Citation Nr: 21032824
Decision Date: 05/28/21	Archive Date: 05/28/21

DOCKET NO. 18-53 182
DATE: May 28, 2021

REMANDED

Entitlement to service connection for a gastrointestinal (GI) disability, claimed as irritable bowel syndrome, to include as secondary to the Veteran's service-connected hemorrhoids or coronary artery disease (CAD), is remanded.

REASONS FOR REMAND

The Veteran served on active duty from October 1962 to October 1964, January 1967 to December 1969, and October 1970 to September 1985.

This case comes before the Board of Veterans' Appeals (Board) on appeal of a May 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).

The Board notes that the Veteran has new representation. A valid VA Form 21-22 was submitted in March 2021. Additionally, the Board received a Privacy Act Request in March 2021.  On May 13, 2021, the Board sent a letter and a compact disc (CD) containing the Veteran's VA file to the Veteran's representative.

The Board remanded the claim in November 2020 to obtain a VA medical examination. The Veteran was afforded a VA examination in February 2021 to comply with November 2020 remand. The February 2021 VA examination was limited to secondary service connection due to the Veteran's service-connected hemorrhoids. However, the February 2021 examiner noted a diagnosis of irritable bowel syndrome (IBS). The prior October 2019 VA examiner did not find a diagnosis of IBS and only listed diverticulitis, chronic diarrhea, and mild proctitis. Due to the diagnosis of IBS in the February 2021 VA examination, a new examination is warranted to address direct service connection. 

In April 2021, the VA received additional argument Veteran's representative. The Veteran's representative contends that the Veteran's GI disability is secondary to his service-connected CAD. The Veteran has been service -connected for CAD since April 2017. The Board finds that the issue of entitlement to service connection for a GI disability secondary to the service-connected CAD has been raised by the evidence of record. Thus, a remand for a new VA examination to address secondary service-connection due to the Veteran's service-connected CAD is also warranted.

The matter is REMANDED for the following action:

1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), make efforts to obtain any outstanding VA and private treatment records to update the claims file.

2. Schedule the Veteran for a new VA medical examination to determine the nature, onset, and likely etiology of the claimed GI disabilities. The claims file must be made available to the examiner, including a copy of this remand and argument submitted by the Veteran or his representative, and the examiner shall indicate in the report that the claims file was reviewed. All necessary tests and studies must be performed. The examiner must address the following:

(a.) Document all GI diagnoses, including but not limited to irritable bowel syndrome, diverticulitis, chronic diarrhea, proctitis, rectal bleeding, gastroenteritis, and colitis.

(a.) Determine whether it is at least as likely as not (50 percent or greater probability) that any of the Veteran's diagnosed GI disabilities were incurred in or are otherwise attributable to the Veteran's active service.

(b.) Determine whether it is at least as likely as not (50 percent or greater probability) that any of the Veteran's diagnosed GI disabilities were caused or aggravated by the Veteran's service-connected hemorrhoids or coronary artery disease. The examiner must address both causation and aggravation in the examination.

All opinions offered must be accompanied by a clear rationale consistent with the evidence of record. The Board notes that causation and aggravation are independent concepts and should have separate findings and rationales. See Atencio v. O'Rourke, 30 Vet. App. 74 (2018).  

 

 

A. C. MACKENZIE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Hetman

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.