Citation Nr: 21003201 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 15-11 568 DATE: January 19, 2021 REMANDED Service connection for a stomach condition is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1968 to March 1970. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an October 2012 decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2018, the Veteran appeared at a Travel Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. In February 2019 and August 2020, the Board remanded the claim for further evidentiary development.   Service connection for a stomach condition is remanded. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Veteran was afforded a VA examination in November 2020. The examiner identified gastric ulcer, gastroesophageal reflux disease (GERD), and colon cancer as diagnoses. The examiner offered a negative nexus opinion on all conditions. The examiner’s rationale was, in essence, that there was no evidence of these conditions arising in service or at separation. The examiner stated that the Veteran’s separation examination did not indicate stomach, liver, or intestinal problems. The examiner added that “[d]espite the [V]eteran’s claims to the contrary, there is no evidence to support a chronic condition arising in service or proximate to service.” The Board finds this VA examination to be inadequate. The examiner’s entire rationale is based on an absence of medical evidence while ignoring the Veteran’s competent lay evidence. Namely, the examiner stated that the Veteran’s service treatment records (STRs), including his separation examination, were silent for any treatment for stomach, liver, or intestinal problems, but the Veteran has stated that his stomach issues began in service and worsened when he was in Vietnam. Indeed, the Board specifically instructed that the examiner should consider the Veteran’s reported history regarding receiving treatment in Vietnam and experiencing continuity of symptomatology since service to be credible. Instead, the examiner stated that “[d]espite the [V]eteran’s claims to the contrary, there is no evidence to support a chronic condition arising in service or proximate to service.” For these reasons, the Board finds the November 2020 VA examination to be inadequate.   The matters are REMANDED for the following actions: 1. Obtain and associate with the claims file VA treatment records from October 2020 to present. 2. Forward the Veteran’s claims file to an appropriate clinician for an addendum opinion on the nature and etiology of any stomach disability, including peptic ulcer disease, colon cancer, and GERD. If the reviewing clinician determines that an examination is necessary (including via telehealth interview) to provide the requested opinion, then such must be scheduled. The reviewing clinician must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including treatment the Veteran has reported receiving during his service in Vietnam. In providing an opinion on this matter, the reviewing clinician should consider the Veteran’s reported history, including as provided in the transcript of the August 2018 Board hearing, regarding receiving treatment in Vietnam and experiencing continuity of symptomatology since service to be credible. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not   be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Patel, 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.