Citation Nr: 21006699 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 20-30 406 DATE: February 4, 2021 REMANDED Service connection for irritable bowel syndrome (IBS) is remanded. Service connection for gastroesophageal reflex disease (GERD) is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1964 to May 1966. The Veteran’s service treatment records (STRs) do not contain complaints of any gastrointestinal disorders, to include IBS and GERD. However, the Veteran does not assert that his IBS and GERD are related to his active duty service; instead he asserts that his IBS and GERD are secondary to his service-connected diabetes mellitus, type II. The Board notes that the Veteran has not been afforded a VA examination for his gastrointestinal conditions, to include both IBS and GERD. The Board also notes that the Veteran’s VA and private treatment records show that he has been diagnosed and his being followed for GERD. The Veteran’s post service medical records do not show a diagnosis for IBS; however, he has been found to be unable to tolerate diabetic medication due to diarrhea. See VA Treatment Record dated November 9, 2020. The VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4). Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or symptoms of disability, (2) establishes that the veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). Here, the Veteran has shown that he is diagnosed with GERD and has symptoms of IBS and he is indicated that the claimed disabilities may be associated with his service-connected diabetes mellitus, type II. The Veteran has not been afforded a VA examination to address the etiology of his claimed conditions. As such, the Board finds that the Veteran’s theory to secondary service connection has not been addressed and VA examinations must be scheduled for etiology opinions regarding both GERD and IBS. McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The Board also notes that the Veteran’s Form 9 appears to indicate that there are outstanding VA and private treatment records. The Board finds that the outstanding treatment records should be obtained to ensure due process and a complete record upon which to decide the claim. 38 U.S.C. § 5103; 38 C.F.R. § 3.159. The matters are REMANDED for the following action: 1. Contact the Veteran to identify any outstanding records of pertinent medical treatment from VA and/or private health care providers, specifically from Dr. Jim Elam from Mercy’s Smith-Glynn clinic and Dr. Thomas Davis from Marshfield VA Clinic. With the Veteran’s assistance obtain copies of any pertinent records and associate them with the claims file. See Form 9 dated September 22, 2020. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. 2. Schedule the Veteran for VA examinations to determine the etiology of any diagnosed gastrointestinal disabilities, to include GERD and IBS. The examiner should provide the following opinions: (a) Is it at least as likely as not (50 percent or greater probability) that GERD is proximately due to or caused by the service-connected diabetes mellitus, type II? Why or why not? (b) Is it at least as likely as not (50 percent or greater probability) that GERD has been aggravated (made worse) by the service-connected diabetes mellitus, type II? Why or why not? If aggravation is found, the examiner should identify a baseline level of severity of the GERD by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the GERD. If such cannot be done, it should be explained why. (c) If the Veteran is diagnosed with IBS, or another intestinal disorder; is it at least as likely as not (50 percent or greater probability) that such a disability is proximately due to or caused by the service-connected diabetes mellitus, type II? Why or why not? The Board notes that the Veteran has been found to be unable to tolerate metformin due to diarrhea. See VA Treatment Record dated November 9, 2020. (d) If the Veteran is diagnosed with IBS, or another intestinal disorder, is it at least as likely as not (50 percent or greater probability) that it has been aggravated (made worse) by the service-connected diabetes mellitus, type II? Why or why not? If aggravation is found, the examiner should identify a baseline level of severity of IBS or another intestinal disorder by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the gastrointestinal disability. If such cannot be done, it should be explained why. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Fu, 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.