Citation Nr: 21074846 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 15-03 124 DATE: December 16, 2021 REMANDED Entitlement to service connection for a gastrointestinal disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1983 to April 1987, November 2001 to May 2002, November 2002 to December 2002, January 2002 to January 2003, June 2003 to September 2003, July 2007 to January 2008, and February 2008 to April 2009. He had additional service in the U.S. Air National Guard. This matter comes before the Board of Veterans' Appeals (Board) from a June 2013 rating decision. In May 2018, March 2020, and March 2021 the Board remanded the Veteran's claim for additional development and it now returns for further appellate review. The Board notes that, while the appellant's representative stated in a November 2021 brief that he did not have access to the Veteran's file and therefore could not submit an Informal Hearing Presentation. However, the Board notes there is no prejudice to the Veteran in proceeding with the issuance of this Remand as such access has been granted and, following the completion of the requested development, his representative will be given the opportunity to submit additional argument prior to the case's return to the Board. Entitlement to service connection for a gastrointestinal disorder. As noted in the previous remand, the Veteran underwent an October 2019 VA examination in which the examiner diagnosed the Veteran with intermittent small bowel obstruction but determined that the diagnosis is not etiologically related to service. In March 2020, the Board determined that this examination was inadequate because the examiner did not provide a rationale for discounting the Veteran's statements regarding the onset of symptoms in the 1980s and did not correctly consider the Veteran's National Guard service. As a result, the Board remanded for an additional VA examination. During a November 2020 VA examination, the examiner determined that the Veteran did not have a current objective diagnosis or history of an intestinal condition and indicated objective labs and diagnostic testing were needed to diagnose such a condition. However, the Board found this opinion to be inadequate, as it did not address the October 2019 diagnosis or the medical records in the claims file. Accordingly, a new addendum opinion was obtained in August 2021. However, the examiner failed to address the Veteran's statements regarding the onset of gastrointestinal symptomatology following illness during a deployment to Egypt in 1985. Rather, the examiner simply stated that there were no service treatment records showing a diagnosis of chronic irritable bowel syndrome. In this regard, in Dalton v. Nicholson, 21 Vet. App. 23 (2007), the U.S. Court of Appeals for Veterans Claims determined that an examination was inadequate where the examiner did not comment on a veteran's reports of in-service event and instead relied on the absence of evidence in his service treatment records to provide a negative opinion. Consequently, a remand is necessary in order to obtain an addendum opinion addressing the etiology of the Veteran's claimed gastrointestinal disorder that does not rely solely on the absence of a diagnosis in his STRs. Furthermore, the examiner failed to address other relevant in-service and post-service treatment records, as was specifically required by the March 2021 remand. Accordingly, the examiner selected to write the addendum opinion should comply with the prior remand instructions and reconcile any opinion with the enumerated treatment records listed again below. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following action: 1. Obtain an addendum opinion by an appropriate clinician to determine the nature and etiology of the Veteran's claimed gastrointestinal disorder. The record and a copy of this remand must be made available to, and reviewed by, this clinician. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following a review of the record, the clinician should be provided with the following questions and requested to address each in detail: (A) Identify all gastrointestinal disorders that have been present at any time since May 2011, even if such are asymptomatic or resolved. In this regard, the examiner should indicate whether the Veteran does, in fact, have a diagnosis during the period on appeal of irritable bowel syndrome. In offering such opinion, the examiner must consider the February and June 2021 private treatment records reflecting treatment for irritable bowel syndrome (B) For each diagnosed gastrointestinal disorder, to include intermittent small bowel obstruction, the examiner should state whether there is clear and unmistakable evidence that such disorder preexisted the Veteran's entry into active duty in May 1983. In offering such opinion, the examiner must consider medical treatment records from November 1990, September 1991, and January 1999 reflecting the Veteran's reports that he underwent surgery at age 2 for intestinal obstruction. (C) If there is clear and unmistakable evidence that any gastrointestinal disorder preexisted such period of service, the examiner is asked to opine whether there is clear and unmistakable evidence that the gastrointestinal disorder did NOT undergo an increase in the underlying pathology during service, i.e., was not aggravated during service. (D) If there was an increase in the severity of the Veteran's gastrointestinal disorder during service, the examiner should offer an opinion as to whether such increase was clearly and unmistakably due to the natural progress of the disease. (E) For any gastrointestinal disorder, to include irritable bowel syndrome, for which there is no clear and unmistakable evidence that such preexisted service, then the examiner is asked to opine whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such is directly related to active service or active duty training. Additionally, the examiner must specifically address the following, as was required in the prior remand instructions: the Veteran's statements that he initially began having stomach issues during a tour of duty to Egypt in June to December 1985, and he has had recurrent gastrointestinal symptoms since that time (see August 2013 and November 2019 Veteran Statements); July 1985 service treatment records indicating treatment for diarrhea during an active tour of duty; May 1991 service treatment records indicating stomach pain; September 1991 private medical records indicating gastroenteritis and early small bowel obstruction; February 1993 private medical records indicating partial bowel obstruction; November 1996 private medical records indicating adynamic ileus with possible bowel obstruction; July 1997 service treatment records indicating recurrent abdominal obstruction; and October 2019 VA examination determining the Veteran had a diagnosis of intermittent small bowel obstruction. A rationale for any opinion offered should be provided. 2. If upon completion of the above action the claim remains denied, the matter must be returned to the Board after compliance with appellate procedures. K. L. WALLIN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Breckenridge 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.