Citation Nr: 21076599 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 17-48 689 DATE: December 27, 2021 REMANDED Entitlement to service connection for a gastrointestinal disability, to include as due to an undiagnosed illness or exposure to environmental hazards, is remanded. Entitlement to an initial disability evaluation in excess of 30 percent for service-connected asthma is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from May 2003 until July 2007 and received an honorable discharge. This matter comes before the Board of Veterans' Appeals (BVA or Board) from a July 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This appeal was previously before the Board in July 2019 when it was remanded for further development regarding entitlement to service connection for the claimed gastrointestinal condition, hearing loss, and tinnitus and issuance of a supplemental statement of the case (SSOC) for the issue of entitlement to an increased rating for asthma. Service connection for hearing loss and tinnitus were granted in a July 2020 rating decision. The grant of service connection represents a full grant of the benefit sought regarding hearing loss and tinnitus. Thus, those issues are no longer before the Board. Turning to the issue of entitlement to service connection for a gastrointestinal condition, the Board finds there has not been substantial compliance with its prior remand instructions, and another remand is now required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Finally, although there has been substantial compliance with the Board's remand instructions regarding the Veteran's claim for increased rating for asthma, another remand is required for the reasons described below. 1. Entitlement to service connection for a gastrointestinal disability, to include as due to an undiagnosed illness or exposure to environmental hazards, is remanded. The Veteran seeks entitlement to service connection for a gastrointestinal disability. He asserts his symptoms are due to exposure to environmental hazards during service. The Board cannot make a fully informed decision on this issue because the VA medical opinions obtained in December 2019 are inadequate. The December 2019 opinion provider reached a negative nexus opinion. However, the opinion provider impermissibly relied upon an absence of formal diagnosis or documented treatment to support their opinion. The Board notes that the December 2017 VA examination indicated that the Veteran has functional impairment as a result of his symptoms; however, the examiner failed to offer any opinion regarding the etiology of the functional impairment. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Additionally, the clinician does not appear to have considered the Veteran's report of increased bowel movements and bloating approximately one year after separation from service that have continued since. A medical opinion that does not consider all evidence of record, including Veteran lay statements, is inadequate for adjudication. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Finally, the opinion provider stated that further evaluation is needed to determine if the Veteran has a GI condition and to determine what type of impairment he has but did not order any additional testing or evaluation. On remand, the agency of original jurisdiction must obtain a new VA medical etiology opinion that is sufficient for adjudication. 2. Entitlement to an initial disability evaluation in excess of 30 percent for service-connected asthma is remanded. In the October 2021 Informal Hearing Presentation (IHP), the Veteran's representative requested the Veteran be provided a contemporaneous medical examination to assess the current severity of his service-connected asthma. The Veteran was last provided with a VA examination in December 2017. Due to the length of time since the last examination and the Veteran's contention that his condition has worsened, the matter is remanded to provide the Veteran with a contemporaneous medical evaluation to assess the current severity of his service-connected asthma. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from July 2020 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected asthma. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 3. Schedule the Veteran for a VA Gulf War examination and opinion by an appropriate medical professional to determine the nature and etiology of any gastrointestinal disorder, including IBS. The examiner must review the claims file and note that review in the report. The medical examiner should answer the following: a) The examiner should specifically state whether the Veteran's reported symptoms (frequent bowel movements, diarrhea, nausea, etc.) are attributed to a known clinical diagnosis. If so, please specify each such diagnosis. b) For each diagnosed gastrointestinal disorder, please opine whether it is at least as likely as not (i.e., probability of 50 percent) that the diagnosed disorder manifested during service or is causally or etiologically due to service, to include exposure to environmental hazards while serving in the Gulf War. c) If the Veteran's symptoms have not been determined to be associated with a known clinical diagnosis, the examiner should indicate whether the Veteran has objective indications of a chronic disability resulting from a medically unexplained chronic multisymptom illness, as established by history, physical examination, and lab tests, that has either (1) existed for 6 months or more, or (2) exhibited intermittent episodes of improvement and worsening over a 6-month period. All provided opinions must be supported by complete rationale. The examiner is notified that the Veteran is competent to report symptoms he experiences or has experienced including onset date. A lack of diagnosis or documented medical treatment may not form the sole basis of a negative nexus opinion. L. ANDERSEN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. Collins, 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.