Citation Nr: 21070402 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 15-43 613 DATE: November 23, 2021 REMANDED Entitlement to service connection for ulcerative colitis, to include as due to exposure to herbicide agents is remanded. REASONS FOR REMAND The Veteran honorably served on active duty in the United States Air Force from September 1967 to September 1971 during the Vietnam Era. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a March 2013 rating decision issued by a Department of Veteran's Affairs (VA) Regional Office (RO). The RO most recently issued a supplemental statement of the case (SSOC) in July 2021. This matter is now properly before the Board. In March 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A written transcript of this hearing has been prepared and associated with the evidence of record. This matter was previously remanded in July 2019 and in May 2021. Regrettably the Board must remand this matter once again for a new VA examination. In July 2019, the Board remanded this matter to provide the Veteran with a medical examination on the nature and etiology of his claimed condition. In May 2021, the Board again remanded for a medical examination on the nature and etiology of his claimed condition. Although regrettable, additional remand is required for substantial compliance with the Board's remand instructions; specifically, the medical opinion provided insufficient rationale for its conclusions and did not address lay evidence. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998). While this opinion addresses the lack of a presumptive relationship between herbicides and ulcerative colitis, it does not provide sufficient rationale as to whether the Veteran's condition is nevertheless directly related to the Veteran's service. See Combee v. Brown, 34 F.3d 1039,1042 (Fed. Cir. 1994). The examiner also failed to address lay statements made by the Veteran that his symptoms started while in service. The June 2021 VA examiner referenced the Veteran's lay statements but did not directly address the complaints or symptoms the Veteran claims started in service. Furthermore, the examiner failed to address the nature and etiology of the Veteran's ulcerative colitis. The examiner focused the rationale on whether the Veteran's ulcerative colitis was related to agent orange exposure or other herbicide exposure. The examiner failed to address the Veteran's symptoms that led to the diagnosis, symptoms that would be expected to be related to ulcerative colitis. The Board finds that the Veteran's overall symptoms should be addressed directly to determine whether the Veteran is in fact entitled to service-connection for his ulcerative colitis, especially since the Veteran claims that he has had symptoms in and since service. Finally, in October 2021, the Veteran submitted a statement suggesting that his research found that "subjects with PTSD have increased risk for major autoimmune disorders and PTSD was associated with TWO-FOLD increase in inflammatory bowel disease which includes [the Veteran's] diagnosis of ulcerative colitis." The Veteran is presently service-connected for PTSD which is rated as 70 percent disabling. In support of his assertion, the Veteran submitted an article from the National Center for PTSD authored by Dr. T. Neylan and Dr. A. O'Donovan, titled "Inflammation and PTSD." This article was associated with the Veteran's electronic record on October 13, 2021. This new evidence/theory necessitates a medical opinion and the examiner assigned to this case is to provide an opinion as to whether it is at least as likely as not that the Veteran's ulcerative colitis is either caused by or aggravated by his service-connected PTSD. The examiner must cite and discuss the above referenced article from the National Center for PTSD when formulating an opinion. The matters are REMANDED for the following action: 1. Obtain any outstanding medical records or evidence. 2. Obtain a new VA examination from a VA examiner other than the examiners that previously examined the Veteran. The new examiner must have sufficient expertise to determine the nature and etiology of the Veteran's ulcerative colitis. The claims file must be made available to and be fully reviewed by the examiner including a copy of this remand. The examiner should discuss the Veteran's symptoms of ulcerative colitis, particularly addressing the symptoms the Veteran's claims may have started while in service. The examiner should thoroughly review the Veteran's claims file and comment on whether any symptoms or conditions previously diagnosed may have been related to ulcerative colitis. Following a review of the casefile and this Remand, the examiner must state an opinion as to whether: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's ulcerative colitis was caused by or is otherwise etiologically related to his military service (to include but not be limited to his exposure to herbicidal agents). This opinion must address whether the Veteran's condition is at least as likely as not directly related to his active service. The examiner must clearly and specifically consider and address relevant lay statements of record indicating that his ulcerative colitis may have started in service (such as contained in the Board hearing transcript, service treatment records, and statements filed in support of his claim). (b) The examiner is to also opine as to whether it is at least as likely as not that the Veteran's ulcerative colitis is secondary to his service-connected PTSD. This must include opinions as to whether it is at least as likely as not that the Veteran's ulcerative colitis was (a) caused by his service-connected PTSD or (b) aggravated (made worse) by his service-connected PTSD. The examiner must consider and discuss the article from the National Center for PTSD authored by Dr. T. Neylan and Dr. A. O'Donovan, titled "Inflammation and PTSD" which is of record. The examiner should identify the reasons behind his or her conclusions by identifying the facts and information that support the opinion, and then explaining how that evidence justifies the opinion. If the examiner is unable to provide the required opinion, he or she should explain why this is the case and identify what, if any, additional evidence would allow for a more conclusive opinion. CONTINUED ON NEXT PAGE 3. After completion of the above, the claim should be readjudicated. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Hailu, 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.