Citation Nr: 18159485 Decision Date: 12/19/18 Archive Date: 12/19/18 DOCKET NO. 09-40 968 DATE: December 19, 2018 REMANDED Entitlement to service connection for irritable bowel syndrome (IBS) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1998 to November 1998, from January 2003 to May 2006, and from September 2006 to February 2007. This matter is on appeal from a June 2008 rating decision by the Department of Veterans Affairs Regional Office in Detroit Michigan. The Board notes that the Veteran initiated appeals on four issues in his Notice of Disagreement dated July 2008; entitlement to service connection for right knee strain, left knee strain, irritable bowel syndrome (IBS), and pes planus. However, in his October 2009 VA Form 9, he perfected appeals only for the issues of entitlement to service connection for pes planus and IBS. The issues of service connection for right knee strain and left knee strain were not perfected, and are not before the Board. In October 2014 service connection was granted for pes planus. In March 2017, the Board remanded the Veteran’s appeal because the April 2008 VA examination was found to be inadequate, as it identifies missing medical evidence that could help the Veteran substantiate his claim for benefits. Because the requested development has not been fully completed, further action to ensure compliance with the remand directive is required. Stegall v. West, 11 Vet. App. 268 (1998). The Board finds that additional development is necessary before a decision may be rendered with respect to the issue on appeal. A remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). In March 2017, the Board remanded the issue of entitlement to service connection for IBS because the April 2008 VA opinion was found to be inadequate as it identified missing medical evidence that could help the Veteran substantiate his claim for benefits. Per the March 2017 remand, upon obtaining the Veteran’s outstanding medical treatment records, the Board directed that a VA examiner should opine as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that the Veteran’s IBS is etiologically related to his active duty service. Additionally, the Board directed that in providing an opinion as to the etiology of the Veteran’s IBS, the requested opinion must be accompanied by a thorough statement of reasons and bases for the opinions rendered. Such a discussion may include factors such as what factors may have caused the Veteran’s IBS. In May 2017, the Veteran was afforded a VA examination. In response to the Veteran’s VA examination results and after reviewing the medical evidence of record, the examiner opined that the Veteran’s IBS is less likely than not to have had its onset in active service or is etiologically related to active service. The VA examiner then went on to say that the Veteran has a long history of GI symptoms and the Veteran has shown symptoms that are strongly related to IBS like abdominal pain, diarrhea and constipation episodes. In the diagnosis of IBS, the Rome IV criteria of IBS require that patients have had recurrent abdominal pain on average of at least one day per week during the previous three months and associated with two or more of the following: related to defecation, change in stool frequency. The examiner opined that the Veteran showed all of the above symptoms. The Board also finds this opinion to be inadequate as to the determinative matter of the nature and etiology of the Veteran’s IBS claim as the examiner did not provide medical support and adequate rationale for the conclusions reached. While the examiner has provided a medical conclusion after reviewing the evidence of record, he did not provide a reason or bases for this conclusion. Instead, the examiner only confirmed that the Veteran has met the requirements for IBS, but his rationale does not address the etiology of the Veteran’s IBS, and why he opines that it less likely did not have its onset during active service. In order to properly adjudicate this appeal, a fully articulated and soundly reasoned medical opinion that specifically addresses the nature and etiology of the Veteran’s IBS claim and whether its onset occurred during active service is needed. As such, another VA examination must be afforded to the Veteran to obtain adequate clinical findings and opinions, as previously directed in the May 2017 remand. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007). Accordingly, this matter is hereby REMANDED for the following action: 1. The Veteran’s claim file must be forwarded and reviewed by a different VA examiner than the one who conducted the examination in May 2017 for a new etiology opinion. No examination is required unless the examiner deems it necessary. The examiner must specify that the claim file has been reviewed. The examiner must elicit from the record a full history. 2. Based on a review of the evidence of record, and with consideration of the Veteran’s statements, the examiner must provide an opinion as to whether the current IBS diagnosis had its onset during or is otherwise related to active service and address the nature and etiology of the Veteran’s IBS. (a) The requested opinion must be accompanied by a thorough statement of reasons and bases for the opinions rendered. Such a discussion may include factors such as what factors may have caused the Veteran’s IBS. A complete rationale must be provided for all opinions expressed. If the examiner cannot provide a requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why that opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals LAW CLERK FOR THE BOARD Tiffany Blackwood