Citation Nr: 21010908 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 15-39 978 DATE: February 26, 2021 REMANDED Entitlement to service connection for thrombocytopenia also claimed as idiopathic thrombocytopenic purpura (ITP) is remanded. Entitlement to service connection for removal of the spleen is remanded. Entitlement to service connection for Crohn’s disease, to include anemia, is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for headaches, to include migraines, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1989 to July 1991and from January 1993 to March 2000, to include service in Southwest Asia. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2018 the Veteran testified at a hearing before the undersigned. In June 2019, the Board rendered a decision on the Veteran’s appeal by reopening and then denying service connection for the issues indicated above. In July 2020, the United States Court of Appeals for Veterans Claims vacated the Board’s decision as to these issues and remanded them pursuant to a Joint Motion for Partial Remand, which found the prior VA examination reports did not provide adequate explanations as to whether the Veteran’s ITP and Crohn’s disease were part of a medically unexplained chronic multisymptom illness (MUCMI). The remaining issues are intertwined with the ITP and Crohn’s disease issues. Remand is required for an additional medical opinion. The matters are REMANDED for the following action: Forward the case to an examiner of the appropriate expertise. After review of the evidence of record, the examiner should opine as to whether the Veteran’s idiopathic thrombocytopenic purpura (ITP) and Crohn’s disease are at least as likely as not (50 percent probability or greater) medically unexplained chronic multisymptom illnesses due to the Veteran’s service in Southwest Asia. In answering this question, the examiner is asked to address the following: (a) Is the etiology of either condition inconclusive? For legal purposes, this discussion must take into consideration this Veteran’s unique symptoms. If the etiology is partially understood, this should be explained. (b) Is the pathophysiology of either condition inconclusive? For legal purposes, this discussion must take into consideration this Veteran’s unique symptoms. If the pathophysiology is partially understood, this should be explained. (c) The significance of the June 2014 VA examiner’s comment that the etiology of the Veteran’s multiple autoimmune syndromes is idiopathic, which appears to suggest they arose spontaneously or the cause is unknown. The examiner should also address whether the Veteran’s GERD and headaches are at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) the Veteran’s ITP and/or Crohn’s disease. A rationale for all opinions expressed is requested as adjudicators are precluded from making any medical findings. If actual examination(s), including with other specialists is required, the appropriate examination(s) should be ordered. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Havelka, 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.