Citation Nr: 21000223 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 15-27 367 DATE: January 4, 2021 REMANDED Entitlement to service connection for fatigue, to include as due to an undiagnosed illness, is remanded. Entitlement to service connection for a gastrointestinal disability, diagnosed as chronic diarrhea and/or infectious colitis (other than irritable bowel syndrome and weight loss), to include as due to an undiagnosed illness, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1988 to January 1989 and from December 1990 to April 1991. In March 2018 and March 2020, the Board remanded the Veteran’s claims for further development. The issue of entitlement to service connection for headaches was also remanded by the Board in March 2020. The Agency of Original Jurisdiction (AOJ) granted service connection for tension headaches in a September 2020 rating decision. That issue, having been granted in full, is no longer for appellate review. Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). 1. Entitlement to service connection for fatigue, to include as due to an undiagnosed illness, is remanded. The March 2020 Board remand ordered the AOJ to “schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s fatigue.” In September 2020, a Gulf War Medical Examination was completed. The Gulf War General Medical Examination Disability Benefits Questionnaire (DBQ) medical history requests that the examiner identify each affected system/area and to complete the associated Questionnaires as part of this General Medical exam report. The examiner indicates that a Chronic Fatigue Syndrome DBQ was completed in relation to the Gulf War General Medical Examination. A Chronic Fatigue Syndrome DBQ related to this exam, however, has not been associated with the claims file, and it is unclear if such an examination was completed. The Board finds that this issue must be remanded again to either associate the September 2020 Chronic Fatigue Syndrome DBQ with the claims file, or to conduct such an examination. 2. Entitlement to service connection for a gastrointestinal disability, diagnosed as chronic diarrhea and/or infectious colitis (other than irritable bowel syndrome and weight loss) is remanded. In September 2020, the Veteran was provided a VA examination regarding his gastrointestinal (GI) symptoms. The examiner noted that “the Veteran has a diagnosis of PTSD and depression, and there is research showing that there might be a correlation between PTSD and GI system symptoms.” The examiner opined that “Although further investigation is necessary, I believe that this is the right path to evaluate this Veteran and the possible connection between his PTSD, Depression, and GI symptoms.” In October 2020, a medical opinion was obtained regarding whether the Veteran’s GI condition was caused, or aggravated by, his service-connected depression. The examiner opined that the Veteran’s focal colitis was less likely than not caused by his service-connected psychiatric condition. The examiner supported this opinion by stating that no chronic diagnosis of colitis is documented in the treatment notes and that no ongoing GI assessment is documented. The examiner also stated that the literature referenced in the September 2020 medical opinion only shows a possible association. The Board does not find this opinion to be adequate as it does not address pertinent facts of record. Significantly, the October 2020 examiner does not address the diagnosis of diarrhea by the January 2015 VA examiner or the Veteran’s reports of recurrent abdominal distress in January 2015. As such, the Board finds that a new medical opinion addressing secondary service connection for a disability manifested by the Veteran’s gastrointestinal symptoms (other than irritable bowel syndrome and weight loss) should be obtained. The matters are REMANDED for the following action: 1. Undertake appropriate efforts to associate with the claims file a Chronic Fatigue Syndrome DBQ completed in September 2020. If such an examination report is not available, then a new examination should be afforded. 2. Obtain a medical opinion regarding the etiology of the Veteran’s focal colitis and diarrhea. The examiner is asked to address each of the following: (A.) Whether the Veteran’s focal colitis and/or diarrhea diagnosed during the appeal period at least as likely as not (50 percent or greater probability) are/were caused by, or the result of, the Veteran’s service-connected disabilities, including major depressive disorder. (B.) If not, whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s focal colitis and/or diarrhea diagnosed during the appeal period have been aggravated by the Veteran’s service-connected disabilities, including major depressive disorder. By aggravation, the Board means an increase in severity that is beyond natural progression. The examiner is asked to consider the 2017 article cited by the September 2020 examiner. The VA examiner must provide separate findings and rationales as to whether the Veteran’s focal colitis and/or diarrhea were caused by, or aggravated by, his service-connected disabilities. A complete rationale for all opinions must be provided. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.M. Johnson, 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.