Citation Nr: 21014494 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 15-03 124 DATE: March 12, 2021 REMANDED Entitlement to service connection for a gastrointestinal disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1983 to April 1987, November 2001 to May 2002, November 2002 to December 2002, January 2002 to January 2003, June 2003 to September 2003, July 2007 to January 2008, and February 2008 to April 2009. He also served in the U.S. Air National Guard. The Veteran underwent an October 2019 VA examination in which the examiner diagnosed the Veteran with intermittent small bowel obstruction but determined that the diagnosis is not etiologically related to service. In March 2020, the Board determined that this examination is inadequate because the examiner did not provide a rationale for discounting the Veteran’s statements regarding the onset of symptoms in the 1980s and did not correctly consider the Veteran’s National Guard service. As a result, the Board remanded for an additional VA examination. During a November 2020 VA examination, the examiner determined that the Veteran did not have a current objective diagnosis or history of an intestinal condition and indicated objective labs and diagnostic testing was needed to diagnose such a condition. This opinion is also inadequate as it does not address the October 2019 diagnosis or the medical records in the claims file. The Board notes that, other than the diagnosis during the October 2019 VA examination, the claims file contains several medical records related to treatment for gastrointestinal issues, including: • July 1985 service treatment records indicating treatment for diarrhea; • May 1991 service treatment records indicating stomach pain; • September 1991 private medical records indicating gastroenteritis and early small bowel obstruction; • February 1993 private medical records indicating partial bowel obstruction; • November 1996 private medical records indicating adynamic ileus with possible bowel obstruction; and • July 1997 service treatment records indicating recurrent abdominal obstruction. The Veteran has also provided statements regarding the onset and continuation of gastrointestinal symptomology. See, e.g., August 2013 and November 2019 Veteran Statements. A remand is needed to obtain an additional VA examination with the appropriate objective testing to determine any current gastrointestinal diagnoses and whether any such diagnoses are etiologically related to service or aggravated by service. Additionally, the time periods in which the Veteran served periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) remain unclear. A remand is needed to obtain clarification as to the specific dates and character of the Veteran’s service, including his Military Master Pay Account (MMPA) with the Defense Finance and Accounting Service (DFAS) pay records. The matters are REMANDED for the following action: 1. Obtain VA treatment records since October 2020 and associate them with the claims file. 2. Verify the dates of the Veteran’s ACDUTRA, INACDUTRA and any other type of reserve service. Specifically, attempt to obtain the Veteran’s Master Military Pay Account (MMPA) from the Defense Finance and Accounting Service (DFAS). Record any attempts to obtain this information in the claims file. 3. Schedule the Veteran for an examination by an appropriate examiner for an opinion regarding the nature and etiology of any diagnosed gastrointestinal disorders. The examiner must complete any required objective diagnostic testing, including objective labs, needed to make these diagnoses. The examiner should answer the following questions: (a) Is it at least as likely as not (i.e., probability of 50 percent or greater) that any diagnosed gastrointestinal disorders are etiologically related to active duty service? (b) Is it at least as likely as not (i.e., probability of 50 percent or greater) that active duty service aggravated (caused a functional increase in the severity of) any diagnosed gastrointestinal disorder? In answering these questions, the examiner is requested to explain whether there is any medical reason to accept or reject the Veteran’s belief that his gastrointestinal symptoms began during service. The examiner must also address the following: • the Veteran’s statements that he initially began having stomach issues during a tour of duty to Egypt in June to December 1985, and he has had gastrointestinal symptoms on several occasions since that time (see August 2013 and November 2019 Veteran Statements); • July 1985 service treatment records indicating treatment for diarrhea; • May 1991 service treatment records indicating stomach pain; • September 1991 private medical records indicating gastroenteritis and early small bowel obstruction; • February 1993 private medical records indicating partial bowel obstruction; • November 1996 private medical records indicating adynamic ileus with possible bowel obstruction; • July 1997 service treatment records indicating recurrent abdominal obstruction; and • October 2019 VA examination determining the Veteran had a diagnosis of intermittent small bowel obstruction. (Continued on next page) A comprehensive rationale must be furnished for all opinions expressed. J. NICHOLS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Howell, 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.