Citation Nr: 18153511 Decision Date: 11/28/18 Archive Date: 11/27/18 DOCKET NO. 13-12 337 DATE: November 28, 2018 ORDER Service connection for irritable bowel syndrome (IBS), to include as a qualifying chronic disability is granted. REMANDED Entitlement to service connection for a left elbow epicondylitis (also claimed as stiff and sore joints) is remanded FINDINGS OF FACT 1. The Veteran had active service in Southwest Asia during the Persian Gulf War. 2. The Veteran has a functional gastrointestinal disorder, namely IBS, which is presumptively due to his Persian Gulf War service. CONCLUSION OF LAW The criteria for service connection for IBS have been met. 38 U.S.C. §§ 1110, 1117, 5107 (2012); 38 C.F.R. §§ 3.303, 3.317 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the Marine Corps Reserve, with periods of active duty from June 1968 to February 1969 and December 1990 to June 1991, to include service in Southwest Asia during the Persian Gulf War. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2012 rating decision by the Department of Veterans Affairs (VA). This case was most recently remanded in June 2017 for further development; it has since been re-assigned to the undersigned. In April 2015, the Veteran requested a Board hearing by live videoconference, but withdrew his hearing request in a February 2017 statement. In July 2017, the Veteran was then scheduled for a Board hearing at a local VA office, but again withdrew his hearing request as noted by VA correspondence in September 2017. As such, the hearing requests are deemed withdrawn. See 38 C.F.R. § 20.704(e). Service connection for a gastrointestinal disability is granted. The Veteran contends that he is entitled to service connection for IBS. The Board concludes that the Veteran is a Persian Gulf Veteran with a qualifying chronic disability, namely IBS. Service connection is therefore warranted. 38 C.F.R. § 3.317 (2017). Service connection may be awarded on a presumptive basis to a Persian Gulf veteran who (1) exhibits objective indications; (2) of a chronic disability such as those listed in paragraph (b) of 38 C.F.R. § 3.317; (3) which became manifest either during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10% or more not later than December 31, 2021; and (4) such symptomatology by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. Gutierrez v. Principi, 19 Vet. App. 1, 7 (2004); 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Srvice connection may be given for medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs and symptoms, as well as for any diagnosed illness that the VA Secretary determines by regulation warrants a presumption of service connection. 38 C.F.R. § 3.317 (a)(2)(i)(B). A ‘Persian Gulf Veteran” is a veteran with active service in the Southwest Asia theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(d). In this case, the Veteran’s DD-214 indicates that he had active service in Southwest Asia during the Persian Gulf War. While the Veteran’s service treatment records for the period at issue are negative for any complaints of or treatment for gastrointestinal symptoms, VA and private treatment records document diagnoses of IBS in June 1994, April 2016, and April 2017 and note that his symptoms had persisted since the Veteran’s return from deployment to the Southwest Asia (May 1992, June 1998, May 2001, July 2001, September 2002, February 2004, March 2018, September 2018). There is no evidence of record which controverts these findings. Functional gastrointestinal disorders, including IBS,are medically unexplained chronic multisymptom illnesses pursuant to 38 C.F.R. § 3.317 (a)(2)(i)(B). In sum, the record supports a finding that the Veteran has IBS which manifested after his time in the Persian Gulf. There is no evidence in the claim file suggesting that this disability can be attributed to any known clinical diagnosis. Accordingly, the service connection for IBS is warranted. REASONS FOR REMAND Entitlement to service connection for left elbow epicondylitis is remanded. The Board finds that further development is necessary to comply with VA’s duty to assist the Veteran to obtain evidence needed to substantiate his claim. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Veteran contends his left elbow epicondylitis is related to his active service as an ammunition officer while deployed to Southwest Asia. Specifically, he asserts that he suffers form joint disabilities, including his elbow, that are due to exposure to chemicals and other environmental hazards while service in the Persian Gulf. See April 2015 VA Form 9. Upon review of the record the Board notes that the September 2017, January 2015, and August 2010 VA examiners found there was no evidence of any diagnosis or condition of the left elbow. However, a December 2008 VA examination report shows a diagnosis of left elbow epicondylitis with tenderness of the medial epicondyle and both VA and private treatment records show reports of left elbow pain and stiffness throughout the appeal period (December 2008, August 2010, September 2011, November 2013, January 2014, July 2014, January 2015). As such, a new VA examination is necessary. The matter is REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records for the Veteran’s disabilities from September 2017 to the present. 2. After the above development is completed, the AOJ should arrange for a VA examination of the Veteran to determine the nature and likely cause of his left elbow epicondylitis. The examiner should review the claim file and note such review was conducted. Based on review of the record and examination of the Veteran, the examiner should provide an opinion with detailed rationale that responds to the following: (a.) Please identify, by diagnosis, all left elbow disabilities present during the appeal period (from November 2008). In doing so, it should be noted that the record contains a diagnosis of left elbow epicondylitis. (b.) Is it at least as likely as not (50% or greater probability) that the Veteran’s left elbow epicondylitis was either incurred in or otherwise related to the Veteran’s military service? Please explain why. In doing so, the examiner should address the Veteran’s statements, of record, that his left elbow disability is related to his active service as an ammunition officer while deployed to Southwest Asia during Operation Desert Shield/Desert Storm. 3. If upon completion of the above action the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Roe, Associate Counsel