Citation Nr: 21021239 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 16-07 076 DATE: April 12, 2021 REMANDED Entitlement to service connection for a gastrointestinal disorder, to include irritable bowel syndrome (IBS), is remanded. Entitlement to service connection for sinusitis is remanded. REASONS FOR REMAND The Veteran had active service from November 1990 to January 1991, with prior Reserve service from August 1988 to February 1989. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an April 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the other matters appealed to the Board in the Veteran’s February 2016 substantive appeal have since been granted service connection in subsequent rating decisions, or denied service connection through a Board decision. As to the issue of entitlement to service connection for sleep apnea, the Veteran perfected an appeal to the Board in March 2018 and requested a Board video conference hearing, which has not yet been scheduled. Thus, this issue will be addressed in a subsequent Board decision, after the Veteran has been afforded the opportunity participate in his requested hearing. In addition, the Veteran testified at an October 2017 Board hearing before a different Veterans Law Judge. The transcript is associated with the claims file. The Veteran was provided an opportunity for another hearing in January 2021 because the VLJ who conducted the hearing in October 2017 is no longer at the Board. The Veteran was told that if the Board did not receive a response within 30 days from the date of the January 2021 letter, it would be assumed that he did not want another hearing. The Board did not receive a response from the Veteran or his representative; as such, this option is deemed waived. 1. Entitlement to service connection for a gastrointestinal disorder, to include irritable bowel syndrome. 2. Entitlement to service connection for sinusitis. The Board finds that the November 2020 addendum opinions regarding the Veteran’s gastrointestinal disorder and sinusitis were not fully responsive to the directives specified in the August 2020 Board remand. Stegall v. West, 11 Vet. App. 268 (1998). In this case, the prior January 2020 opinion regarding the Veteran’s gastrointestinal disorder was based on an inaccurate factual premise. The January 2020 opinion stated the Veteran’s symptoms such as rectal bleeding had an onset in 2001 and STRs are silent as to symptoms that could be related to IBS. However, STRs from December 1990 show complaints of rectal bleeding and abdominal pain during service. As such, the August 2020 Board remand directed the examiner to address and reconcile the records from December 1990 with the opinion provided. The Board finds that the examiner did not adequately follow the August 2020 remand directives. The October 2020 opinion merely states “STR dated 12/03/1990 diagnosis for the veteran was rectal bleed.” Merely mentioning the December 1990 STR as reported by the Veteran is not the same as discussion of his contentions. Additionally, the examiner did not address the report of abdominal pain in the same December 1990 record, nor reconcile the STR with the Veteran’s assertions that he has had gastrointestinal symptoms since service. Furthermore, the medical examiner cannot solely rely on the absence of medical records corroborating in-service symptoms to conclude that there is no relationship between the current disability and service. Moreover, the prior January 2020 opinion regarding the Veteran’s sinusitis stated the condition was acute and had resolved based on a May 2019 record. The August 2020 Board remand stated that this opinion was based on an inaccurate factual premise. The Board directed the examiner to address VA treatment records from February 2018 that describe the Veteran’s sinusitis as chronic and notes reports by the Veteran of sinus flare ups up to six times a year. In addition, the examiner was to clarify which May 2019 record was referenced, as it was not in the file. The October 2020 examiner did not address the February 2018 VA treatment records regarding chronicity, nor clarify which May 2019 was referenced. In addition, the opinion did not provide a cogent rationale for the conclusion reached. Such rationale should include supporting evidence specific to the facts, conditions, and circumstances of the case. As such, the Board finds that a new opinion should be provided on remand to address the deficiencies noted above and fulfill the prior remand directives. The matters are REMANDED for the following action: Forward the record and a copy of this remand to the examiner who completed the October 2020 VA gastrointestinal and sinus addendum opinions. If that examiner is unavailable, forward the case to a suitably qualified VA examiner for completion of addendum opinions. The entire record must be reviewed prior to offering an opinion. The appropriate examiner must opine as to: Whether it is at least as likely as not (50 percent probability or greater) that any gastrointestinal disability, and/or chronic sinusitis, found on examination or proximate to the appeal period, was incurred in or caused by service. The rationale must be provided for each opinion proffered, to include reference to any supporting medical literature. The examiner is reminded that the absence of in-service treatment is not fatal to a Veteran’s claim. The examiner must address the Veteran’s lay statements as to onset and symptoms. The examiner must reconcile his/her opinion with the Veteran’s service treatment records which reflect that he complained of bloody stools and abdominal pain in December 1990. The examiner must also address the February 2018 VA treatment records showing complaints of chronic sinusitis and reports of flare-ups up to six times a year. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ariasaif, Associate 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.