Citation Nr: 18146106 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 09-45 538 DATE: October 30, 2018 REMANDED Entitlement to service connection for a gastrointestinal disability. REASONS FOR REMAND The Veteran served on active duty from October 1987 to December 2007. This appeal is before the Board of Veterans’ Appeals (Board) from an April 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. In November 2011, the Veteran testified during a Board hearing in Montgomery, Alabama, before the undersigned Veterans Law Judge. A transcript is included in the claims file. In November 2012 the Board remanded the remaining issue on appeal with instruction to provide the Veteran with a VA examination. The Board subsequently denied his claim in a May 2017 decision. He appealed the denial to the United States Court of Appeals for Veterans Claims (Court), which vacated the denial in an April 2018 order granting a joint motion for remand (JMR). The issue is therefore again before the Board. Entitlement to service connection for a gastrointestinal disability The Veteran seeks service connection for a gastrointestinal disability. The JMR granted by the Court indicates that remand for a new VA examination is necessary. Specifically, the JMR noted that the April 2015 VA examination is inadequate and did not comply with the instructions in the November 2012 Board remand in violation of Stegall v. West, 11 Vet. App. 268 (1998). The November 2012 remand instructed that the examiner discuss pertinent lay evidence, including statements by the Veteran describing his symptoms. The April 2015 VA examination report, however, failed to address the Veteran’s reports of diarrhea and other symptoms in October 2006, November 2007, November 2008, and October 2009. As it was the August 2007 examiner’s failure to consider such statements that caused the Board to find that examination inadequate, the April 2015 examination failed to address the deficiencies articulated in the November 2012 remand. The JMR also instructed that the April 2015 examiner failed to consider the Veteran’s December 2007 diagnosis of irritable bowel syndrome (IBS). A new examination is therefore necessary. The matter is REMANDED for the following action: 1. Obtain and associate with the claims file any additional medical evidence that may have come into existence but has not been associated with the record. 2. Return the claims file to the April 2015 VA examiner, or to another qualified examiner if unavailable. The claims file must be reviewed by the examiner. A new examination may be ordered if the examiner deems it necessary. Following a review of the claims file and any clinical examination results, the examiner should diagnose any gastrointestinal disabilities exhibited by the Veteran since separation from service. For any disability diagnosed, the examiner should offer opinions as to whether it is at least as likely as not (i.e. 50 percent probability or more) (a) that such disability arose in or was caused by service, and (b) that such disability is due to or aggravated (permanently worsened beyond natural progression) by the Veteran’s service-connected cluster migraine headaches. This shall include consideration of the medication taken for them. If aggravation is found, the examiner finally shall opine as to the baseline level prior to aggravation and the current level of the gastrointestinal disability, in order to determine the amount of disability solely attributable to aggravation. All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. The discussion must refer to the Veteran’s lay reports of diarrhea and other symptoms in October 2006, November 2007, November 2008, and October 2009, as well as his December 2007 diagnosis of IBS. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After completing the above, and any other development deemed necessary, readjudicate the appeal. If the benefit sought remains denied, provide an additional supplemental statement of the case to the Veteran and his representative, and return the appeal to the Board. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Gallagher, Counsel