Citation Nr: 21029448 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 15-06 359A DATE: May 13, 2021 REMANDED Entitlement to service connection for a stomach condition, to include irritable bowel syndrome (IBS) is remanded. REASONS FOR REMAND The Veteran served on active duty from November 2001 to May 2002, and from October 2003 to February 2004. He had additional service in the Army National Guard from July 2001 to December 2004. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a July 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO or AOJ). In February 2018, the Veteran testified before the undersigned Veterans Law Judge in a Video Conference Board Hearing. A transcript of that hearing is of record. The record reflects that you received a letter indicating that you could request a virtual tele-hearing instead of waiting for a travel board hearing. Upon further review, you do not have a pending hearing request. You provided testimony in a hearing with a Veterans Law Judge on February 2, 2018. I have considered the transcript of that hearing as evidence in making my decision. This case was previously before the Board in November 2019 when it was remanded for additional development. It has now returned to the Board for further appellate action. Unfortunately, the Board finds that further action in this appeal is warranted, even though such will, regrettably, further delay an appellate decision on this matter. A remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions, and imposes upon the VA a concomitant duty to ensure compliance with the terms of the remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). Here, the Veteran contends that he began experiencing IBS symptoms immediately after in-service vaccinations. See June 2011 statement. The Veteran was afforded a VA examination in December 2019 in which the examiner diagnosed IBS. However, the examiner stated that review of the records did not indicate chronic gastrointestinal conditions during active service. The examiner added that medical literature does not support causation of chronic gastrointestinal problems due to vaccines in service. For those reasons, the examiner opined that it is less likely than not there is a claimed gastrointestinal condition related to vaccines in service. Service treatment records document that the Veteran was seen for complaints of flu-like symptoms, with cramping and constant stomach pain, shortly after entering active service. See November 2003 service treatment record. As such, the December 2019 opinion is based upon an inaccurate factual basis. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). A new opinion is needed. The Veteran also submitted an article from the International Journal of Environmental Research and Public Health, which discusses a connection between pre-deployment vaccinations and IBS. The December 2019 VA opinion, was based, in part, on a finding that medical literature does not support causation of chronic gastrointestinal problems due to vaccines in service. On remand, the examiner should consider the treatise materials submitted by the Veteran. The matters are REMANDED for the following action: Schedule the Veteran for a new examination by an appropriate clinician to determine the nature and etiology of any stomach condition, to include IBS. After reviewing the claims file and examining the Veteran, the examiner should address the following: (a) Identify/diagnose any stomach condition, to include IBS existing at any time during the appeal period. (b) For each identified stomach condition, to include IBS, state whether it is at least as likely as not (50 percent or greater probability) that such disability had its onset in service or is/was otherwise etiologically related to service, to include the Veteran's in-service complaints of flu-like symptoms, with cramping and constant stomach pain. In this regard, the November 2003 service treatment record should be addressed. Additionally, the examiner should also discuss the article from the International Journal of Environmental Research and Public Health, submitted by the Veteran, which discusses a connection between pre-deployment vaccinations and IBS. A complete rationale for all opinions must be provided. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith, 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.