Citation Nr: 21002322 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 10-44 872 DATE: January 13, 2021 REMANDED Service connection for a gastric disorder, to include irritable bowel syndrome, including as secondary to service-connected hepatitis is remanded. Entitlement to a compensable rating for service-connected hepatitis is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1970 to July 1972 in the U.S. Army. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. In July 2015, the Veteran testified before a Veterans Law Judge (VLJ) who is no longer employed by the Board. A transcript of the hearing is of record. In February 2020, the Veteran was notified that the VLJ who conducted the July 2015 Board hearing was no longer employed by the Board and that he had a right to another Board hearing. The Veteran was given 30 days to respond. As no response was received, the Board assumes that the Veteran does not desire another Board hearing. This matter was most recently before the Board in November 2017, at which time the issues on appeal were remanded for further development. This case has now been returned to the Board for appellate consideration. A remand by the Board confers on the Veteran, as a matter of law, the right to compliance with the remand order. Stegall v. West, 11 Vet. App. 268, 271 (1998). While the Board sincerely regrets further delay in this matter, after a review of the record, the Board finds that the RO has not complied with its November 2017 remand directives. Service Connection for Gastric Disorder The November 2017 Board remand instructed the RO to obtain an opinion addressing the nature and etiology of all digestive system symptoms and their associated diagnoses. The RO attempted to schedule the Veteran for a VA examination in March 2019, however the Veteran declined the examination and his medical records indicated that he preferred his VA examination to be completed at a contractor. In September 2019, the RO rescheduled the Veteran’s VA examination with a contractor, however in October 2019 the examination was cancelled because the Veteran was unavailable. See October 2019 Exam Request. There is no indication in the record that the examination was rescheduled. The Board reminds the Veteran that the "duty to assist is not always a one-way street," and that he has an obligation to actively participate, to include attending a scheduled VA examination. He is expected to cooperate in the efforts to adjudicate the claim, and his failure to do so would subject him to the risk of an adverse adjudication based on an incomplete and underdeveloped record. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991); Kowalski v. Nicholson, 19 Vet. App. 171, 178 (2005). Pursuant to 38 C.F.R. § 3.655, failure to appear for a scheduled VA examination may detrimentally affect the claim because the subsequent adjudication will be based solely on the evidence of record. Increased Rating for Hepatitis Because a decision on the remanded issue of service connection for a gastric disability could significantly impact a decision on the issue of an increased rating for hepatitis (see 38 C.F.R. § 4.114), the issues are inextricably intertwined. Accordingly, remand of the claim for an increased rating for hepatitis required.   The matters are REMANDED for the following action: Schedule the Veteran for a VA examination to determine the nature and etiology of any current digestive system symptomatology and associated diagnoses, including irritable bowel syndrome (IBS), diverticulosis, and benign colon polyp. The examination should be performed by appropriate clinician other than the clinician who performed the January 2017 examination. The claims file should be made available to the physician and review should be noted. After complete review of the file the physician must address the following: (a.) Identify any and all symptoms and sequelae of the digestive system, to include vomiting, nausea, diarrhea, and constipation, and provide a diagnosis for the symptoms manifested. (b.) For each diagnosis of the digestive system, is it at least as likely as not (a 50 percent probability or greater) that the disorder had its onset during service or was caused or otherwise related to any in service injury, event, or disease? (c.) For each diagnosis of the digestive system, is it at least as likely as not (50 percent probability or greater) that the disorder was caused or aggravated by his service-connected hepatitis? The physician is advised that aggravation means an increase in the severity of the underlying disability beyond its natural progression. If aggravation is found, the physician must attempt to establish a baseline level of severity of the digestive system disability prior to aggravation by the service-connected disability. In rendering the opinion, the physician is asked to consider and discuss the significance of the following: • August 10, 1971: two-week history of gastrointestinal issues, to include nausea and diarrhea. • August 11, 1971: diarrhea, nausea, and vomiting attributed to hepatitis. • November 26, 1980: long history of stomach cramps, gassiness, and alternating diarrhea and constipation. IBS diagnosed. • March 23, 1988: 16-year history of intermittent diarrhea and constipation. • September 2, 2011: treating doctor notes that Veteran’s statements linking his digestive conditions to his hepatitis are “reasonable.” A comprehensive explanation for any opinion offered must be provided based on the specific facts of this case and any pertinent medical principles and evidence in the claims file. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Kernen, 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.