Citation Nr: 21013266 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 17-11 461 -DATE: March 9, 2021 REMANDED Entitlement to service connection for gastrointestinal (GI) condition is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from February 1969 to June 1973. This matter comes before the Board of Veterans’ Appeals (“Board”) on appeal from July 2016 rating decision issued by the Department of Veterans Affairs (“VA”) Regional Office (“RO”). The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in November 2020. A transcript of the hearing is associated with the record. Entitlement to service connection for gastrointestinal (GI) condition is remanded. The RO previously listed the issue as “service connection for bilroth II due to peptic ulcer disease (claimed as diverticulitis, bacteria overflow into stomach following stomach surgery),” but the Board is recharacterizing it as seen above to allow for the most favorable review of the evidence and the claim. See Brokowsi v. Shinseki, 23 Vet. App. 79 (2009); Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran has already been granted service connection for post-traumatic stress disorder (“PTSD”) that has been recharacterized by RO as “post-traumatic stress disorder and secondary major depressive disorder with history of alcohol dependence-in full sustained remission,” which means alcohol dependence has been etiologically linked to the service-connected PTSD, and is considered service-connected for purposes of consideration of secondary service connection for any disabilities caused or aggravated by the past alcohol abuse. At the November 2020 Board hearing, the Veteran asserted that his gastrointestinal condition is related to his January 1976 stomach surgery, which he believes was a result of alcohol abuse that destroyed the lining of his stomach, hence a part of the stomach and eight inches of his small intestines were removed. The Veteran also stated that the doctor told him that his stomach lining was burned and that is why a part of his small intestine was removed. Several VA medical treatment records have notations that the Veteran underwent a stomach surgery in 1976, and one of the treatment records from September 2000 indicates that the 1976 gastric surgery was taken place in San Bernardino, CA. However, there is no actual treatment record of this surgery in the claims file to determine the causes that led to stomach problems and the surgery. Hence, a remand is warranted to obtain the actual record of the January 1976 gastric surgery. For ascertaining the nature and etiology of the Veteran’s gastrointestinal condition, a VA medical opinion was obtained in May 2016. The examiner noted that the Veteran has history of Bilroth II in 1976 for peptic ulcer, which has been confirmed by a March 2009 endoscopy showing remnant stomach. However, the examiner opined that it is less likely than not that the Veteran’s current abdominal pain is residual of his peptic ulcer disease or substance abuse but noted that there can be other causes of current stomach problems post Bilroth II, such as NSAID or chronic opioid use. Remand is also warranted to obtain opinion whether the Veteran’s current gastrointestinal problems have potential causal or aggravation relationship to medications that he takes for treatment of service-connected disabilities. The Board notes that recently in November 2020, a VA physician stated that the Veteran’s gastrointestinal disorders started in 1976 after Bilroth II surgery, presumably due to excess alcohol intake, which may have caused peptic ulcer disease vs. toxic injury to the gastric mucosa, and the Veteran subsequently suffered from multiple gastric abnormalities. The physician opined that the Veteran’s GI problems are greater than 50% related to his 1976 gastric surgery. Hence, a remand is also warranted for an opinion for ascertaining underlying causes that led to 1976 gastric surgery. The matter is REMANDED for the following actions: 1. Obtain any outstanding VA and private treatment records, specifically the 1976 gastric surgery records. Request the Veteran to clarify where did he undergo the 1976 surgery, and either provide those records or provide sufficient information and authorization for VA to try to obtain them on his behalf. If the 1976 gastric surgery was through VA facility, the RO should take all necessary steps to obtain the records. However, if through a non-VA facility, then RO should make at least two attempts to request and obtain the records, with the Veteran’s authorization. 2. Then obtain a supplemental opinion, preferably from someone specializing in gastrointestinal medicine for ascertaining the nature and etiology of the Veteran’s current gastrointestinal condition. Forward the claims file and copy of this remand to the examiner. Further in-person examination of the Veteran is left to the discretion of the clinician providing the opinion. If the clinician deems a new examination is necessary for providing opinion, then such an examination should be scheduled. 3. The examiner is advised to review the claims file including May 2016 and November 2020 VA opinions. Specifically, the November 2020 medical opinion linking the Veteran’s gastrointestinal problems with his 1976 gastric surgery. The examiner is also advised to consider the Veteran’s contentions regarding alcohol abuse, and to opine if the Veteran’s current gastrointestinal problems and his January 1976 gastric surgery are at least as likely as not caused or aggravated by his alcohol dependence, which has already been etiologically linked to the service-connected PTSD. The examiner should also provide opinion if the Veteran’s current gastrointestinal problems are at least as likely as not caused or aggravated by medications which the Veteran takes for treatment of service-connected disabilities. 4. A complete rationale for the opinions rendered must be provided. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 5. Thereafter, readjudicate the claim on appeal. If the benefit sought remains denied issue the Veteran and his representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning the matter to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Tariq, Nadeem, Associate Attorney 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.