Citation Nr: 21024617 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 09-33 384 DATE: April 23, 2021 REMANDED Entitlement to service connection for a gastrointestinal disorder other than the Veteran’s service-connected gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1985 to December 1989, with periods of Reserve duty between December 1989 and October 1993. In February 2018 the Board denied the Veteran’s claim of entitlement to service connection for a gastrointestinal disability other than GERD and IBS, which the Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In November 2018, the Court issued an order that vacated the Board decision and remanded the claim for compliance with a Joint Motion for Partial Remand (JMPR). In the November 2018 JMPR, the parties agreed that the Veteran’s in-service treatment records for hernia from the Bethesda Naval Hospital (Walter Reed Medical Center) were outstanding and needed to be obtained. They noted that the Veteran was treated there for a hernia in August 1989 and he contended that his gastrointestinal disorder is related to the medications used to treat his hernia in service. To comply with the directives of the November 2018 JMPR, the Board, in May 2019, remanded the issue to obtain the outstanding service treatment records from the Bethesda Medical Center. Subsequently, in July 2019, records from the Bethesda Medical Center were obtained, which show that the Veteran underwent a left inguinal herniorrhaphy in August 1989. Afterwards, in March 2020, the Agency of Original Jurisdiction (AOJ) obtained an opinion regarding the etiology of the Veteran’s gastrointestinal disorder other than GERD and IBS. In the instructions, the AOJ instructed the examiner to opine as to whether the Veteran has a diagnosis of a gastrointestinal disorder other than IBS and GERD that at least as likely as not was incurred in or caused by the surgical repair of inguinal hernia during service. The AOJ explained that prior to the August 2014 VA examination, service treatment records were not in the file and have now been obtained. While the AOJ instructed the examiner to provide an opinion with particular attention to the service treatment records received in July 2019, which show inguinal hernia, the AOJ also asked the examiner to provide an opinion as directed by the Board’s March 2014 remand as to whether the Veteran’s current gastrointestinal disability is related to the Veteran’s hiatal hernia and medications used to treat the hernia. However, a December 2020 Board decision indicated that the March 2020 examiner did not address whether the Veteran’s current gastrointestinal disorder other than IBS and GERD is related to his inguinal hernia during service; thus the Board found that the VA opinion was inadequate and remanded the issue for another opinion. The Board instructed that, upon remand, a VA examiner should opine as to whether it was at least as likely as not that the Veteran’s gastrointestinal disorder, other than his service-connected GERD and IBS, to include colitis and Crohn’s disease, is etiologically related to his in-service treatment for inguinal hernia along with the medications used to treat inguinal hernia, specifically considering the service treatment records showing left inguinal hernia the left inguinal herniorrhaphy in August 1989. Entitlement to service connection for a gastrointestinal disorder other than the Veteran’s service-connected gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) is remanded. Following the December 2020 Board decision, the requested VA opinion was obtained in February 2021. However, the examiner’s opinion only addresses the cause of the left inguinal hernia; the examiner did not address whether the Veteran’s gastrointestinal disorder, other than his service-connected GERD and IBS, is etiologically related to his in-service treatment for inguinal hernia along with the medications used to treat inguinal hernia. Thus, the Board finds that another remand is necessary to ensure compliance with the Board’s December 2020 remand. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: Obtain a VA opinion regarding the etiology of the Veteran’s gastrointestinal disorder, other than his service-connected GERD and IBS, from an appropriate medical examiner. The examiner should be provided a copy of the claims file, to include all pertinent treatment records, and this remand. The examiner is asked to do the following: (Continued on the next page)   Opine whether it is at least as likely as not (50 percent probability or more) that the Veteran’s gastrointestinal disorder (other than his service-connected GERD and IBS), to include colitis and Crohn’s disease, is etiologically related to his in-service treatment for inguinal hernia along with the medications used to treat inguinal hernia. The examiner is asked to consider the service treatment records that show left inguinal hernia and that the Veteran underwent a left inguinal herniorrhaphy in August 1989. A full rationale should be provided for all stated medical opinions. If the examiner is not able to provide an opinion, he or she should explain why. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Hite, 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.