Citation Nr: 20046892 Decision Date: 07/14/20 Archive Date: 07/14/20 DOCKET NO. 15-26 251 DATE: July 14, 2020 REMANDED 1. Entitlement to service connection for diverticulitis is remanded. 2. Entitlement to service connection for a back disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from May 1966 to March 1970. These matters are before the Board of Veterans’ Appeals (Board) on appeal of November 2012 and May 2016 Department of Veterans Affairs (VA) rating decisions. In August 2018, a videoconference hearing was held before the undersigned; a transcript is in the record. In May 2019, these matters were remanded for additional development. 1. Entitlement to service connection for diverticulitis. Further development of the record remains necessary for proper merits adjudication of these claims. The May 2019 Board remanded ordered a VA examination to obtain an opinion that addressed whether the Veteran’s complaints in service could have been early manifestations of diverticulitis (considering his August 2018 Board hearing testimony that symptoms of diarrhea, constipation, and abdominal pain became manifest in service and have persisted since. On September 2019 VA examination, the examiner noted that diverticulitis is most likely caused by chronic constipation and life-long low fiber diet. He opined that the Veteran’s CT exam in 2006 (36 years after service) revealed very mild diverticulitis and that the one complaint of constipation in-service [noted in STRs] and several complaints of gastroenteritis (probable infectious in origin) would not be the etiology of very mild diverticulitis. The examiner acknowledged the Veteran’s and his brother’s testimony concerning abdominal pain, but did not acknowledge the Veteran’s hearing testimony concerning chronic constipation (that ever since separation, he alternates between diarrhea and constipation). Accordingly, the opinion is not fully responsive to the Board’s remand directives, and corrective action is necessary. See Stegall v. West, 22 Vet. App. 268, 271 (1998). 2. Entitlement to service connection for a back disability. The May 2019 Board remand requested an examination to secure a medical opinion regarding the nature and likely etiology of the Veteran’s low back disability. The examiner was to note the Veteran’s back injuries in service and his and his brother’s reports of continuity of symptoms since separation. On August 2019 VA examination, degenerative arthritis of the spine was diagnosed. The examiner did opine regarding the low back disability. The opinion is non-responsive to the Board’s remand directives, and corrective action is necessary. See Stegall, 22 Vet. App. at 271. The matters are REMANDED for the following: 1. Return the record to the September 2019 examiner for review and an addendum opinion regarding the likely etiology of his diverticulitis. [If that provider is unavailable or unable to give an opinion sought, forward the record to another appropriate clinician for review and the opinion sought (and if in such circumstances further examination of the Veteran is deemed necessary, such should be arranged).] The Veteran’s record (specifically including the Veteran’s videoconference Board hearing testimony regarding experiencing alternating constipation and diarrhea since service) must be reviewed by the examiner. The examiner should: (a.) Opine whether it is at least as likely as not (a 50% or better probability) that it is etiologically related to his service (as due to disease, injury, or event, or by onset, therein)? [The rationale must acknowledge (discuss the significance, if any) of the sworn testimony regarding continuing digestive system symptoms since service (b.) If the diverticulitis is found to be unrelated to service, identify the etiology for the diverticulitis that is considered to be more likely (and explain why that is so). All opinions must include rationale. 2. Return the record to the August 2019 examiner for review and an addendum opinion regarding the likely etiology of his low back disability. [If that provider is unavailable or unable to give an opinion sought, forward the record to another appropriate clinician for review and the opinion sought (and if in such circumstances further examination of the Veteran is deemed necessary, such should be arranged).] The provider should note the Veteran’s STRs showing complaints of back pain and injuries in service and his and his brother’s hearing testimony regarding continuity of symptoms. The examiner should: (a.) Identify the likely etiology for each low back disability diagnosed. Specifically, is it at least as likely as not (a 50% or better probability) that it is related directly to his service, to include as due to low back complaints and injuries noted therein? (b.) If a diagnosed back disability is determined to be unrelated to service, identify the etiology for the disability that is considered more likely (and explain why that is so). All opinions must include rationale. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Naumovich, 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.