Citation Nr: 21014586 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 12-34 824 DATE: March 15, 2021 REMANDED Entitlement to service connection for a gastrointestinal disability, claimed as secondary to post-traumatic stress disorder (PTSD) and major depressive disorder, is remanded. REASONS FOR REMAND In May 2020, the Board of Veterans’ Appeals (Board) remanded the Veteran’s service connection claim for a gastrointestinal disability for an opinion addressing whether substance abuse issues potentially related to his service-connected psychiatric disability served as an intermediate step to the development of the claimed gastrointestinal disability. In November 2020, the Agency of Original Jurisdiction obtained the requested opinion. Unfortunately, the Board finds the November 2020 opinion is inadequate to make an informed decision on the Veteran’s claim. Initially, the Board notes the November 2020 VA examiner provided an opinion under the section of the disability benefits questionnaire that relates to “aggravation of a condition that existed prior to service”; therefore, the noted conclusion does not relate to the Board’s prior inquiry regarding secondary service connection. Further, the November 2020 VA examiner reported the Veteran is not currently diagnosed with a substance abuse condition and has no symptoms of substance abuse, citing 2019 treatment records that note his substance issues are in remission; however, VA treatment records associated with the claims file in December 2020 show the Veteran’s VA opioid treatment was recently stopped due to “aberrancy” at which time he requested a referral to an outside pain provider. This raises two issues: (1) the November 2020 VA examiner did not consider a full, accurate history and (2) there may be outstanding relevant private treatment records for the Veteran. Finally, the Court of Appeals of Veterans Claims has held the provisions of 38 C.F.R. § 3.310 do not establish a temporal element for secondary service connection; therefore, the Board finds the requested opinion must be provided, regardless of whether the Veteran’s substance abuse have resolved, due to the possibility that past substance abuse related to his now service-connected psychiatric disability caused or aggravated the claimed gastrointestinal disability. See Frost v. Shulkin, 29 Vet. App. 131 (2017). The matter is REMANDED for the following action: 1. Ask the Veteran to identify any potentially relevant outstanding private treatment records, to include, but not limited to, any pain management he may have received outside of the VA system. 2. Obtain a new opinion regarding the Veteran’s claim of service connection for a gastrointestinal disability, preferably from an examiner who has not previously examined the Veteran and/or provided an opinion regarding his claim. The determination as to whether an in-person examination of the Veteran is necessary should be left to the discretion of the medical professional providing the opinion. The selected examiner must provide an opinion addressing whether any present or past substance abuse in the Veteran’s case was at least as likely as not (50 percent probability or greater) caused or aggravated by his service-connected psychiatric disorder. If so, the examiner must further address whether this substance abuse at least as likely as not (50 percent probability or greater) caused or aggravated a gastrointestinal disability, as suggested by the Veteran’s August 2017 VA examiner. The opinion must address both causation and aggravation to be deemed adequate. The examiner is advised aggravation means an increase in the severity of the underlying disability beyond its natural progression. If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. A complete rationale must be provided to support any conclusion reached in the requested opinion. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. S. Kyle, 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.