Citation Nr: 21029327 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 16-42 959 DATE: May 13, 2021 REMANDED Entitlement to service connection for a gastrointestinal disability is remanded. REASONS FOR REMAND The Veteran honorably served in the United States Army from April 2003 to April 2006 and from February to October 2008, including two tours of combat duty in Iraq in support of Operation Iraqi Freedom. This matter appears before the Board of Veterans' Appeals (Board) on appeal of a May 2016 rating decision of the Regional Office (RO). In September 2019, the Veteran testified before the undersigned Veterans Law Judge via videoconference hearing from the RO in Nashville, Tennessee; a transcript is of record. In January 2020, the Board remanded the Veteran's claim of entitlement to the Agency of Original Jurisdiction (AOJ) to make additional attempts to receive service treatment records and VA treatment records. Additionally, the Board remanded the Veteran's claim for a VA examination discussing the nature and etiology of the Veteran's gastrointestinal diagnoses. VA associated additional records with the Veteran's claim. However, VA sent a November 2020 letter to the Veteran explaining that records from July 1, 2018 to October 1, 2018 cannot be located and all efforts were made to obtain the records. Further, VA determined that the service treatment records received may be incomplete and all efforts were made to obtain them. The letter asked the Veteran to provide any records he may have in his possession since they could be unlocated elsewhere. Additionally, the Veteran was afforded VA examinations in March 2020. He underwent examination for esophageal conditions, rectum and anus conditions, and intestinal conditions. During the esophageal conditions examination, the Veteran was diagnosed with gastroesophageal reflux disease (GERD). During the rectum and anus conditions examination, the Veteran was diagnosed with internal or external hemorrhoids and colon polyp. This examination also mentioned the Veteran's April 2016 colonoscopy showed diverticulosis. During the intestinal conditions examination, the Veteran was not diagnosed with an intestinal condition. The examiner opined that these conditions were less likely than not caused by the Veteran's reported exposures to burn pits while deployed to Iraq. The March 2020 examiner provided an addendum opinion in November 2020. The examiner specifically noted that GERD and hemorrhoids are diseases with a clear and specific etiology. However, the examiner noted that the Veteran's diverticulosis and benign polyp are a diagnosable multi-symptom illness (MUCMI) with a partially explained etiology. A multisymptom illness is a MUCMI where either the etiology or pathophysiology of the illness is inconclusive. Stewart v. Wilkie, 30 Vet. App. 383, 389-90 (2018). A multisymptom illness is not a MUCMI where both the etiology and the pathophysiology of the illness are partially understood. Id. The determination of whether a MUCMI is "medically unexplained," that is, the etiology and pathophysiology of the multisymptom illness, must be particular to the claimant's case. Id. at 291. The examiner made no opinion and did not address the pathophysiology of the Veteran's diverticulosis and benign polyp. Accordingly, on remand, a medical opinion must be obtained to discuss these matters. The matters are REMANDED for the following action: Obtain an addendum opinion, from the same clinician as the March 2020 VA examination and November 2020 addendum opinion if possible, to determine the nature and etiology of his diverticulosis and benign polyp. The examiner must review the entire claims file, including a copy of this remand. The examiner is asked to provide responses to the following: A) Is the etiology of the Veteran's diverticulosis and benign polyp (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran's specific case and cannot be based on the etiology of the disease or disability population as a whole. B) Is the pathophysiology of the Veteran's diverticulosis and benign polyp (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran's specific case and cannot be based on the pathophysiology of the disease or disability population as a whole. C) If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (a 50 percent or greater probability) that the Veteran's diverticulosis and benign polyp was incurred in, or is otherwise related to, his active service, including as due to exposure to burn pits in Iraq? (Continued on the next page) A complete rationale must be provided for all opinions expressed. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. N. Fournier, 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.