Citation Nr: 21065560 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 18-19 697 DATE: October 26, 2021 REMANDED Entitlement to service connection for a gastrointestinal disability, to include gastritis and irritable bowel syndrome (IBS), as due to asbestos and herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served in the United States Navy from December 1956 to November 1960. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Veteran presented testimony before the undersigned. A copy of the transcript is associated with the claims file. These matters were remanded for further development in July 2019 and December 2020 and have been returned to the Board for appellate consideration. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900. Entitlement to service connection for a gastrointestinal disability, to include gastritis and IBS, as due to asbestos and herbicide exposure, is remanded. The Veteran contends that his current gastrointestinal condition is related to service, to include as due to both asbestos and herbicide agent exposure. Pursuant to the December 2020 Board remand, an August 2021 VA examination was obtained. The examination demonstrated a diagnosis for chronic diarrhea, and the Veteran's reports of worsening IBS following service with alternating symptoms of diarrhea and constipation. The examiner remarked that there was no evidence of IBS and provided a negative nexus opinion. The examiner noted recent medical records evidenced pancreatic insufficiency which caused the Veteran's diarrhea but concluded that there was not enough evidence to suggest a gastrointestinal condition prior to 2019 without resorting to speculation. The examiner also acknowledged the Veteran's contentions that his gastrointestinal condition is related to asbestos and herbicide exposure but noted that the claimed IBS is not a disease presumptively caused by Agent Orange exposure. In addition, medical research demonstrated minimal gastrointestinal effects produced by asbestos exposure, although inconclusive, and the most likely result of asbestos exposure, either via environmentally or occupational hazards, would be the development of stomach cancer, which the Veteran does not have. The Board finds the August 2021 VA examination is inadequate. Private medical records from Dr. L.A. dated in January 2019 showed a diagnosis and treatment for acute erosive antral gastritis; however, the August 2021 VA examination only reflected a diagnosis for chronic diarrhea. See March 2019 Medical Treatment Record. Furthermore, the examiner did not provide a sufficient rationale in support of the opinion that the claimed condition is not directly related to service. In a September 2021 correspondence, the Veteran asserted that he was diagnosed with pancreatitis due to severe diarrhea in 1979 at Jedda Army Base. He also asserted that he was diagnosed with IBS in 1972 in the army base in Saudi Arabia, which was later confirmed by several doctors and specialists in California and Texas. As these records have not been obtained, on remand the RO must make attempts to obtain these records. Furthermore, in October 2021, the Veteran and his representative indicated that the August 2021 VA examination was inadequate due to the nurse practitioner's lack of expertise in gastrointestinal disorders and that the accompanying opinion was not supported by an adequate rationale. As such, on remand the RO must assure that the examiner providing the requested opinion is a qualified clinician specializing in gastrointestinal disorders. The matter is REMANDED for the following actions: 1. With any necessary assistance from the Veteran, obtain any outstanding VA and/or private treatment records, to include service treatment records from Jedda Army Base in Saudi Arabia during the Veteran's period of active service. All efforts to obtain these records should be documented in the claims file. 2. After the above development, obtain an addendum opinion from a qualified clinician specializing in gastrointestinal disorders to determine the nature and etiology of the Veteran's gastrointestinal condition. The examiner is requested to review all pertinent records associated with the claims file, including this Remand, and to indicate review of the file in the examination report. The examiner must identify all gastrointestinal disorders present during the appeal period, to include acute erosive antral gastritis, diarrhea, and IBS. For each diagnosed/identified disorder, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) due to or aggravated by an in-service injury, event, or disease, to include as due to exposure to asbestos therein. The examiner should address any conflicting medical evidence of record. The examiner must also consider the Veteran's own statements regarding his disability, since a layperson is competent to address symptoms as experienced and his recollections of past history and treatment. If the examiner has reason based on other evidence of record or medical knowledge to question the Veteran's self-reported history, the examiner should so state and provide a complete explanation why this is so. A clear rationale for all opinions, and a discussion of the facts and medical principles involved must be provided. 3. Readjudicate the claim on appeal. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Asfaw, 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.