Citation Nr: 21028365 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 19-18 899 DATE: May 11, 2021 REMANDED Entitlement to service connection for a gastrointestinal disorder, to include irritable bowel syndrome (IBS) or an undiagnosed illness, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1987 to August 1994. The matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In an April 2020 decision, the Board denied the claim for service connection for a gastrointestinal disorder. Additionally, the Board remanded the claims for service connection for coronary artery disease (CAD), right ear hearing loss, headaches, and a skin disorder as well as a claim for entitlement to a total disability rating based on individual unemployability (TDIU) for further development. Subsequently, the Veteran appealed the denial of the claim for service connection for a gastrointestinal disorder to the United States Court of Appeals for Veterans Claims (Court). In January 2021, pursuant to the Joint Motion for Partial Remand (JMPR), the Court vacated the Board's April 2020 denial for service connection for a gastrointestinal disorder and remanded the matter for action consistent with the JMPR. Accordingly, the claim has been returned to the Board. Moreover, as noted above, the issues before the Board in April 2020 included entitlement to service connection for headaches, a skin disorder, as well as a TDIU. While on remand, the agency of original jurisdiction (AOJ) granted service connection for headaches and scalp folliculitis in a September 2020 rating decision. Additionally, the AOJ granted a TDIU, effective January 26, 2019. The Board notes that the evidence of record indicates that the Veteran's last date of employment was January 25, 2019. Accordingly, as these grants represent a full grant of the benefits sought on appeal with respect to these issues, the matters are no longer in appellate status, and will not be further addressed herein. Lastly, the Board notes that in response to a September 2020 supplemental statement of the case (SSOC), regarding the claims for service connection for CAD and right ear hearing loss, the Veteran opted into the Appeals Modernization Act (AMA) and withdrew his appeal for these two claims from the legacy appeals system by filing a Decision Review Request: Higher-Level Review in October 2020. Accordingly, these claims are now docketed under the AMA and are not before the Board at this time under the Legacy system. Service Connection for a Gastrointestinal Disorder The Veteran seeks service connection for a gastrointestinal disorder, to include IBS or an undiagnosed illness. Specifically, he reports that his symptoms began in 1993 and that he would be chronically constipated for days and then have long periods of daily diarrhea, and that it was a cycle that repeated. See January 2020 affidavit. The Veteran's service treatment records (STRs) indicate that the Veteran reported gastrointestinal issues in January 1994; he received IV fluid hydration for his diarrhea at that time. The Veteran's 2010 private treatment records note reports of abdominal pain, diarrhea, and constipation. An April 2010 colonoscopy revealed evidence of suspected colitis in the right colon. An August 2017 VA examiner opined that the Veteran did not have and has never been diagnosed with an intestinal condition. The examiner reasoned that Veteran's minimal bowel movement symptoms were consistent with that of the general population and not that of IBS, and that there were no other gastrointestinal disorders evidenced. During a March 2020 VA fibromyalgia examination, a VA examiner noted that the Veteran's irritable bowel symptoms were attributed to his service-connected fibromyalgia. The examiner also noted that the Veteran's symptoms were compatible with a diagnosis of IBS. The January 2021 JMPR determined that the Board failed to discuss the Veteran's reports of onset and severity of his gastrointestinal disorder as well as failed to provide to discussion as to whether the Veteran's symptoms warranted service connection under 38 C.F.R. § 3.317. Accordingly, based on the number of medical questions presented, remand for an adequate VA examination and medical opinion is necessary. The matter is REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, schedule the Veteran for an examination with an appropriate medical professional to determine the nature and etiology of the Veteran's gastrointestinal disorder. Following a review of the record, the examiner should provide responses as to the following: a) Please identify, by diagnosis, all disabilities manifesting in digestive issues during the appellate period (March 2017 to present). b) For each disability diagnosed, does such disability have an understood or partially understood etiology and/or pathophysiology? Please explain why. c) If the answer in (b) is yes, then is it at least as likely as not (a 50 percent or greater probability) that such disability was either incurred in or otherwise related to the Veteran's active service? d) Are any of the Veteran's symptoms (including but not limited to constipation, diarrhea, and stomach pain/cramping) attributable to IBS or another functional gastrointestinal disorder and/or another medically unexplained chronic multisymptom illness? e) Are any of the Veteran's symptoms and disability patterns objective indications of manifestations of a chronic undiagnosed illness? A complete rationale must be provided for all opinions expressed. If an opinion cannot be offered without resort to mere speculation, the examiner must indicate why this is the case and what additional evidence, if any, would allow for a more definitive opinion. Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Robinson, 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.