradenitis suppurativa during service and there is no continuity since service. The examiner also stated that medical literature fails to establish a causal relationship. The Board finds this opinion inadequate because it is conclusory and is not supported by an adequate rationale. See Stefl, 21 Vet. App. 120. Significantly, the opinion was based on generalized medical literature, without specific discussion as to how such general literature is applicable in consideration of the Veteran's specific military and medical history. Concerning secondary service connection, the examiner opined that the Veteran's hidradenitis suppurativa is less likely than not caused by her allergic rhinitis. In doing so, the examiner stated that medical literature fails to establish a causal relationship between hidradenitis suppurativa and allergic rhinitis. Concerning aggravation, the examiner opined that the Veteran's hidradenitis suppurativa is less likely than not aggravated beyond its natural progression by allergic rhinitis. The Board finds this opinion inadequate because it is conclusory and uses the wrong evidentiary standard.

The Board finds that the failure to obtain an adequate medical opinion and relevant private treatment records constitute pre-decisional duty to assist errors, and therefore a remand is warranted so that the relevant outstanding private treatment records and an addendum medical opinion may be obtained. 38 C.F.R. §§ 3.159(c), 20.802(a).

The matter is REMANDED for the following action:

1. Ask the Veteran to complete VA Form 21-4142 and 21-4142a for all private treatment received for hidradenitis suppurativa, to include Advanced Dermatology, located in Greenville, SC. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. Note: these records may also be available in VistA Imaging.

2. After the above development has been completed, obtain an addendum opinion from a clinician who has not previously provided an opinion for this Veteran, if possible, concerning the etiology of the Veteran's hidradenitis suppurativa. Schedule the Veteran for an examination only if deemed necessary by the clinician. The claims file must be reviewed. The examiner should address the following:

(a
4142a for all private treatment received for hidradenitis suppurativa, to include Advanced Dermatology, located in Greenville, SC. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. Note: these records may also be available in VistA Imaging.

(a.) Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that hidradenitis suppurativa had its onset during active service or is otherwise etiologically related to it.

(b.) If the answer to (a) above is no, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's hidradenitis suppurativa is caused by her service-connected allergic rhinitis to include as due to medications to treat such.

(c.) If not, then is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's hidradenitis suppurativa is aggravated (any worsening) by her service-connected allergic rhinitis, to include as due to medications to treat such?

Specifically, would the hidradenitis suppurativa have been less severe but for the service-connected allergic rhinitis, either because there is an etiological link or because the allergic rhinitis resulted in the inability to treat the hidradenitis suppurativa?

Separate causation and aggravation opinions should be provided.

The examiner must provide a complete rationale for his or her opinion(s). If the requested opinion cannot be provided without resorting to mere speculation, the examiner should explain why.

Rebecca N. Poulson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board S. Gary, 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.

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