Citation Nr: 21028638 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 13-33 650 DATE: May 11, 2021 REMANDED Entitlement to service connection for a gastrointestinal disability is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1977 to December 1979. This appeal comes to the Board of Veterans' Appeals (Board) from a rating decision dated September 2012 issued by a Department of Veterans Affairs (VA) Regional Office (RO). In its decision, the RO denied service connection for a digestive condition (also claimed as GI syndrome, diverticulitis, and inflammatory bowel disorder). The Veteran's appealed issue, among others, was before the Board in September 2017 and December 2018, when it was determined that remand was necessary to ensure that VA fulfilled its duty to assist the Veteran in substantiating his appeal. The Board's prior remand directives and the subsequent actions by the AOJ will be recounted below. The Veteran's appeal has been returned to the Board for further appellate consideration. Issues no longer in appellate status The Board's prior remands also included appealed issues to establish service connection for disabilities of the neck and low back. After the Board's most recent remand directives had been substantially completed, the AOJ established service connection for these disabilities in a June 2020 rating decision. Although the appeal period of this decision remains pending, the Veteran has not expressed disagreement with the assigned initial evaluation or effective date for these awards and thus, the issues are no longer in appellate status and will be discussed no further. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (where an appealed claim for service connection is granted during the pendency of the appeal, a second notice of disagreement must thereafter be timely filed to initiate appellate review of "downstream" issues such as the compensation level assigned for the disability or the effective date of service connection). 1. Entitlement to service connection for a gastrointestinal disability is remanded. Unfortunately, another remand is necessary because the Board's prior remand directives have not been substantially completed. Specifically, the record for review unambiguously reflects that the Veteran experienced a bout of gastroenteritis with gastrointestinal syndrome during active duty in April 1979, and episodes of diverticulitis and diverticulosis were diagnosed during the appeal period. Despite this evidence, the February 2020 VA examination report only reflects the in-service diagnosis. To the extent that the VA examiner alluded to the post-service diagnoses within the unfavorable opinion, such allusions are inconsistent with the VA examination report finding that only gastroenteritis with gastrointestinal syndrome is the only "stomach or duodenum" disability of record. This internal inconsistency renders the February 2020 VA examination and medical opinions inadequate, and thus, the Board's prior remand directives have not been substantially completed. As such, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998); see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). The matters are REMANDED for the following actions: 1. The AOJ must return the Veteran's complete electronic VA file to the VA clinician who completed the February 2020 VA examination, if available. After another review of the complete record, the VA examiner is asked to address the following: a. Identify all gastrointestinal disabilities present during and since the Veteran's active duty. *In addressing the above, the examiner must specifically confirm the prior diagnoses of gastroenteritis with gastrointestinal syndrome during active duty and episodes of diverticulitis and diverticulosis in 2011 and 2012 or state whether, citing bolstering evidence, such were rendered in error. *If any disability identified in part (a) is found to have resolved since the initial diagnosis, such should be stated, and the finding must be accompanied by supporting evidence. b. For any disability identified in part (a) which was active at any time from October 2011 to the present, provide an opinion addressing whether such is at least as likely as not proximately due to or the result of any incident of the Veteran's active duty, to specifically include the April 1979 diagnosis of gastroenteritis with gastrointestinal syndrome. *In addressing the above, the examiner is on notice that the Veteran is considered to be competent and credible to report symptoms which he experiences through his senses, so include gastrointestinal symptoms. As such, the requested opinion must take into account the Veteran's reports of experiencing gastrointestinal symptoms during and since service. His reports of such may not be discounted due to a lack of objective medical evidence showing complaints of or treatment for such symptoms. *If the clinician who conducted the February 2020 VA examination is unavailable, the AOJ must arrange for the Veteran's file to be transferred to another appropriate clinician for completion of the above. 2. Thereafter, the AOJ must readjudicate the Veteran's appeal in light of the totality of the evidence. If the benefit sought is not granted to the fullest extent, the Veteran and his representative must be provided a copy of the readjudication and afforded and appropriate period to respond. SCOTT W. DALE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Bristor 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.