Citation Nr: 21031325 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 12-33 512 DATE: May 21, 2021 REMANDED Entitlement to service connection for ulcerative colitis (to include as secondary to PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty with the Army from June 1974 to June 1976. This matter comes before the Board of Veterans' Appeals (Board) on appeal from September 2010 and April 2012 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing in June 2015. A transcript of the proceeding has been associated with the claims file. The Veteran's claims were previously remanded by the Board in an April 2019 decision. The Board finds that the RO has substantially complied with the April 2019 Board remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The Board also notes that the Veteran has an appeal pending for service connection for chronic myelogenous leukemia. The Board will not address this claim in this decision. 1. Entitlement to service connection for ulcerative colitis (to include as secondary to PTSD) is remanded. The Veteran contends that his ulcerative colitis began in service as evidenced by reports of stomach issues in service and continuity of treatment. In the alternative, the Veteran contends that his service-connected PTSD has aggravated his stomach condition. In November 2018, the Veteran was afforded a VA examination for his ulcerative colitis. P.M., a nurse practitioner, opined that the Veteran's UC was less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner cited a single web article for the contention that the medical literature did not support a causal relationship between UC and PTSD. Further, the examiner did not provide an opinion on whether the Veteran's service-connected PTSD aggravated his UC beyond its natural progression. Thus, this opinion is inadequate. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (holding that when adjudicating a secondary service-connection issue, it is clear error for the Board to rely on an opinion that addressed only causation). Accordingly, a remand is required for an addendum opinion that addresses aggravation as well. Furthermore, there are conflicting opinions in the record. In August 2020, Z. Virk, M.D., the Veteran's treatment provider at a VA gastro clinic provided an opinion. Dr. Virk. opined that the Veteran's toxic gas exposure contributed to the Veteran's colitis. Dr. V. also opined that PTSD is closely related to colitis and the PTSD symptoms are contributed to his colitis condition. The Veteran has also submitted medical literature showing an associating between PTSD and stomach symptoms. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate medical professional regarding the etiology of the Veteran's ulcerative colitis and resolving the conflicting opinions of record. The examiner is directed to consider the record, the Veteran's lay statements, the August 2020 opinion of Dr. Virk, the medical literature submitted to the file, and any previous VA examinations. The examiner is asked to opine on the following: Is it at least as likely as not (50 percent or greater probability) that the Veteran's ulcerative colitis began in or was caused by the Veteran's active duty service? Is it at least as likely as not (50 percent or greater probability) that the Veteran's ulcerative colitis was caused by, related to, or is aggravated (any increase in severity, regardless of permanence) by his service-connected PTSD? All medical opinions should be supported by an adequate rationale and a discussion of all relevant facts in this case. If medical literature is relied upon in rendering this determination, the VA examiner should specifically cite each reference material utilized. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. Taylor, 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.