Citation Nr: 18142157 Decision Date: 10/16/18 Archive Date: 10/12/18 DOCKET NO. 10-42 607 DATE: October 16, 2018 REMANDED Entitlement to service connection for diverticulitis is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1985 to August 1991. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an October 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2016, the Board remanded the issue of diverticulosis for an addendum medical opinion, which was provided in June 2016. As the requested development has been completed, no further action to ensure compliance with the remand directive is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). However, as will be discussed further below, remand is warranted because at the time of the original VA examination in September 2009 certain relevant evidence was unavailable for the examiner to review. Entitlement to service connection for diverticulitis is remanded. The Veteran contends that his current diagnosis of diverticulosis is related to his active military service. During service his treatment records show that he experienced abdominal pain in June 1989. A series of X-rays were taken while he was in the hospital. The first series revealed adynamic ileus versus early obstruction. The second imaging results showed small bowel loops suspicious for sentinel ielus but no specific abnormality was identified. When he was discharged the diagnosis was lower abdominal pain, resolved, with no etiology. In September 2009, the Veteran was afforded a VA examination to determine whether his current diagnosis of diverticulosis/abdominal pain was related to his active military service. The examiner opined that the Veteran’s bowel/large intestine/stomach condition was less likely than not caused by or a result of his military service. The rationale cited a lack of medical treatment from February 1992 to December 2007. Based on a review of the evidence of record, the Board finds that the examiner did not have access to the Veteran’s German medical treatment records following his discharge from service. After his discharge, the Veteran lived in Germany working in a civilian capacity and sought treatment for his abdominal pain with a local German doctor. The records were associated with the file in January 2009, however they were not translated until September 2018. The translated medical records reveal medical treatment for diarrhea and gastroenteritis in April 1996, February 2003, and October 2006 while he lived in Germany. The Board notes that the Veteran’s accredited representative in a November 2016 brief also identified the fact that the September 2009 examination in addition to an addendum examination in June 2016 did not mention the German treatment records. The Board further notes that during the pendency of the claim the Veteran was granted service connection for irritable bowel syndrome (IBS) in August 2015 based on his service in the Persian Gulf War. Although an addendum medical opinion was sought in June 2016 to determine whether the IBS aggravated the diverticulosis, the Board finds the examination inadequate as it was based on the September 2009 examination, which did not consider the German medical records. The evidence of record establishes that an incident of abdominal pain occurred in-service and his current symptoms may be related to that event. As such, remand is warranted to afford the Veteran another VA examination to determine the etiology of his diverticulosis; to include a determination of whether or not the diverticulosis is secondary to his service-connected IBS. See McLendon v. Nicholson, 20 Vet. App. 79, 81-86 (2006). The matter is REMANDED for the following actions: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his diverticulosis disability. The examiner must opine is it at least likely as not related to an in-service injury, event, or disease. Specifically, the opinion should consider the treatment records from Germany February 1992 to 2007, as well as the Veteran’s lay statements at the September 2009 examination that his abdominal symptoms have been present since 1991. The examiner should then also address the following: (a.) Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s diverticulosis is caused by his service-connected irritable bowel syndrome. (b.) Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s diverticulosis is aggravated by (i.e., has permanently increased in severity beyond the natural progress due to) his service-connected irritable bowel syndrome. If aggravation is found, the examiner should address the following medical issues: (1) the baseline manifestations of the Veteran’s diverticulosis found prior to aggravation; and (2) the increased manifestations which, in the examiner’s opinion, are proximately due to the service-connected irritable bowel syndrome. (c.) If either of the above questions is answered in the affirmative, the examiner should then clarify whether each disability involves some distinct and separate symptoms (if so, then identify the symptoms attributable to each) or whether the two disorders have entirely duplicative symptoms sets. ERIC S. LEBOFF Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. M. Williams, Associate Counsel