Citation Nr: 21002484 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 13-24 433 DATE: January 13, 2021 ORDER Entitlement to a 10 percent disability rating for irritable bowel syndrome (IBS) is granted. REMANDED Entitlement to a disability rating in excess of 10 percent for IBS is remanded. Entitlement to service connection for chronic fatigue syndrome (CFS) is remanded. FINDING OF FACT Competent medical evidence indicates the Veteran’s IBS is manifested by constipation with abdominal discomfort with frequent episodes of abdominal distress. CONCLUSION OF LAW The criteria for a 10 percent disability rating for IBS have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.114, Diagnostic Code 7319. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 1990 to May 1991, including service in the Southwest Asia theater of operations from January 1991 to April 1991. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2017, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a video conference hearing. A transcript of her testimony is of record. These matters were previously before the Board in October 2018, when they were remanded for additional development. INCREASED RATING 1. Entitlement to a compensable disability rating for IBS The Veteran contends that she is entitled to a higher rating for her IBS. The Veteran’s IBS is rated pursuant to 38 C.F.R. § 4.114, Diagnostic Code 7319. In pertinent part, a noncompensable rating is assigned for mild irritable colon syndrome, resulting in disturbances of bowel function with occasional episodes of abdominal distress; a 10 percent rating is assigned for moderate irritable colon syndrome, resulting in frequent episodes of bowel disturbance with abdominal distress. On the June 2011 VA examination, the Veteran stated she has problems with her bowels three of four times a week with lots of gas daily. She says some foods cause her to have more constipation, and she tries to avoid certain foods. The November 2017 VA examiner concluded that the Veteran has constipation with abdominal discomfort with frequent episodes of abdominal distress. Upon review of the record, the Board finds that a rating of 10 percent is warranted for the Veteran’s IBS. The question of entitlement to an even higher rating is addressed in the remand section below. REASONS FOR REMAND 2. Entitlement to a rating in excess of 10 percent for IBS is remanded. The Veteran is seeking entitlement to a higher disability rating for IBS. The Board finds that an updated VA examination is needed prior to adjudication of this claim. The Veteran’s last VA examination in connection with this claim was conducted in November 2017. However, the Veteran has contended that her IBS has continued to worsen since the November 2017 VA examination. Accordingly, a new VA examination is warranted. See Palczewski v. Nicholson, 21 Vet. App. 174 (2007). 3. Entitlement to service connection for CFS is remanded. The Veteran is seeking entitlement to service connection for CFS. The Board finds that additional development is needed prior to adjudication of this claim. In accordance with prior remand instructions, a new VA medical opinion was obtained in November 2019. The VA examiner was instructed to opine whether notes that the Vet has constipation with abdominal discomfort with frequent episodes of abdominal distress it is at least as likely as not that the Veteran’s claimed fatigue represents an undiagnosed illness related to her Persian Gulf War service. However, the VA examiner opined that the Veteran’s “condition claimed was less likely than not incurred in or caused by the claimed in-service injury, event or illness,” because CFS “is an illness characterized by debilitating fatigue and several flu-like symptoms” which “may have both physical and psychiatric manifestations and closely resembles neurasthenia, neurocirculatory asthenia, fibrositis, or fibromyalgia.” See November 2019 VA examination. As this opinion and provided rationale do not address the question presented, additional opinion is warranted in order to comply with the terms of the Board’s prior remand instructions. See Stegall v. West, 11 Vet. App. 268 (1998) (a remand by the Board confers on the appellant, as a matter of law, the right to compliance with the remand orders). The matters are REMANDED for the following action: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated her for her claimed disabilities. After securing any necessary releases, request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. 2. Ask the Veteran to provide the names and addresses of all medical care providers who have treated her for her claimed CFS and service-connected IBS. After securing the necessary releases, request any identified records that are not duplicates of those associated with the claims file. If any requested records cannot be obtained, the Veteran should be notified of such. 3. Schedule the Veteran for a VA examination to assess the current severity of her service-connected IBS. The claims file must be reviewed by the examiner in conjunction with the examination. Any tests deemed necessary should be conducted, and all clinical findings should be reported in detail. All symptomatology associated with the Veteran’s IBS should be reported. 4. Obtain an addendum opinion with respect to the Veteran’s CFS claim. The claims file must be reviewed by the examiner. If a new examination is deemed necessary to respond to the request, one should be scheduled. Following review of the claims file, the clinician should opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s claimed fatigue represents an undiagnosed illness related to her Persian Gulf War service. The clinician should explain why or why not. 5. If the claims remain denied, issue a supplemental statement of the case. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. N. Wilson, 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.