Citation Nr: 21011684 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 16-39 844 DATE: March 2, 2021 REMANDED Entitlement to service connection for a gastrointestinal disorder, including diverticulitis, colitis, diverticulosis is remanded. REASONS FOR REMAND The Veteran had active service from May 1987 to May 1994, including service in the Persian Gulf. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision of a Regional Office (RO) for Department of Veterans Affairs (VA). In April 2019, the Veteran testified at a Central Office Hearing before the undersigned Veterans’ Law Judge and a copy of the transcript has been associated with the claims file. The Board remanded the Veteran’s claim for an additional opinion in August 2019. On remand, the Veteran was provided with a January 2020 VA Gulf War medical examination. The VA examiner indicated that the Veteran’s conditions of benign neoplasm of the colon, diverticulosis, and disorder of the rectum and anus had a clear etiology and were therefore not an undiagnosed illness. The examiner did not, however, address the Veteran’s reports of diarrhea, cramping, stomach pain,   gas, and constipation that began during service and continuing after service as an undiagnosed illness under 38 C.F.R. § 3.317. As such, the Board finds a further opinion is necessary. Regarding a direct service connection opinion, the examiner found that it was less likely than not that the Veteran’s gastrointestinal conditions were related to service. The examiner noted there were no treatment records during service for benign neoplasms of the colon, diverticulosis, or a disorder of the rectus or anus and no treatment records for these conditions for approximately 9 years after service. However, the examiner failed to address the Veteran’s reports of diarrhea, cramping, gas, and constipation that the Veteran reported beginning in service and continued following service which he believes resulted in his diverticulosis and colon polyps. See hearing testimony at 6,10. As the examiner failed to address the Veteran’s reports of continual gastrointestinal issues following service and whether such symptoms are related to his current diagnoses the Board finds that this opinion is inadequate. The matters are REMANDED for the following action: 1. Associate with the claims folder any outstanding VA or private treatment records. 2. Allow the Veteran to identify any relevant, outstanding private treatment records and attempt to obtain any such records where the appropriate authorization is provided. 3. Obtain an addendum VA medical opinion to answer the following inquiry, the need for further examination is left to the discretion of the clinician.: In offering an opinion the examiner should accept as reliable the Veteran’s reports regarding his consistent experience of diarrhea, stomach pain, cramps, and gas   following service in the Persian Gulf during service and continuing following service in rendering any opinion, unless there is a stated medical reason not to do so. Therefore, the examiner must specifically acknowledge and consider this history in formulating an opinion as to whether any current gastrointestinal disorder is related to service or are the result of an undiagnosed illness. a) If the Veteran’s symptoms of diarrhea, stomach pain, cramping, gas, and constipation during service and continuing after his service were attributable to a known diagnosis or whether such symptoms were more than likely are an undiagnosed illness resulting from his service in the Persian Gulf. If the symptoms reported were due to an undiagnosed illness whether it is at least as likely as not that the current symptoms may also be due to such undiagnosed illness. b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s benign neoplasm of the colon, diverticulosis, or disorder of the rectum and anus were incurred in or are otherwise etiologically related to his active duty service, to include his 1987 and 1988 treatment for diarrhea, or to his reports of diarrhea, stomach pain, cramping, gas, and constipation following his service in the Persian Gulf and continuing following service until his diagnosis?   A discussion of the medical principles involved in the development of these conditions would be beneficial. The examiner must provide a complete rationale for any opinion expressed and should note that an opinion that fails to address the Veteran’s unrecorded history of symptoms will render the opinion report inadequate. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board John M. Middleton 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.