Citation Nr: 21021456 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 15-26 097 DATE: April 13, 2021 REMANDED Entitlement to service connection for a seizure disorder, claimed as residuals of a heat injury, is remanded. Entitlement to service connection for a gastrointestinal disorder, to include irritable bowel syndrome (IBS), abdominal hernias, residuals of surgery for a perforated colon, scar tissue of the colon, bladder problems and bowel problems, is remanded. REASONS FOR REMAND The Veteran had active duty for training (ACDUTRA) from January 1986 to July 1986 and July 7, 1990 to July 21, 1990, as well as active duty service from January 1991 to June 1991, with additional reserve service. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California. This case was previously before the Board in September 2017, at which time the issues currently on appeal were remanded for additional development. The case has now been returned to the Board for further appellate action. In April 2018, an informal Decision Review Officer (DRO) hearing was held at the RO. A transcript of the hearing is included in the claims file. In September 2017, the Board also remanded the issues of entitlement to service connection for an acquired psychiatric disorder and a bilateral knee disability. In a December 2020 rating decision, the agency of original jurisdiction (AOJ) granted service connection for an acquired psychiatric disorder, right and left knee strains, and right and left knee patellar subluxation. An initial rating was assigned for each of these disabilities. As this decision represents a full grant of the benefits sought with respect to this claim for service connection, such issue is no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). Service Connection The Board finds that additional development is required before the claims on appeal may be decided. Seizures The Veteran asserts that he has a seizure disorder, to include residuals of an in-service heat injury, that is related to his periods of service. At a December 2020 VA examination, the examiner noted that the Veteran was diagnosed with seizures in August 2004 and that continuous medication was required to control seizure activity. In a corresponding medical opinion, the examiner opined that the Veteran’s seizure disorder was not related to service. In support of this conclusion, the examiner reported that although the Veteran had a history of petit mal seizures that were controlled by medication, there were no witnesses to his seizures. In a separate opinion, the examiner opined that the Veteran’s seizures did not cause in-service heat stroke. The Board finds that the December 2020 VA examination report and medical opinions are inadequate to adjudicate the claim. In this regard, the Board is unable to interpret the opinions so as to adequately assess them. The examiner’s comments on seizures are not adequate to determine if the disorder is related to service as there was an insufficient rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Moreover, the examiner did not explain the significance of having a witness to the Veteran’s seizures when a seizure disorder had been diagnosed and did not address whether the Veteran has any other chronic residuals of a heat injury episode. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, the Board finds that new VA medical opinion is warranted to address the nature and etiology of his claimed seizure disorder. Gastrointestinal Disorder The Veteran asserts that he has a gastrointestinal disorder that is related to service to include a June 1988 motor vehicle accident, a July 1990 episode of heat stroke, and/or medication associated with a March 1991 dental surgery and subsequent infection. In December 2020, the Veteran was afforded a VA examination related to his gastrointestinal disorder. The examiner reported that the Veteran had a diagnosis of IBS that required continuous medication for treatment. In a corresponding medical opinion, the examiner opined that the Veteran’s gastrointestinal disorder was less likely than not related to service. In support of this conclusion, the examiner commented that the Veteran’s IBS began in 2004, several years following service discharge, and that it therefore was not related to active service. The examiner also provided a negative nexus opinion addressing secondary service connection as due to the medication from the Veteran’s dental surgery. In support of that conclusion, the examiner reported that the Veteran did not begin to experience loose stools until six months following the March 1991 dental surgery. The Board finds that it is unable to decide the claim based on the findings contained in the December 2020 VA medical opinion reports. In this regard, the examiner did not consider the Veteran’s reports that he has experienced continuous abdominal irregularities since service. See, e.g., Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination was inadequate where the examiner did not comment on a Veteran’s reports of in-service injury and instead relied on the absence of evidence in a Veteran’s service treatment records to provide a negative opinion). Moreover, the examiner did not explain the significance of the Veteran not having a diagnosis of IBS until several years following his separation from service, and or experiencing loose stools six months following his March 1991 dental procedure. As the opinions are not adequate, they cannot serve as the basis of a denial of entitlement to service connection. Therefore, the Board finds that a new VA medical opinions are warranted to address the nature and etiology of his claimed gastrointestinal disorder. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records from January 2021 to present. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran’s claimed seizure disorder, to include any chronic residuals of the July 1990 in-service heat injury episode. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present residuals of an in-service heat injury, to specifically include a seizure disorder, had its onset during his active service, or is otherwise etiologically related to such service. The examiner must consider the Veteran’s lay statements regarding the onset and continuity of his symptoms, to specifically include the Veteran’s contention that the onset of his seizures is related to a July 1990 in-service heat injury episode; a May 1994 episode of lightheadedness; and an April 1995 report that the Veteran experienced sensation he compared to his mind fading during periods of heat. The examiner should also determine whether the Veteran has any other chronic residuals of the head injury episode, and if so, should carefully identify those residuals. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 3. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran’s gastrointestinal disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to the following: (A) Is at least as likely as not (50 percent or better probability) that any currently present gastrointestinal disorder, to include IBS, abdominal hernias, residuals of surgery for a perforated colon, scar tissue of the colon, bladder problems and bowel problems, had its onset during his active service, or is otherwise etiologically related to such service? (B) ) If the date of onset of the Veteran’s gastrointestinal disorder is identified as being before the Veteran’s period of ACDUTRA from July 7, 1990 to July 21, 1990, or active duty from January 1991 to June 1991, offer an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s gastrointestinal disorder was aggravated (permanent increase in severity beyond normal progression) by the above-mentioned periods of ACDUTRA and active service. (C) Is at least as likely as not (50 percent or better probability) that the gastrointestinal disorder was caused OR aggravated by medication taken for the March 1991 dental surgery and subsequent infection? The examiner must consider the Veteran’s lay statements regarding the onset and continuity of his symptoms, to include his report that his gastrointestinal disorder is related to a June 1988 truck accident. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher O'Donnell, 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.