Citation Nr: 21010487 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 11-18 681 DATE: February 25, 2021 REMANDED Entitlement to service connection for a functional gastrointestinal disorder, to include due to an undiagnosed illness manifested by gastritis and heartburn is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1988 to May 1992. In November 2019, this matter was last before the Board, at which time it was remanded for further development. 1. Entitlement to service connection for a functional gastrointestinal disorder, to include due to an undiagnosed illness manifested by gastritis and heartburn is remanded. In November 2019, the Board remanded the matter to obtain an addendum to an August 2017 VA medical opinion. In February 2020 an opinion addressing the theory of direct service connection was obtained. In June 2020, another addendum was obtained to that opinion to address the question of medically unexplained chronic multisymptom illness (MUCMI). Unfortunately, the June 2020 opinion must be returned for clarification. Primarily at issue is whether, prior to 2007, the Veteran had a diagnosable gastrointestinal disorder attributable to service, or whether the Veteran had a MUCMI related to the various gastrointestinal issues he complained of during the appeal period. In the June 2020 addendum, the examiner concluded that the Veteran did not have a MUCMI but stated that the Veteran “may have had some non-ulcer dyspepsia” prior to 2007. Notably, functional dyspepsia is a functional gastrointestinal disorder characterized as a MUCMI. See 38 C.F.R. § 3.317(a)(2)(i)(3), Note. A medical opinion expressed in terms of may also implies may or may not and is too speculative to establish a plausible claim. Obert v. Brown, 5 Vet. App. at 30, 33 (1993); see also Davis v. West, 13 Vet. App. 178, 185 (1999); Bostain v. West, 11 Vet. App. 124, 127-28 (1998). Accordingly, the report is returned for clarification. 38 C.F.R. § 4.2. The matters are REMANDED for the following action: 1. Provide the claims file to the June 2020 VA examiner, or to another qualified medical professional if that individual is not available, in order to elicit an addendum opinion. The examiner is asked to provide an addendum opinion of the nature and etiology of the Veteran’s “non-ulcer dyspepsia” or any other gastrointestinal condition found to account for the Veteran’s gastrointestinal symptomatology for the period from late 1993 to 2007 (when the Veteran was first formally assessed as having GERD). The examiner must review the entire claims file, including a copy of this remand. The necessity of another physical examination is left to the discretion of the examiner. The examiner is asked to provide responses to the following: A) Is the etiology of the Veteran’s non-ulcer dyspepsia, or any other found gastrointestinal condition, (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran’s specific case and cannot be based on the etiology of the disease or disability population as a whole. B) Is the pathophysiology of the Veteran’s non-ulcer dyspepsia, or any other found gastrointestinal condition, (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran’s specific case and cannot be based on the pathophysiology of the disease or disability population as a whole. C) If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s non-ulcer dyspepsia, or any other found gastrointestinal condition, was incurred in, or is otherwise related to, his active service? A complete rationale must be provided for all opinions expressed. (Continued on the next page)   2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joseph R. Keselyak, 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.