Citation Nr: 21021125 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 19-01 825 DATE: April 9, 2021 REMANDED Service connection for a gastrointestinal disorder, to include irritable bowel syndrome (IBS), and rectal cancer is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from December 1990 to May 1991, including service in the Persian Gulf from January to April 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2018 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned Veterans Law Judge (VLJ) in March 2021. At the March 2021 hearing the Veteran expanded his claim and as such the Board has identified the issue as set forth above. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Gastrointestinal Disability The Veteran seeks service connection for a gastrointestinal disability. He asserts that his gastrointestinal disability is related to burn pit exposure while he served in Southwest Asia. He highlights that upon return from service in the Persian Gulf he had several lesions removed from his rectal area. He also reports having recurrent gastrointestinal symptoms, to specifically include diarrhea, since service. The Veteran also asserts that in light of his recurrent diarrhea and IBS symptoms since service, he maintains that his IBS played a role in his development of his rectal cancer. As such, the Board is required to consider theories of entitlement to benefits that are either raised by the claimant or reasonably raised by the record. Lynch v. Wilkie, 30 Vet. App. 296, 304 (2018). If the Board determines that a claimed condition was caused by an unclaimed condition, the Secretary must investigate service connection for the unclaimed condition if there is evidence suggesting that it may be associated with service. DeLisio v. Shinseki, 25 Vet. App. 45, 54 (2011). This is because pro se claimants may not have the medical or legal expertise to identify the precise disability for which they are seeking compensation, and VA has a duty to liberally construe their filings. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Here, the August 2018 VA examination shows that he has a history of rectal cancer, stage II with no active disease. Medical records do not contain any specific findings regarding IBS. In addition, the Veteran highlights that he has no family history of rectal cancer and that he has had recurrent diarrhea since service. In light of the foregoing, the Board finds that a remand is warranted for a new VA examination and medical opinion. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service e.g., gastrointestinal problems. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) for the Veteran’s gastrointestinal disability, to include IBS and rectal cancer. In responding to the inquiries below, the examiner must acknowledge and discuss, and assume as true, that the Veteran has no family history of rectal cancer and that he has had recurrent diarrhea since service. A diagnosis of IBS must be ruled in or excluded. For any disability found to be present, the VA examiner should opine whether it is least as likely as not that the disability had its onset in service, is related to service, or is related to exposure to toxins due to service in the Persian Gulf. Then, based on the results of the examination, the examiner is asked to address each of the following questions: (a) Do the Veteran’s a gastrointestinal disability resulting in functional impairment? (b) Please state whether the Veteran’s gastrointestinal disabilities are attributable to a known clinical diagnosis. If the Veteran does not now have, but previously had any such condition, when did that condition resolve? (c) If, after examining the Veteran and reviewing the claims file, you determine that the Veteran’s disability pattern is either (1) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (2) a disease with a clear and specific etiology and diagnosis, then please provide an opinion as to whether it is related to a presumed environmental exposure experienced by the Veteran during service in Southwest Asia? (d) Is it at least as likely as not that any gastrointestinal disorder had its onset directly during the Veteran’s service or is otherwise causally related to any event or circumstance of his service, including environmental exposures during service in Southwest Asia during the Persian Gulf War? (e) If not directly related to service on the basis of questions (b)-(d), is any gastrointestinal disorder proximately due to, the result of, or caused by any service-connected disabilities or medications related to service-connected disabilities? (f) If not caused by another medical condition, has any gastrointestinal disorder been aggravated by any service-connected disabilities or medications related to service-connected disabilities? In answering question (f), if the Veteran has IBS, please opine as to whether it is at least as likely as not that his IBS increased the likelihood that the Veteran developed rectal cancer. In answering all questions (a) to (f), please articulate the reasons underpinning your conclusions. That is, (1) identify what facts and information support your opinion, and (2) explain how that evidence justifies your opinion. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Ijitimehin, Kemi D. 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.