Citation Nr: 21027843 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 20-06 828 DATE: May 7, 2021 REMANDED Entitlement to service connection for bowel dysfunction, claimed as secondary to service-connected diabetes mellitus, type II, (DMII) and/or prostate cancer, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1961 to August 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in November 2015 by a Department of Veterans Affairs (VA) Regional Office. In September 2020 and December 2020, the Board remanded the case for additional development and it now returns for further appellate review. Entitlement to service connection for bowel dysfunction, claimed as secondary to service-connected DMII and/or prostate cancer. The Veteran initially contended that he has bowel dysfunction as a result of his service-connected DMII. In this regard, an August 2012 private treatment record reflected that his loose stools, fecal leakage, and incontinence are related to oral medications taken for DMII. Similarly, at an October 2015 VA examination, the Veteran reported that taking Metformin at a higher dose caused him diarrhea, which is a common side effect of the medication. However, the examiner found that he did not have chronic diarrhea or bowel incontinence; rather, he only experienced diarrhea as a side effect if he takes a higher dose of Metformin. Thereafter, in his February 2016 notice of disagreement, the Veteran asserted that his bowel dysfunction was related to his service-connected prostate cancer, to include treatment thereof. Additionally, in a May 2019 private treatment record, he reported that, while he had bowel dyscontrol before prostate surgery, he felt such had worsened since surgery. Ten days later, the Veteran presented with fecal urgency and associated incontinence, and his physician worried that such symptoms could be secondary to a motility problem, especially with findings of decreased rectal tone on examination. In a March 2021 statement, he again asserted that his bowel dysfunction is related to radiation treatment for his prostate cancer. At a February 2021 VA examination, the examiner diagnosed chronic diarrhea, and opined that such was less likely than not proximately due to or the result of the Veteran's service-connected DMII. In support of such opinion, he noted that, in June 2019, the Veteran reported fecal urgency with associated incontinence, but had multiple vascular medical comorbidities and there was a lack of an indication that such symptoms were due to his DMII. The examiner further found that, given the lack of evidence of uncontrolled diabetes, or other clinical data to support the progression of the Veteran's diabetes with developing such symptoms, it was less likely than not that his chronic diarrhea was related to his DMII. However, as the February 2021 VA examiner did not address whether the Veteran's bowel dysfunction is caused by any medications or treatment for his DMII, to include Metformin, or aggravated by his DMII, to include any medications or treatment for such disability, or caused or aggravated by his prostate cancer, to include any medications or treatment, such as radiation, for such disability, a remand is necessary to obtain an addendum opinion addressing such matters. Accordingly, the matter is REMANDED for the following action: Return the record, to include a copy of this Remand, to the February 2021 VA examiner, or another appropriate VA examiner if he is unavailable, to obtain an addendum opinion as to the etiology of the Veteran's bowel dysfunction. Following a review of the record, the examiner should address the following inquiries: (A) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's bowel dysfunction, diagnosed as chronic diarrhea, is caused or aggravated by his service-connected DMII, to include any medications, such as Metformin, or treatment for such disability? (B) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's bowel dysfunction, diagnosed as chronic diarrhea, is caused or aggravated by his service-connected prostate cancer, to include any medications or treatment, such as radiation therapy, for such disability? For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dawn A. Leung, 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.