Citation Nr: 18157344 Decision Date: 12/12/18 Archive Date: 12/12/18 DOCKET NO. 15-07 296 DATE: December 12, 2018 REMANDED Entitlement to service connection for a gastrointestinal disability, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served honorably on active duty with the United States Marine Corps from December 1976 to December 1979 and with the United States Army from August 2003 to July 2004. He also had service in the National Guard and Reserves. In June 2018, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. During the hearing, the Veteran’s representative suggested that the Veteran’s gastrointestinal condition may have been aggravated by his service-connected PTSD. Therefore, the Board has broadened the Veteran’s claim under Clemons v. Shinseki, 23 Vet. App. 1 (2009) to include consideration of whether service connection may be warranted on a secondary basis. Entitlement to service connection for a gastrointestinal disability is remanded. Although the Board regrets the delay, remand for additional development is necessary. During his June 2018 Board hearing, the Veteran testified that he goes to the VA hospital for treatment “once a month.” However, the Veteran’s VA treatment records have not been associated with the claims file. Therefore, remand is necessary to obtain any outstanding VA treatment records. Remand is also necessary to afford the Veteran a new VA examination in connection with his claim. The Veteran was most recently afforded a VA examination in September 2014. The examiner noted that the Veteran had been diagnosed with irritable bowel syndrome (IBS) but did not provide a date of diagnosis. When describing the history of the Veteran’s condition, the examiner wrote, “[h]e has had irritable bowel syndrome for years. Once in a while he has a flare, consisting of stomach cramps and bloating.” However, the examiner concluded that the Veteran’s “current condition” was less likely than not related to service: “there is no evidence in the medical record of the [Veteran] complaining of symptoms of IBS recently or seeking treatment for it.” The Board finds this conclusion confusing and at odds with the rest of the examination report indicating a current diagnosis of IBS. Additionally, as previously discussed, the Veteran’s representative has suggested that the Veteran’s claimed gastrointestinal issues may be related to his service-connected PTSD on a secondary basis. The September 2014 examiner did not discuss the possible relationship between the Veteran’s gastrointestinal symptoms and his PTSD. Therefore, remand is also warranted for consideration of the Veteran’s claim on a secondary basis. Accordingly, the matter is REMANDED for the following actions: 1. Obtain and associate with the claims file any outstanding VA treatment records. 2. Then, schedule the Veteran for another VA examination concerning the nature and etiology of his claimed gastrointestinal disability. The claims file, including a copy of this Remand, must be made available to and be reviewed by the examiner. The examiner is requested to provide a complete rationale for any opinion given. Specifically, the examiner must provide a detailed opinion in response to the following question: Is it at least as likely as not (50 percent probability or greater) that the Veteran has a gastrointestinal disability, including IBS, that was incurred during active service? For any diagnosed gastrointestinal disability that is not found to be directly related to service, the examiner is to provide a detailed opinion in response to the following question: Is it at least as likely as not (50 percent probability or greater) that the Veteran has a gastrointestinal disability that was caused or aggravated by his service-connected PTSD, or medications taken in treatment thereof? The term “aggravation” means a permanent increase in the claimed disability; that is, an irreversible worsening of the condition beyond the natural clinical course and character of the condition due to the service-connected disability as contrasted to a temporary worsening of symptoms. In all conclusions, the examiner must identify and explain the medical basis or bases, with identification of the evidence of record. If an opinion cannot be offered without resorting to mere speculation, the examiner should explain why this is the case and identify any additional evidence that may allow for a more definitive opinion. 3. Then, readjudicate the appeal. If the benefit sought remains denied, issue a supplemental statement of the case to the Veteran and his representative and return the case to the Board. L. CHU Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. T. Raftery, Associate Counsel