Citation Nr: 20005546 Decision Date: 01/23/20 Archive Date: 01/22/20 DOCKET NO. 19-12 818 DATE: January 23, 2020 REMANDED Entitlement to service connection for a gastrointestinal disorder, to include as due to a Gulf War illness, is remanded. Introduction The Veteran served honorably on active duty during the Gulf War Era in the United States Marine Corps from June 1996 to June 2000, and the United States Army from October 2003 to February 2005. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from January 2018 and April 2018 Rating Decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia. As a preliminary matter, the Board notes that the Veteran originally claimed service connection for Irritable Bowel Syndrome (IBS) resulting from exposure to environmental hazards during the Gulf War. However, the evidence of record (discussed in more detail below) suggests the Veteran suffers from frequently alternating episodes of constipation and diarrhea. Thus, the Board has recharacterized this issue as entitlement to service connection for a gastrointestinal disorder, to include as due to a Gulf War illness. REASONS FOR REMAND Entitlement to service connection for a gastrointestinal disorder, to include as due to a Gulf War illness, is remanded. The Veteran underwent a VA compensation and pension (C&P) examination in January 2018 at which time an Intestinal Conditions Disability Benefits Questionnaire (DBQ) form and Medical Opinion DBQ form were completed. Thereafter, in March 2018 another Medical Opinion DBQ form was completed by the same VA examiner. According to the January 2018 VA examination report, the Veteran’s problems with constipation began after he was deployed in Southwest Asia in 2004, abdominal pain associated with constipation began about three to four years before the VA examination, and problems with diarrhea began February 2017. The VA examiner noted that “[t]he [V]eteran does not have IBS, since he has one day of diarrhea only about once per month, and that is following prolonged constipation.” Additionally, the VA examiner indicated the Veteran “does not have the typical alternating constipation/diarrhea form of IBS.” Finally, the VA examiner offered the opinion that, “[g]iven the absence of any documentation of constipation or abdominal pain until 2014 (10 years after deployment) and the absence of any diarrhea until 2017 (13 years after deployment),” that it “is less likely than not that his chronic constipation is related to service in [Southwest] Asia.” In February 2018 the Veteran was seen as a new patient referral by a private practice nurse practitioner, Mr. B.P.R., at a gastroenterology clinic. After discussing the Veteran’s history and conducting a physical examination, Mr. B.P.R. assessed him with IBS with constipation. In the March 2018 VA examination report, the same VA examiner was asked to provide an addendum opinion in light of the assessment by Mr. B.P.R. Again, according to the VA examiner, the Veteran has chronic constipation as opposed to IBS and only experiences diarrhea for “one day” after taking a laxative. Nevertheless, the VA examiner opined that, “even if we were to concede that the [V]eteran has IBS,” the length of time before the Veteran’s symptoms began meant “it is less likely than not” his chronic constipation is related to military service. The Board finds the VA examination reports are inadequate for purposes of determining if service connection is warranted in this matter. For purposes of 38 C.F.R. § 3.317 (Compensation for Certain Disabilities Occurring in Persian Gulf Veterans), a formal diagnosis of IBS is not necessarily required. Instead, that regulation pertains to compensation for certain qualifying chronic disabilities resulting from, among other conditions, functional gastrointestinal disorders (as opposed to structural gastrointestinal diseases), which are characterized by chronic or recurrent symptoms that are unexplained by any structural, endoscopic, laboratory, or other objective signs of injury or disease and may be related to any part of the gastrointestinal tract. 38 C.F.R. § 3.317(a)(2)(i)(B)(3). In addition to IBS, the regulation also identifies, among other conditions, functional constipation. Id. Furthermore, the VA examiner’s reliance upon the amount of time that transpired before commencement of the Veteran’s gastrointestinal symptomology is flawed in this matter. According to the regulation at issue here, such a functional gastrointestinal disorder could manifest to a degree of 10 percent or more not later than December 31, 2021, and still be compensable. Id. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA Gulf War Illness examination with an examiner possessing appropriate expertise (preferably a gastroenterologist), who has not previously examined the Veteran, to fully assess and provide an opinion regarding the nature, severity, and etiology of the Veteran’s gastrointestinal condition. All pertinent evidence of record, as well as this remand, must be made available to and reviewed by the examiner. Any indicated special diagnostic tests that are deemed necessary for an accurate assessment must be conducted. All pertinent symptomology and findings must be reported. It should be noted the Veteran is competent to attest to factual matters of which he has first-hand knowledge, such as observable symptomology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner shall provide a fully-reasoned explanation. Without deference to any previously rendered medical opinions of record, the examiner must respond to the following: (a.) Determine whether the Veteran has an undiagnosed chronic gastrointestinal illness (as opposed to a confirmed diagnosis). (b.) If the Veteran has an undiagnosed chronic gastrointestinal illness, does it constitute a functional gastrointestinal disorder (as opposed to a structural gastrointestinal disease) characterized by chronic or recurrent symptoms that are unexplained by any structural, endoscopic, laboratory, or other objective signs of injury or disease and may be related to any part of the gastrointestinal tract (e.g., IBS or functional constipation). (c.) If so, address whether it is at least as likely as not (50 percent probability or greater) that such symptoms are an undiagnosed illness resulting from his service in the Persian Gulf. (d.) If the Veteran experiences symptoms that are attributable to a known clinical diagnosis, address whether it is at least as likely as not (50 percent probability or greater) that such diagnosis is related to or had its onset in service. The examiner must provide a complete rationale for his or her opinion(s). If any of the above requested opinions cannot be made without resorting to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts), a deficiency in the record (i.e., additional facts are required), or the examiner (i.e., does not have the knowledge or training). T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Worsham, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.