Citation Nr: 21068125 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 15-23 516 DATE: November 9, 2021 REMANDED The issue of service connection for a gastrointestinal disorder is remanded. REASONS FOR REMAND The Veteran served in the U.S. Marine Corps from January to March 1974. The issue of service connection for a gastrointestinal disorder is remanded. The matters are REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: This is a remand under the ruling in Stegall v. West, 11 Vet.App. 268 (1998) (holding that a remand by the Court or the Board confers on the veteran or other claimant, as a matter of law, the right to compliance with the remand orders). The Board has remanded this appeal multiple times to attempt to obtain an adequate VA medical opinion. In the April 2021 remand, the Board directed that the "examiner must obtain a full history from the Veteran." The July 2021 opinions were based solely on a records review, however, and no history was obtained. Additionally, the clinician failed to provide separate opinions for causation and aggravation by the Veteran's service-connected left groin neuroma removal residuals. The clinician also stated that gastroesophageal reflux disease (GERD) was not caused by service or by service-connected disorders because he could not determine when GERD was first diagnosed without resort to mere speculation. Lastly, the clinician did not discuss whether the medication the Veteran took for pain caused by his hernia and neuroma removal procedures caused or aggravated a gastrointestinal disorder. Therefore, the opinions are inadequate, the RO failed to comply with the Board's remand directives in violation of Stegall and remand is again necessary. THE REMAND DIRECTIVES FOLLOW. 2. Obtain a VA medical opinion from a qualified gastroenterologist. If necessary, to respond to the inquiries below, schedule the Veteran for a VA examination to obtain an opinion as to the nature and etiology of a gastrointestinal disorder. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address the following: (a.) Whether each identified gastrointestinal disorder was caused by any in-service event, injury, disease, or disorder, or in any way originated during service. (b.) Whether each identified gastrointestinal disorder was caused by any service-connected disorder, including because of medication taken to treat pain caused by bilateral inguinal hernias and repairs, nerve entrapment, and left groin neuroma and removal. (c.) Whether each identified gastrointestinal disorder was aggravated by any service-connected disorder, including because of medication taken to treat pain caused by bilateral inguinal hernias and repairs, nerve entrapment, and left groin neuroma and removal. Service connection is currently in effect for adjustment disorder with anxiety and unspecified depressive disorder; painful scar as a residual of bilateral inguinal repairs; tinnitus; status-post bilateral inguinal hernia repairs; left groin status-post neuroma removal; erectile dysfunction; and bilateral hearing loss. THE EXAMINER IS ADVISED THAT SEPARATE OPINIONS ABOUT CAUSATION AND AGGRAVATION (I.E., A WORSENING OF ANY DEGREE FOR ANY PERIOD) ARE REQUIED. The examiner's attention is drawn to the following: *Service treatment records (STRs), VA treatment records, and private treatment records indicate that the Veteran was separated from service due to a right inguinal hernia. He subsequently had right and left inguinal hernia repairs. He then developed a left groin neuroma which was subsequently removed; painful scar; and chronic, severe pain. *December 2009 VA examination report stating that the Veteran was given Motrin to take three times a day for pain due to his hernias and neuroma, that he took the medication, but it caused an upset stomach, and then that he had to take other medication to treat his stomach symptoms. The Veteran reported that he was never told to undergo other procedures but, instead, was just told to take the medication, which he had done for 35 years. *March 2010 claim for service connection in which the Veteran reported that he had stomach symptoms because of the pain from his inguinal hernias, neuroma, and painful scar; and that he developed stomach symptoms because of medication he was taking to treat the pain. *December 2011 Report of General Information where the Veteran stated that his stomach symptoms were caused by medications he took to treat his service-connected disorders. *September 2012 letter from a private physician stating that the Veteran had abdominal pain, dyspepsia, and heartburn, and stating a diagnosis of GERD. *August 2015 VA examination stating a diagnosis of GERD. *September 2018 statement from the Veteran where he reported that the neuroma and nerve entrapment caused pain and that he developed stomach symptoms because of taking daily pain medication. *December 2019 VA examination report indicating that the Veteran has continued to take 800 milligrams of ibuprofen twice a day for pain and in which the examiner stated that the "chronic use of NSAIDs such as Ibuprofen and many other types of NSAIDs could contribute to the precipitation and even aggravation of GERD and/or gastric condition." *February 2020 VA treatment record stating that the Veteran had GERD and dyspepsia "likely exacerbated by recent noncompliance with antacid medication, use of ibuprofen, and dietary choices." VBMS Entry 9/29/2020, p. 54. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. E. Miller, Counsel The Board's action is binding only in this case. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.