Citation Nr: 21031289 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 19-00 397A DATE: May 21, 2021 REMANDED Entitlement to a gastrointestinal disorder to include irritable bowel syndrome (IBS) is remanded. Entitlement to an earlier effective date than June 1, 2016 for entitlement to service connection for tinnitus is remanded. Entitlement to a disability rating exceeding 10 percent for tinnitus is remanded. Entitlement to an earlier effective date than June 1, 2016 for entitlement to service connection for PTSD is remanded. Entitlement to a disability rating exceeding 50 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1997 to August 1998. This appeal comes to the Board from April 2017, May 2017, and July 2017 rating decisions. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a January 2021 hearing. At the hearing, the Veteran indicated he has experienced ongoing gastrointestinal symptoms since his active duty military service. His service treatment records including entries from August 1998 show reports of vomiting and diarrhea. VA did not afford the Veteran an examination of his IBS claim, and the Veteran testified at the hearing that he is willing to report for one. VA should afford the Veteran a VA examination to determine whether the Veteran's current disabilities are at least as likely as not related to events during service. Regarding the Veteran's PTSD, tinnitus, and TDIU claims, VA associated additional relevant records from private treatment providers and the Social Security Administration with the Veteran's claims file. Neither the Agency of Original Jurisdiction (AOJ) nor VA examiners have considered this evidence in the first instance in the context of the Veteran's increased rating claims. The most recent VA examinations are two to four years old. VA should afford the Veteran a current examination of his PTSD. While the Veteran's rating of 10 percent for tinnitus is the maximum schedular rating, the undersigned VLJ indicated at the hearing VA may consider an extraschedular rating. Therefore, after reviewing the totality of the evidence, the AOJ should consider referring the claim to the Director of Compensation Service for extraschedular consideration. The AOJ should readjudicate the TDIU claim as it is intertwined with the other claims. The Board REMANDS for the following actions: 1. The AOJ should request that the Veteran identify outstanding relevant records. VA should make reasonable attempts to locate the records and add them to the file. 2. After adding relevant records to the file, the AOJ should afford the Veteran a VA examination of his PTSD to assess the severity of the condition. The examiner should consider all relevant evidence including private treatment records VA added to the file since the last examination. The most up-to-date Disability Benefits Questionnaire must be utilized. 3. After adding relevant records to the file, the AOJ should also afford the Veteran a VA examination of his claim for service connection for a gastrointestinal disability. The AOJ should provide the examiner with a complete copy of the claims file, to include this remand order. VA should ensure that the examiner addresses the following: (a.) The VA examiner should identify the Veteran's gastrointestinal disabilities, to include IBS, based on a review of the claims file and an examination of the Veteran if necessary. (b.) The VA examiner should opine whether it is at least as likely as not (50 percent or greater probability) each disability first manifested during or was otherwise caused by events during the Veteran's service. The examiner should provide an adequate rationale with reference to the relevant evidence. Such evidence includes the Veteran's statements indicating his current symptoms started during service. See also August 1998 entries in the Veterans service records (noting the Veteran sought treatment for vomiting and diarrhea). (c.) The VA examiner should also opine whether it is at least as likely as not that the Veteran's gastrointestinal disabilities were caused or aggravated by his service-connected disabilities, to include a psychiatric disorder. The aggravation does not have to be permanent. Temporary aggravation is sufficient for secondary service connection. See Ward v. Wilkie, 31 Vet. App. 233 (2019). 4. The AOJ should consider whether the totality of the evidence supports referring the Veteran's tinnitus claim to the Director of Compensation Service for extraschedular consideration. If referral is made, documentation corresponding to such referral must be added to the claims file. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Duffy, 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.