Citation Nr: 21064660 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 11-28 707 DATE: October 21, 2021 REMANDED Entitlement to service connection for a gastrointestinal disorder, to include irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD), to include as secondary to posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1974 to June 1976. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. The Board remanded this matter in May 2018. In a May 2020 decision, the Board denied service connection for the above claim. The Veteran appealed the Board's May 2020 decision to the United States Court of Appeals for Veterans Claims (Court). In a July 2021 Order, the Court vacated the May 2020 Board decision, and remanded the issue of service connection for a gastrointestinal disorder, to include IBS and GERD, to include as secondary to PTSD to the Board for further development. Entitlement to service connection for a gastrointestinal disorder, to include irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD), to include as secondary to posttraumatic stress disorder (PTSD) is remanded. In the July 2021 Court Order, the Court determined that the Board erroneously relied on the December 2019 VA examination. Specifically, the Court found that the December 2019 VA examiner did not provide an adequate rationale for the negative nexus opinion. The examiner did not reconcile this opinion with the "Evidence comments" in the examination, reflecting that the Veteran experienced symptoms during service, specifically problems with diarrhea in April 1974, and abdominal pain, nausea, and abdominal cramping in December 1974. Additionally, the examiner found there was no continuity of care, but then did not account for the Veteran's reported medical history reflecting that her symptoms of IBS increased in severity over time. The Board is bound by these findings by the Court. The Board also notes that the Veteran's representative argued in an August 2021 Appellate Brief that the Veteran's PTSD medications have caused or aggravated her gastrointestinal disorder. It was argued that side effects of the Veteran's PTSD medications include nausea, upset stomach, dry mouth, constipation, diarrhea, heartburn, vomiting, and stomach pain, which are symptoms of GERD or IBS. The Board finds that this argument has not been adequately addressed by a VA examiner. Therefore, on remand, a clarifying VA opinion, and/or VA examination if determined necessary, must be obtained to determine the etiology of the Veteran's gastrointestinal disorder. The matters are REMANDED for the following actions: 1. Obtain any outstanding VA or private treatment records. Request that the Veteran assist with locating these records, if possible. Associate these records with the claims file. 2. Then, obtain a VA opinion, or VA examination if deemed necessary, by an appropriate examiner to determine the etiology of the Veteran's gastrointestinal disorder, to include IBS and GERD, to include as secondary to PTSD. The claims file and a copy of this remand must be made available for review. Following a review of the pertinent evidence, the examiner must determine the following: (a) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's gastrointestinal disorder, to include IBS and GERD, is caused by or related to service. (b) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's gastrointestinal disorder, to include IBS and GERD, is caused by or aggravated by PTSD, to include the medications taken for the Veteran's PTSD. A clear rationale must be provided for all opinions expressed. The examiner must consider and discuss the following: 1) Veteran's lay statements regarding continuity of symptoms; 2) In-service treatment records specifically showing various digestive symptoms; and 3) Side effects of the various medications taken for the Veteran's PTSD and its impact on causing or aggravating gastrointestinal disorder, to include IBS and GERD. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 3. Thereafter, readjudicate the claim on appeal. If the benefit sought remains denied, issue the Veteran and her representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning the matter to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Brown, Saudiee 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.