Citation Nr: 21041333 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 14-34 988A DATE: July 8, 2021 REMANDED Entitlement to service connection for irritable bowel syndrome (IBS) (claimed as chronic constipation), to include as secondary to service-connected chronic groin pain and medication is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from July 1985 to August 1985. This case comes before the Board of Veterans' Appeals (Board) on appeal of a February 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). When this case was last before the Board in March 2021, it was remanded for additional development. The case has now been returned to the Board for further appellate consideration. The Veteran was afforded a VA examination in April 2021. The VA examiner opined the Veteran's IBS was less likely than not due to the Veteran's military service because there are no medical records documenting IBS during his military service. The examiner also opined the Veteran's IBS was less likely caused by the Veteran's service-connected groin pain because the Veteran was not diagnosed with IBS until 2019; however, the Veteran was diagnosed with chronic constipation in 1999. The examiner did not address this diagnosis in his opinion. Additionally, the examiner states "the claimant has had chronic constipation that has been assessed to be due to the chronic opioid medications prescribed for chronic back pain and groin pain." No further opinion or rationale was provided. Additionally, the Board notes that a recent opinion was issued by the United States Court of Appeals for Veterans Claims (Court), which held that "for a veteran to be service connected on a secondary basis under a causation theory, the primary disability need not be service connected, or even diagnosed, at the time the secondary condition is incurred." Frost v. Shulkin, 29 Vet. App. 131 (2017). Additionally, a clarifying examination request was submitted, but cancelled because it was deemed unclear, after completion of the April 2021 VA examination. However, the Board finds a clarifying opinion is necessary based on the VA examiner's statement that the Veteran's chronic constipation is due to his chronic opioid medication and the Veteran's earlier diagnosis of chronic constipation. This matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's chronic constipation. Following a full review of the record, the clinician should address the following: (a.) Whether it is at least as likely as not that the Veteran's current chronic constipation is proximately due to his service-connected chronic groin pain. (b.) Whether it is at least as likely as not that the Veteran's current chronic constipation is aggravated, i.e., worsened beyond its natural progression by his service-connected chronic groin pain. (c.) Whether it is at least as likely as not that the Veteran's current chronic constipation is proximately due to his opioid medication required for his service-connected chronic groin pain. Any medication taken for the Veteran's non-service connected back pain shall be excluded from this opinion. (d.) Whether it is at least as likely as not that the Veteran's current chronic constipation is aggravated, i.e., worsened beyond its natural progression by his opioid medication required for his service-connected chronic groin pain. Any medication taken for the Veteran's non-service connected back pain shall be excluded from this opinion. Aggravation is defined as any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. The examiner is advised that a finding that the Veteran's chronic constipation was aggravated beyond the normal progression due to a service-connected disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from an already service-connected condition. A complete rationale should be provided for all opinions. The examiner shall consider the Veteran's chronic constipation was diagnosed in December 1999 and the Veteran has been on opioid medication since August 1998. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Townsend, 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.