Citation Nr: 21069298 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 16-26 751 DATE: November 18, 2021 REMANDED Entitlement to service connection for gastrointestinal disability, to include irritable bowel syndrome and gastroesophageal reflux disease (GERD), is remanded. INTRODUCTION The Veteran served on active duty in the United States Army from May 1967 to May 1970. When this case was before the Board in January 2020 and June 2021, the above-noted issue was remanded for further development. The case has since been returned for additional appellate review. REASONS FOR REMAND Further delay of this matter is unfortunate; however, the Board finds additional development is again required before the Veteran's remaining claim is decided. The Board notes that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In its June 2021 decision, the Board instructed the RO to obtain a nexus opinion related to the Veteran's claimed gastrointestinal disabilities. The Board further explained that even though the Veteran's claimed disabilities are not included as presumptive disorders under 38 C.F.R. § 3.309(e), direct service connection may be established by evidence demonstrating the disease was in fact incurred during the service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In September 2021, the RO obtained VA examinations for esophageal conditions, stomach conditions, and intestinal conditions. Following the examinations, the examiner concluded the Veteran's IBS, GERD, hiatal hernia, and gastritis were less likely than not incurred in service, to include his exposure to herbicides. In support of this conclusion, the examiner stated, "the medical literature does not show a correlation between these conditions associated with herbicide exposure and the medical record is also silent for this condition occurring during military years." The VA examiner failed to discuss the Veteran's lay statements that he has had gastrointestinal symptoms since his active-duty service. The VA examiner must consider and expressly discuss the facts, medical principles, and scientific literature relevant to the specific claim at hand. As such, the Board finds a remand is necessary in order to obtain an addendum medical opinion. Accordingly, the case is REMANDED for the following action: Obtain an addendum medical opinion from the Veteran's September 2021 examiner, if available, and if unavailable from an examiner who is competent to address the etiology of the Veteran's gastrointestinal disabilities, to include IBS, GERD, hiatal hernia, and gastritis. All pertinent evidence of record must be made available to and reviewed by the examiner. Another examination of the Veteran should be performed only if deemed necessary by the examiner providing the opinion. Following a review of the relevant records and lay statements, the examiner should state an opinion with respect to whether any diagnosed gastrointestinal disability at least as likely as not (a 50 percent probability or greater) originated during the Veteran's period of active service or is otherwise etiologically related to his active service, to specifically include as a result of his exposure to herbicide agents. The examiner is asked to consider and expressly discuss the facts, medical principles, and scientific literature relevant to this case. The examiner must provide a complete rationale for any proffered opinion. In this regard, the examiner must discuss and consider the Veteran's competent lay statements, and assume such statements are credible for purpose of this opinion. The examiner must discuss and consider the Veteran's hearing testimony before a Decision Review Officer in June 2016, his spouse's statement dated July 27, 2016, and any other relevant lay statements. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Nestander, Jessica S. 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.