Citation Nr: 21077187 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 17-45 283 DATE: December 28, 2021 REMANDED Entitlement to service connection for residuals of intestinal surgery, including abdominal adhesions and gall bladder removal, associated with duodenal ulcer disease is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for irritable bowel syndrome (IBS) is remanded. Entitlement to service connection for a disability of the anus and rectum. Entitlement to a rating in excess of 40 percent for duodenal ulcer disease is remanded. Entitlement to a compensable rating for residual scar from post-vagotomy and pyloroplasty is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1984 to January 1987 and from December 1990 to April 1991. In July 2021, a videoconference hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran's claims file. As an initial matter, it is noted that at the July 2021 hearing, the claims for IBS and GERD were characterized as first requiring new and material evidence to reopen before the underlying service connection issues could be addressed. However, upon further review of the claims file, it has been determined that new and material evidence is not needed. Therefore, the issues have been recharacterized accordingly. Notably, this is a favorable finding for the Veteran, and he is not prejudiced in this regard. Residuals of intestinal surgery, including abdominal adhesions and gall bladder removal, GERD, and IBS Review of the record shows that, while the service treatment records (STRs) from the Veteran's first period of service have been associated with the claims folder, there are no STRs from his second period of active duty. As such, the Veteran's complete STRs have not been obtained, but should be associated with the claims file if possible. In addition, it is noted that service connection for residuals of intestinal surgery and GERD were denied based upon negative VA nexus medical opinions. At the July 2021 Board hearing, the Veteran asserted that he had been told by private physicians that there was a relationship between his service-connected duodenal ulcer disease and the residuals of intestinal surgery, GERD, and IBS. In support of his claim, he subsequently submitted an opinion from his private physician supporting the contention that his GERD and abdominal adhesions are secondary to his service-connected disability. Where there is a wide diversity of medical opinion, an additional examination should be performed. Cousino v. Derwinski, 1 Vet. App. 536 (1991). Under these circumstances the matter must be remanded for additional development. A disability of the anus and rectum In a March 2014 rating decision, the Veteran was denied service connection for a disorder of the anus and rectum. The Veteran, in correspondence dated in August 2014, submitted a notice of disagreement to the denial. As noted below, a Statement of the Case (SOC) must be issued in response to this notice of disagreement. Manlincon v. West, 12 Vet. App. 238 (1999). Ratings for residual scar from post-vagotomy and pyloroplasty and duodenal ulcer disease During the hearing before the undersigned, the Veteran testified that his service-connected duodenal ulcer disease and scarring had worsened in severity since the most recent VA examination. Specifically, he testified to experiencing pain at the site of the scar as well as anemia due to the duodenal ulcer disease. As such, an additional VA examination is warranted. The Veteran also testified that he has been receiving regular treatment for his service-connected disabilities at the VA Medical Center in Jacksonville, Florida, including treatment in May 2021. These records have not been associated with the record, but may be of probative value. The matters are REMANDED for the following action: 1. Obtain the Veteran's complete STRs from his second period of service. 2. Obtain the Veteran's VA treatment records for the period from 2017 to the Present. 3. Send the Veteran and his representative a statement of the case that addresses the issue of service connect for a disability of the anus and rectum. If the Veteran perfects an appeal by submitting a timely VA Form 9, the issue should be returned to the Board for further appellate consideration. 4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's residuals of intestinal surgery, including abdominal adhesions and gall bladder removal, GERD, and IBS are at least as likely as not proximately due to a service-connected disability or aggravated beyond its natural progression by a service-connected disability. In addressing this question, the examiner should consider and discuss both the VA medical opinions and private medical opinion already of record. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected duodenal ulcer disease and service-connected scars. 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. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joseph P. Gervasio 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.