Citation Nr: 21072954 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 17-49 209 DATE: December 7, 2021 ORDER Entitlement to service connection for an intestinal/stomach condition, to include irritable bowel syndrome (IBS) and appendicitis residuals is denied. REMANDED Entitlement to an acquired psychiatric disorder, to include major depressive disorder is remanded. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had an intestinal/stomach condition at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for an intestinal/stomach condition due to service or service-connected disease or injury are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 2001 to January 2005 in the United States Navy. In January 2020, the Board remanded the claims for additional development. There has been substantial compliance with the remand in connection with claim decided here and the Board will proceed with adjudication. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection for a gastrointestinal/stomach condition, to include IBS and residuals of appendicitis. The Veteran contends that he has a stomach/intestinal condition, to include IBS and residuals of appendicitis that are etiologically related to active-duty service. Alternatively, he contends that the condition is caused or aggravated by his service-connected gastroesophageal reflux disease (GERD). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of any stomach or intestinal condition, to include IBS and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Furthermore, the Board concludes that the Veteran does not have any residuals of appendicitis apart from a scar due to his appendectomy. The February 2020 VA examiner evaluated the Veteran and determined that he did not experience any intestinal symptoms associated with his 2011 appendicitis procedure. While the examination was an intestinal surgery examination, the examiner offered additional opinions that made clear that the Veteran did not have a diagnosis of any stomach or intestinal disorder, to include IBS. Additionally, the examiner identified a single scar as the only residual from the Veteran's appendicitis related procedure. The examiner further opined that, despite being admitted and undergoing a procedure for acute appendicitis with an inflammatory mass in 2011, this condition was not related to viral gastroenteritis which resolved during service, or, secondary to GERD. The rationale against direct service connection focused on the acute nature of the in-service gastroenteritis compared to the specifics of how appendicitis develops. The rationale against secondary service connection explained that the systems/organs impacted by GERD and appendicitis are completely "anatomically and etiologically unrelated" and thus no causal or aggravating relationship exists between the two. Therefore, the sole residual of the Veteran's procedure, the scar, cannot be connected to service or service-connected GERD. While the Veteran believes he has a current diagnosis of an intestinal/stomach disorder, to include IBS and appendicitis residuals, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. REASONS FOR REMAND Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for an acquired psychiatric disorder because no VA examiner has opined whether the Veteran's major depressive disorder is secondary to his service-connected GERD. The Board notes that the previous remand text indicates that these opinions are necessary, however, the directives did not include corresponding requests. Therefore, further opinion is necessary. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's major depressive disorder is at least as likely as not related to proximately due to or aggravated beyond its natural progression by a service-connected disability. 2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.S. McLeod 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.