Citation Nr: 20021469 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 15-03 124 DATE: March 25, 2020 REMANDED Entitlement to service connection for a gastrointestinal condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from May 1983 to April 1987, November 2001 to May 2002, November to December 2002, January 2002 to January 2003, June 2003 to September 2003, July 2007 to January 2008, and from February 2008 to April 2009. He had additional service with the U.S. Air National Guard. In May 2018, the Board remanded the issue of entitlement to service connection for a gastrointestinal disability for further development, including for a VA examination. Notably, the agency of original jurisdiction (AOJ) was instructed to obtain an opinion that adequately addressed whether the Veteran had any diagnosed gastrointestinal disability, and if so, whether the disability was at least as likely as not related to the Veteran’s service. Upon review of the record, the Board finds that the claim must be remanded. The Board sincerely regrets the additional delay caused by this remand but wishes to assure the Veteran that it is necessary for a full and fair adjudication of his claim. Entitlement to service connection for a gastrointestinal condition is remanded. The Board finds that a new examination and etiological opinion is warranted for the Veteran’s claim. The Veteran contends his gastrointestinal condition is related to his service. In October 2019, the Veteran appeared for a VA examination, in which the examiner noted a diagnosis of intermittent small bowel obstruction from 1991. The Veteran reported getting sick while on tour in Egypt in the 1980’s and that he lost a lot of weight. Since then, the Veteran explained that he has been experiencing stomach cramps and pain, which occurs six to eight times a year and lasts three to four days each time. The Veteran also reported he has normal bowel pattern twice daily. The October 2019 examiner opined it was less likely than not the Veteran’s gastrointestinal condition incurred in service or was caused by an in-service injury, event or illness. She explained the onset of intermittent intestinal obstructions dated back to 1991, which fell outside of the Veteran’s active duty service periods. As there was no indication the Veteran suffered from acute flares of the intestinal obstructions while on active duty, his condition was not related to service. The Board finds the October 2019 examination and opinion to be inadequate. A medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. Stefl v. Nicholson, 21 Vet. App. 102, 124 (2007). In addition to clear conclusions with supporting data, a medical opinion must contain a reasoned medical explanation connecting the two and consider all the relevant evidence of record, including lay statements. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Here, the examiner failed to explain why she discounted the Veteran’s report of the onset of stomach problems in the 1980s while on tour and failed to consider that the Veteran was in the U.S. Air National Guard from March 1988 to April 2009, when the examiner deemed the disability began. See September 2009 Third Party Correspondence, p. 7. Additionally, the Board notes that a formal finding was made that the Veteran’s STRs for the period of May 1983 to April 1987 were unavailable. See May 2013 VA Memo. However, in November 2019, the Veteran submitted service treatment records (STRs) showing he complained of diarrhea in July 1985, which was not previously before the October 2019 examiner. See November 2019 Medical Treatment Record – Government Facility, p. 3. In light of this new evidence, a new examination and etiological opinion is warranted. See Nieves-Rodriguez v. Peake, 22 Vet. App. at 301; see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA provides a claimant with a medical examination or opinion, it must ensure that the examination or opinion is adequate). As noted, the examiner found the disability began in 1991; private treatment records also demonstrate a history of gastrointestinal problems in 1991 and 1993. See August 2013 Medical treatment Record – Non-Government Facility, pp. 3, 11, 13, 15, 17, 25, 27, 60, 62, 72. The Veteran’s periods of active duty for training (ACDUTRA) in the Air National Guard are not clear based on the available evidence. Thus, on remand, the AOJ should attempt to verify the Veteran’s specific dates of ACDUTRA, with emphasis on the years 1990, 1991, and 1993. The matters are REMANDED for the following action: 1. Assist the Veteran in associating with the claims folder any relevant outstanding treatment records. 2. Request records from the appropriate repository to verify the specific dates of ACDUTRA for the Veteran’s Air National Guard service. Document all requests for information, as well as all responses, in the claims folder. 3. Thereafter, schedule the Veteran for a VA examination to determine the nature and etiology of the Veteran’s gastrointestinal condition. The claims folder must be made available to the examiner for review in connection with the examination. The examination report must reflect that such a review was conducted. Any indicated studies should be performed. A detailed history concerning the Veteran’s gastrointestinal condition should be obtained from him. Based upon a review of the relevant evidence of record, the VA examiner should offer the following opinion: (a.) Is it at least as likely as not (i.e., at least a 50 percent probability) that the Veteran’s gastrointestinal condition had its onset in or is related to service? The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his report must be taken into account in formulating the requested opinion. The examiner should address the Veteran’s lay statements that he became ill in 1985, which is corroborated by the Veteran’s 1985 STR, and that he has experienced gastrointestinal problems since service, as well as private treatment records, which showed a history of gastrointestinal problems in 1991 and 1993. See November 2019 Medical Treatment Record – Government Facility, p. 3; August 2013 Medical treatment Record – Non-Government Facility, pp. 3, 11, 13, 15, 17, 25, 27, 60, 62, 72. (Continued on the next page)   The examiner must provide the rationale for all proffered opinions. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so, including whether the inability is the result of a need for additional information or the limits of medical or scientific knowledge. If additional information is needed, the examiner should identify the needed information. A. P. Armstrong Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. L. Park, 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.