Citation Nr: 21070148 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 17-08 513 DATE: November 23, 2021 REMANDED Entitlement to service connection for gastrointestinal condition, to include as secondary to service-connected left buttocks scar, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from April 1980 to October 1990. The issue was remanded by the Board of Veterans' Appeals (Board) in September 2019, August 2020, and April 2021 for further development. The most recent remand in April 2021 specifically instructed the regional office (RO) to schedule a VA examination pertaining to the Veteran's claim that, among other things, addressed a January 2019 private medical opinion stating that bowel incontinence may have been caused by a deep incision during an in-service surgery. Upon review of the record, the Board finds that the claim must be remanded. The Board sincerely regrets the additional delay caused by this remand, particularly as this matter has been the subject of multiple prior remands, but wishes to assure the Veteran that it is necessary for a full and fair adjudication of his claim. Entitlement to service connection for gastrointestinal condition, to include as secondary to service-connected left buttocks scar, is remanded. The Board finds that a new etiological opinion is warranted for the Veteran's claim. The Veteran contends that his gastrointestinal condition is related to his service, or in the alternative, is secondary to his service-connected left buttock scar. The Veteran underwent a VA examination in July 2021, in which the examiner opined that the Veteran's gastrointestinal condition is less likely than not related to service or his service-connected left buttock scar. However, the Board finds that the examination and opinion do not substantially comply with the Board's April 2021 remand directives. Stegall v. West, 11 Vet. App. 268 (1998); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). Unfortunately, the July 2021 examiner failed to address the January 2019 private medical opinion as directed by the Board, just like the previous February 2021 examiner. Accordingly, a remand is necessary to afford the Veteran a new examination to ascertain the nature and etiology of his gastrointestinal condition. The matters are REMANDED for the following action: Obtain an opinion from an appropriate examiner to determine the nature and etiology of the Veteran's gastrointestinal condition. The claims file should be made available to the examiner for review in connection with the examination. The Veteran should be contacted, and an examination scheduled, if the examiner deems it necessary for a complete and well-informed opinion. Based on review of the record, the examiner should respond to the following: (a.) State whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's gastrointestinal condition had its onset in or is related to service. (b.) State whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's gastrointestinal condition was caused or aggravated by the Veteran's service-connected left buttocks scar. An opinion as to both causation and aggravation is requested. THE EXAMINER MUST SPECIFICALLY DISCUSS THE JANUARY 2019 PRIVATE MEDICAL OPINION, INCLUDING THE DETERMINATION THAT BOWEL INCONTINENCE MAY BE CAUSED BY A DEEP INCISION DURING HIS IN-SERVICE SURGERY. THE EXAMINER MUST ALSO CONSIDER AND DISCUSS THE VETERAN'S 2018 BOARD HEARING TESTIMONY AS TO THE ONSET AND PROGRESSION OF HIS CONDITION. (c.) If the examiner finds that the Veteran's gastrointestinal condition was aggravated by his service-connected left buttocks scar, then he/she should specify the baseline level of disability of the gastrointestinal condition prior to aggravation due to the service-connected left buttocks scar. Note that aggravation means any incremental increase in disability in the non-service-connected condition (i.e., any additional impairment of earning capacity) resulting from the service-connected condition. The examiner must provide the rationale for all proffered opinions. 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. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. L. Park, 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.