Citation Nr: 22012170 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 17-45 364 DATE: March 2, 2022 REMANDED Entitlement to a compensable rating for irritable bowel syndrome (IBS) 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 February 2002 to February 2005. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board videoconference hearing before the undersigned in October 2021. A transcript of that hearing is associated with the claims file. 1. Entitlement to a compensable rating for IBS. The Veteran asserts that she is entitled to a compensable rating for her service-connected IBS disability. See Notice of Disagreement Received January 2016. During the October 2021 Board hearing, the Veteran testified that she experienced severe abdominal pain on her left side that was unbearable. Additionally, the Veteran testified that she experiences a pulsating feeling and stabbing sharp pains whenever she is about to have a bowel movement. She testified that the pain that she experiences is unbearable and the intensity of the throbbing makes it difficult to do anything other than lay down. The Veteran stated that sometimes the pain is so bad that she has to go to the Emergency Room (ER). She also testified that she has always experienced the pain, but it has become more severe in the last couple of years. See Hearing Transcript Received October 2021. July 2021 treatment notes from an ER visit indicate that the Veteran experienced abdominal pain on the left side which had been ongoing for the past two weeks and radiated as a sharp pain to the right side occasionally and worsened when the Veteran sat or laid on her back. Additionally, there was a treatment note from the ER visit that stated that the worsening of abdominal cramping that the Veteran experienced was suspected to be related to IBS. See Medical Treatment records Received October 2021. The Board notes that the Veteran's last examination in connection with her IBS disability was in January 2018 and she has asserted that since that time her symptoms have worsened. Furthermore, as discussed above, the Veteran's most recent treatment records indicate that the worsening of symptoms experienced by the Veteran are suspected to be related to her IBS disability. VA's duty to assist includes providing a thorough and comprehensive medical examination. Robinette v. Brown, 8 Vet. App. 69 (1995). The Board notes that the mere passage of time does not require VA to provide a new medical examination. Palczewski v. Nicholson, 21 Vet. App. 174, 182 (2007). However, when available evidence is too old for an adequate evaluation of the Veteran's current condition, VA's duty to assist includes providing a new examination. Weggenmann v. Brown, 5 Vet. App. 281 (1993); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (a Veteran is entitled to a new examination after a two-year period between the last VA examination and the Veteran's contention that the pertinent disability had increased in severity). As there is an indication of worsening IBS symptoms since the last VA examination in January 2018, VA examination is warranted so that the current nature and severity of the Veteran's service-connected IBS disability may be determined. 2. Entitlement to TDIU. The Board notes that the Veteran asserts that her IBS disability renders her unemployable. A claim for TDIU, either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). During the October 2021 Board hearing, the Veteran testified that the severity of her symptoms associated with IBS interfere with her ability to obtain and maintain substantially gainful employment. The Veteran testified that she last worked in 2017 as a ration clerk on a military post where she ordered things and distributed them to the cook. Additionally, the Veteran testified that without medication the pain that she experiences in connection with her IBS is unbearable and even with medication, there are still times when her symptoms are so severe that she has to go to the Emergency Room. See Hearing Transcript Received October 2021. Given the severity of the IBS symptoms described by the Veteran, her IBS disability may interfere with her ability to obtain and maintain substantially gainful employment; however, additional development is necessary to determine the extent that the disability interferes with her ability to do so. The Veteran's claim for TDIU is inextricably intertwined with the issue of entitlement to a compensable rating for the service-connected IBS disability, as the adjudication of this issue may directly impact the Veteran's combined rating. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding issues are inextricably intertwined when a decision on one issue would have a significant impact on a veteran's claim for the second issue). The RO has not developed a claim of entitlement to a TDIU, therefore, a remand of the claim for TDIU is required. On remand, such development should be completed. The matters are REMANDED for the following action: 1. Adjudicate the Veteran's claim for entitlement to TDIU under the provisions of 38 C.F.R. § 4.16 and Rice v. Shinseki, 22 Vet. App. 447 (2009). Request the Veteran complete and submit a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability. 2. Obtain updated VA treatment records. 3. Forward the claims file to a qualified clinician to provide an opinion regarding the nature, severity, and progression of the Veteran's IBS disability during the entire appeal period (from April 7, 2015, to present) based on the evidence of record. In doing so, the examiner must address the Veteran's October 2021 hearing testimony in which she testified that she experiences a pulsating feeling and stabbing sharp pains whenever she is about to have a bowel movement as well as unbearable pain on her left side which manifests in intense throbbing and makes it difficult to do anything other than lay down. See Hearing Transcript Received October 2021. The examiner must also address the treatment records received on October 7, 2021, which chronicle the Veteran's July 15, 2021 Emergency Room (ER) visit and document that the Veteran had abdominal pain on the left side which had been ongoing for the past two weeks that radiated as a sharp pain to the right side occasionally and worsened when the Veteran sat or laid on her back and the note that the worsening abdominal cramping was suspected to be related to IBS. The examiner should opine on whether the records from the July 15, 2021, ER visit indicate that the Veteran's IBS symptoms worsened prior to this date and if so, provide a timeframe of when the worsening likely occurred based on medical expertise, evidence in the record, and the Veteran's lay statements and testimony. In providing the above opinion on the nature and severity of the Veteran's IBS disability, the examiner is reminded that the Veteran is competent to report continuous symptoms and competent to provide descriptions of the severity of the symptoms she experienced since she was granted service connection in April 2015, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports regarding current or past symptoms, the examiner must provide a reason for doing so. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dorsey-Kwansa, 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.