Citation Nr: 1304802 Decision Date: 02/08/13 Archive Date: 02/19/13 DOCKET NO. 07-38 371 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Providence, Rhode Island THE ISSUE Entitlement to service connection for a gastrointestinal disorder, to include irritable bowel syndrome and gastroesophageal reflux disease, to include on a secondary basis. REPRESENTATION Appellant represented by: John S. Berry, Attorney at law ATTORNEY FOR THE BOARD Siobhan Brogdon, Counsel INTRODUCTION The Veteran served on active duty from August 1967 to March 1969. This matter comes before the Department of Veterans Affairs (VA) Board of Veterans Appeals (Board) from a March 2010 rating decision of the VA Regional Office in Providence, Rhode Island that, among other things, denied service connection for a gastrointestinal disability, claimed as irritable bowel syndrome and gastroesophageal reflux disease, to include as secondary to service-connected disability. By decision dated in September 2011, the Board denied new and material evidence to reopen the claim of service connection for sleep apnea, an esophageal disorder, a disability manifested by weak bones, a back disability, and an increased rating for posttraumatic stress disorder (PTSD). These matters are no longer for appellate consideration. The issue of entitlement to service connection for gastrointestinal disability, to include on a secondary basis, was remanded for further development. It is noted, for informational purposes, that this issue was inadvertently listed in the Order section of the September 2011 as having been denied. That was not correct, as the issue was, as noted above, remanded. This has been changed by corrected Order of the Board. Following review of the record, the appeal is REMANDED to the RO. VA will notify the appellant if further action is required. REMAND The Veteran asserts that he has a gastrointestinal disorder, including irritable bowel syndrome and/or gastroesophageal reflux disease that is secondary to or has been aggravated by service-connected PTSD for which service connection is warranted. The Board observes that when this case was remanded in September 2011, it was requested that following examination, an opinion be rendered as to whether the Veteran had a gastrointestinal disorder that was at least as likely as not caused by or proximately due to or aggravated by service-connected disability. The Board observes, however, that following VA examinations in October 2011, one examiner did not offer any opinion, and the other provided a response that gastrointestinal symptoms were "not caused by or aggravated by PTSD". Based on such, the RO confirmed and continued the denial of entitlement to service connection for a gastrointestinal disorder, to include as secondary to PTSD. Subsequently received from the Veteran's attorney/representative were the reports of professional studies and clinical authority relative to PTSD and its potential linkage to physical health, including gastrointestinal symptomatology. In correspondence dated in December 2012, the Veteran's representative referred to the October 2011 examination report and suggested that it was inadequate for rating purposes. He stated that examiner essentially said 'no' when asked if there was a relationship between gastrointestinal disability and PTSD without providing any rationale for her opinion. The representative stated that the examination should be returned, and that further development was indicated because the accompanying literature showed a clear association between PTSD and gastrointestinal conditions. The Board concurs that further development is warranted in this regard. It is pointed out that what was sought by remand in this regard was a thorough review of the record and an opinion enhanced by the examiner's clinical expertise and not just a summary statement. The opinion submitted is cursory and does not provide any clinical rationale for the conclusory finding. As such, the Board finds that the examination report is inadequate for adjudication purposes because it does not furnish the degree of substantiation required to adjudicate a claim for service connection in this regard. If the medical evidence of record is insufficient or of doubtful weight or credibility, the Board is always free to supplement the record by seeking an advisory opinion, ordering a medical examination or citing recognized medical treatises in its decisions that clearly support its conclusions. It is not free to substitute its own judgment for that of an expert. See Colvin v. Derwinski, 1 Vet.App. 171, 175 (1991). The Board thus finds that a VA examination by a specialist is warranted for a more definitive assessment as to whether there is relationship between gastrointestinal disability and service-connected PTSD in order to render a more informed appellate decision. See Hyder v. Derwinski, 1 Vet.App. 221 (1991). Accordingly, the case is REMANDED for the following actions: 1. Schedule the Veteran for a VA examination by a specialist in gastroenterology. The claims folder and access to Virtual VA as appropriate must be made available to the examining physician. The examining physician must indicate whether the claims folder and Virtual VA were reviewed. All indicated tests and studies should be performed and clinical findings must be reported in detail. The examination report should reflect consideration of the Veteran's documented medical history, current complaints, and other assertions, etc. Based on a thorough review of the evidence of record and the physical examination findings, the examiner must opine with a detailed and complete rationale as to whether it is at least as likely as not (i.e., probability of 50 percent) any current gastrointestinal disorder is directly related to service. If not, is it is at least as likely as not that any current gastrointestinal disorder is caused or aggravated (permanently made worse) by service-connected PTSD? The examination report must include well-reasoned rationale for all opinions and conclusions reached. Consideration of the literature provided by the appellant's attorney should also be discussed as to why it is or is not persuasive or pertinent. 2. The RO must ensure that the medical report requested above complies with this remand and its instructions. If the report is insufficient, or if any requested action is not taken or is deficient, it should be returned for correction. See Stegall. 3. After taking any further development deemed appropriate, readjudicate the issue on appeal. If the benefit sought is not granted, provide a supplemental statement of the case to the Veteran and his representative before the case is returned to the Board. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ____________________________________________ MICHAEL D. LYON Veterans Law Judge, Board of Veterans Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).