Citation Nr: 21072524 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 17-09 600 DATE: December 3, 2021 REMANDED Entitlement to service connection for digestive issues (claimed as chronic diarrhea, stomach pains, and irregular bowel movements) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Marine Corps from May 1987 to May 1996. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision by the agency of original jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA), which denied reopening of a claim of service connection for irritable bowel syndrome (claimed as chronic diarrhea, stomach pains, and irregular bowel movements). The Board, in a September 2019 decision, in pertinent part denied entitlement to service connection for irritable bowel syndrome, to include as secondary to service-connected disabilities. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In a September 2020 Order, the Court granted a Joint Motion for Partial Remand (JMPR) and remanded the matters to the Board for action consistent with the motion. In March 2021, the Board remanded the matter of entitlement to service connection for digestive issues (claimed as chronic diarrhea, stomach pains, and irregular bowel movements) for further evidentiary development. The issue is again before the Board. A remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). Where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. As such, another remand is warranted. In its March 2021 remand, the Board directed that the AOJ obtain a VA examination and medical nexus opinion to determine whether the Veteran's claimed digestive issues are at least as likely as not caused or aggravated by active service, to include as due to service in the Southwest Asia theater of operations. The Board directed the VA examiner to also consider the Veteran's lay statements regarding his onset of symptoms in service and post-service symptoms and experiences, to include his statements that his chronic diarrhea and abdominal cramps began while in service. Pursuant to the Board's remand, a VA examination and medical opinion were obtained in August 2021. If VA provides an examination that examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In rendering the negative August 2021 nexus opinion, the VA examiner reasoned that there was an absence of documentary service treatment records for chronic or recurrent gastrointestinal symptoms, thus ignoring the Board's directives to consider the Veteran's lay statements regarding his onset of associated symptoms. The opinion is also internally inconsistent as the VA examiner further opined that the Veteran's digestive issues, gastroesophageal reflux disease (GERD), and Crohn's disease were not incurred in or caused by the irregular bowels or stomach pains during service. While the VA examiner opined that the Veteran's chronic gastritis is at least as likely as not due to acid reflux or GERD, no etiology opinion was rendered for the Veteran's acid reflux or GERD. The VA examiner also referenced that Crohn's disease is an inflammatory bowel disease, but did not indicate whether such is a functional or structural gastrointestinal disease. The VA examiner further provided a conclusory statement that there were no documented irritable bowel syndrome diagnosis or other functional gastrointestinal disorders and or another medically unexplained chronic multi-symptom illness, and in the extended recitation of medical literature and substantial inclusion of the Veteran's medical records, the VA examiner did not discuss how it applied to the Veteran or served as the bases for the medical opinion. Therefore, the opinion is inadequate, and another remand is warranted to obtain a VA medical opinion to determine the nature and etiology of the Veteran's claimed digestive issues. The matters are REMANDED for the following action: 1. Obtain a medical opinion from a gastroenterologist or otherwise qualified VA clinician to determine the nature and etiology of the claimed digestive issues (claimed as chronic diarrhea, stomach pains, and irregular bowel movements). The claims folder must be reviewed in conjunction with such. The examiner must identify any current digestive disorders, to include Crohn's disease, GERD, reflux esophagitis, and gastritis. For each diagnosed disability, the examiner must opine as to whether such is at least as likely as not (50 percent probability or greater) caused or aggravated by service, to include as due to service in the Southwest Asia theater of operations, and to include as due to any service-disability. If any symptoms or conditions are considered to be manifestations of a multi-symptom, undiagnosed illness related to service in Southwest Asia, such should be clearly stated. Competent lay statements regarding the disability must be addressed. A full and complete rationale is required for all opinions expressed. 2. Then, readjudicate the remanded issue. If the benefit sought remains denied, issue a supplemental statement of the case. The case should then be returned to the Board for appellate review if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G.A. Ong, 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.