Citation Nr: 21008345 Decision Date: 02/16/21 Archive Date: 02/16/21 DOCKET NO. 15-03 423 DATE: February 16, 2021 REMANDED Entitlement to service connection for a gastrointestinal disability (also claimed as a stomach disability) is remanded. Entitlement to total disability based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from August 1983 to March 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for a gastrointestinal disability (also claimed as a stomach disability) is remanded. 2. Entitlement to a TDIU is remanded. In June 2020, the Board remanded the issues on appeal for further development; there has not been substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Regarding service connection for the stomach/gastrointestinal disorder, the Board requested a new VA medical opinion be provided. Pursuant to this request, in August 2020, a VA medical doctor opined that “the diagnosed disability, is not at least as likely as not with an onset in service or are otherwise related to service.” Aside from the examination being administered by a general practitioner when a either a gastroenterologist or suitable specialist was requested, there are a few other discrepancies with this opinion, which makes it inadequate. First, in the opinion, the VA examiner indicates “the diagnosed disability” however, does not specifically identify a diagnosed disability. At best the examiner notates the Veteran’s in-service treatment for “stomach pains.” It remains unclear whether the Veteran has a current diagnosed disability; specifically, whether the Veteran’s previously diagnosed gastroesophageal reflux disease, acid peptic disease, irritable bowel syndrome, and ulcerative colitis are on-going or have resolved. As the June 2020 remand directed the examiner to ‘confirm any/all currently diagnosed gastrointestinal disabilities, including but not limited to, GERD, acid peptic disease, IBS, ulcerative colitis, and/or any other diagnosed stomach/gastrointestinal disability,’ the failure to do so renders the opinion inadequate. See Stegall. Next, the opinion and rationale appear to be based on an incomplete factual premise. The examiner indicates that the Veteran’s viral syndrome was ‘self-limited’ with no evidence of other gastrointestinal complaints while in service. This is inaccurate as service treatment records show treatment in March 1984 for complaints of nausea and vomiting, and she was diagnosed with viral syndrome. In April 1984, she was diagnosed with an upper respiratory infection with questionable gastroenteritis. In April 1985, she was diagnosed with acid peptic disease following complaints of epigastric burning distress, nausea with some relief of symptoms with Rolaids. In September 1985, she was diagnosed with gastritis following a complaint of vomiting. In February 1986, she complained of cramps, hot flashes, nausea and vomiting and the referring physician recommended treatment of the complaints as gastroenteritis (and pelvic inflammatory disease). Finally, the Board notes that at her May 2020 VA examination, the Veteran reported that she would undergo a colonoscopy soon. This was affirmed in VA treatment records, as an August 2020 gastrointestinal appointment shows she was to be scheduled for a colonoscopy along with an upper endoscopy. These records are not contained in the Veteran’s file. In sum, a remand is needed for another addendum opinion and to obtain updated VA treatment records. Regarding the entitlement to TDIU, the RO complied with the remand directives by mailing the Veteran a VA Form 21-8940 Veteran's Application for Increased Compensation Based on Unemployability. The Veteran has not submitted a completed application form, but as the appeal is remanded for other development, she now has another opportunity to do so. As the appeal for a TDIU remains inextricably intertwined with the appeal for entitlement to service connection for a gastrointestinal disability, it must be also remanded pending the development and readjudication of the service connection appeal. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Obtain VA treatment records from August 2020 to the present. 2. Forward the Veteran's claims file and a copy of this remand to a VA gastroenterologist or similarly suitable specialist, for an addendum opinion. If such specialist is not available, this should be clearly noted in the claims file by the RO. The examiner must review the claims file. An additional examination should be scheduled if, it is deemed necessary by the examiner. After a review of the claims file, the examiner must respond to the following: (a.) Confirm any/all currently diagnosed gastrointestinal disabilities, including but not limited to, GERD, acid peptic disease, IBS, ulcerative colitis, and/or any other diagnosed stomach/gastrointestinal disability. (b.) For each currently diagnosed disability, is it at least as likely as not (i.e., a 50 percent probability or greater) that the diagnosed disability had its onset in service or are otherwise related to service? Separate opinions should be provided for any/all currently diagnosed disabilities. A detailed rationale for each opinion must be provided. A simple conclusory statement will be deemed inadequate. The VA examiner is directed to consider the extensive in-service history of complaints and injuries, the post-service diagnostic history of the Veteran, as well as the diagnoses posed by previous VA examinations. In providing the requested opinions, consider the Veteran’s description of her in-service symptoms as well as her post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported symptoms in service and thereafter represented the onset of her current disability or disabilities, this should be noted. Stated another way, do the Veteran’s reports about her symptoms align with how the currently diagnosed disability or disabilities is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382 (2010). 3. After ensuring that the requested actions are completed, readjudicate the inextricably intertwined claim on appeal of entitlement to a TDIU. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Telamour, 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.