Citation Nr: 20005785 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 16-21 995 DATE: January 23, 2020 REMANDED Entitlement to service connection for a gastrointestinal disability, to include as due to exposure to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, served on active duty from July 1973 to July 1976 and from March 1983 to April 1986. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In a July 2017 Statement in Support of Claim, the Veteran requests that his appeal be advanced on the docket based on his filing for bankruptcy and for serious illness, as he is diagnosed with end-stage renal disease. See January 2015 private treatment record and VA radiology note. Appeals must be considered in docket number order, but may be advanced if sufficient cause is shown. See 38 U.S.C. § 7107(a)(2) (2012); 38 C.F.R. § 20.900(c) (2018). Here, the Board finds that good cause is shown, and as such, the undersigned Veterans Law Judge grants the motion to have this case advanced on the docket. In correspondence received December 2019, the Veteran expressed his desire to proceed with his appeal pro se. In an October 2018 decision, the Board denied entitlement to service connection for stomach polyps because the evidence was insufficient to show that the Veteran had a diagnosis of stomach polyps during the appeal period. The Veteran then appealed to the United States Court of Appeals for Veterans Claims (Court). In May 2019, the Court granted a May 2019 Joint Motion for Partial Remand (JMPR) by counsel for the Veteran and VA. In pertinent part, the Court vacated the Board’s October 2018 decision as to the denial of service connection for stomach polyps and determined that the Board erred in limiting the Veteran’s claim to conditions of the stomach. The May 2019 JMPR further found that the Board should have characterized the issue more broadly, to include adjudicating whether the Veteran’s colon polyps and diverticulosis were related to his service at Camp Lejeune. Pursuant to the May 2019 JMPR and Court Order, and after reviewing the contentions and evidence of record, the Board recharacterizes the issue as entitlement to service connection for a gastrointestinal disability. See Brokowski v. Shinseki, 23 Vet. App. 79 (2009); Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The issues of entitlement to service connection for a heart disability and anemia remanded by the Board in October 2018 are still being developed by the RO; therefore, those issues will be the subject of a separate Board decision at a later date. 1. Entitlement to service connection for a gastrointestinal disability, to include as due to exposure to contaminated water at Camp Lejeune, is remanded. The Veteran asserts that he currently has a gastrointestinal disability that is related to, or caused by, his active service. The Veteran’s service treatment records (STRs) show complaints of stomach cramps, nausea, vomiting, diarrhea, excessive gas, and blood in stool as well as diagnoses of “G’enteritis” (likely gastroenteritis), rectal bleeding, and hematochezia. See STRs dated November 1973 through February 1986. Furthermore, the Veteran’s post-service treatment records reflect diagnoses of diverticulitis, colon polyps, a stomach ulcer, hemorrhoids, and rectal bleeding. See private treatment records dated February 1996 through August 2002 and VA treatment records dated February 2011 through June 2018. To date, VA has not obtained a competent medical examination and opinion addressing this claim. Given the Veteran’s current diagnoses relating to his gastrointestinal tract and evidence of gastrointestinal symptoms during service, a VA examination should be afforded to him. McClendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, the matter is REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file, and then provide the Veteran with a VA examination to determine the likely etiology of his gastrointestinal disability. The claims file, including a copy of this Remand, must be made available to and be reviewed by the examiner. All indicated studies, tests, and evaluations must be conducted, and all findings reported in detail. After a thorough review of the record and examination of the Veteran, the examiner is asked to respond to the following: (a) Elicit from the Veteran and the record the history of the Veteran’s gastrointestinal symptoms during service and since separation from service. (b) Identify all diagnoses pertaining to the Veteran’s gastrointestinal tract, to include colon polyps and diverticulosis, and, if possible, the onset of same. (c) Provide an opinion as to whether it is as least as likely as not (50 percent probability or greater) that any of the diagnoses pertaining to the Veteran’s gastrointestinal tract had their onset during service or are otherwise related to it, to include as due to exposure to contaminated water while serving at Camp Lejeune. A complete rationale should be provided for all opinions. Although a complete review of the record is imperative, the examiner’s attention is called to the following: ** November 1973 service treatment record. See Veteran’s complaints of stomach cramps, excessive gas, vomiting, and diarrhea. ** July 1975 service treatment record. See Veteran’s complaints of nausea and stomach cramps. ** February 1976 service treatment record. See Veteran’s complaint of vomiting “on and off” for two days. ** August 1985 service treatment record. See Veteran’s complaints of stomach cramps, diarrhea, and nausea, and provider’s diagnosis of “G’enteritis” (likely gastroenteritis). ** November 1985 service treatment record. See Veteran’s complaints of nausea, diarrhea, and possible blood in stool, and indication that “Kaopectate and mylanta didn’t work.” ** February 1986 service treatment record. See Veteran’s complaints of blood in stool, diarrhea, and nausea, and provider’s diagnosis of rectal bleeding and hematochezia. ** February 1996 private treatment record. See provider’s report that at the time of endoscopy, the Veteran’s stomach had a 0.5 cm ulcer at the lip of the duodenum. ** October 1998 private treatment record. See Veteran’s complaints of abdominal pain for the past two days and provider’s notation that he started vomiting while in the clinic. ** June 1999 private treatment record. See Veteran’s complaints of stomach cramps, diarrhea, vertigo, and fatigue, and provider’s assessment of diverticulitis. ** February 2001 to August 2002 private treatment records. See diverticulitis listed as a problem for the Veteran. ** February 2011 VA primary care note. See Veteran’s report that he often gets episodes of bleeding per rectum with stool suggestive of hemorrhoids, and provider’s note “Would get colonoscopy urgent.” ** April 2011 VA emergency department note. See provider’s notation that upon physical examination of the Veteran, a small internal hemorrhoid “minimally tender at 12 o’clock, no fissures or masses” was found, a fecal occult blood test was positive, and diagnosis of rectal bleeding. ** June 2011 VA colonoscopy procedure report. See findings that “there was evidence of few moderately severe diverticuloses in the descending colon and sigmoid colon. Multiple diminutive polyps were found in the rectosigmoid junction and rectum. The first polyp was removed by cold biopsy polypectomy. Specimen(s) delivered to pathology. The first polyp was completely removed and retrieved; it was placed in a jar. Multiple images were captured. Multiple hyperplastic polyps in rectalsigmoid colon. 2 sent for biopsy. Small internal hemorrhoids were found in the anus. The hemorrhoids were not bleeding.” ** July 2014 VA hematology and oncology outpatient note. See provider’s assessment of “Lower GI bleeding: Possible secondary to diverticulosis, though the frequency of his bleeding per rectum has increased recently at least twice a week for the last 2 months.” ** September 2016 VA H&P note. See provider’s assessment of “Lower GI bleed.” ** October 2016 VA hospital admission report. See admitting diagnosis of “GIB” (likely GI bleed). ** June 2018 VA gastroenterology consultation. See Veteran’s complaint of bright red blood with most of his bowel movements, and provider’s diagnosis of internal hemorrhoids upon rectal examination. (Continued on the next page)   2. Lastly, readjudicate the claim on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. M. Gill, 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.