Citation Nr: 22017206 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 17-31 891 DATE: March 24, 2022 REMANDED Service connection for gastrointestinal issues is remanded. REASONS FOR REMAND The Veteran had active-duty service from September 1967 to July 1970. This matter is before the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision by a Department of Veterans Affairs (VA) Regional office (RO). The claim was before the Board in September 2021. At that time, it was remanded for additional development. Service connection for gastrointestinal issues is remanded. Pursuant to the Board's September 2021 remand directive, the Veteran underwent a VA intestinal conditions examination in December 2021, where the examiner noted that the Veteran was diagnosed with irritable bowel syndrome, ulcerative colitis, and Crohn's disease. Additionally, in a separate stomach and duodenal conditions examination, the Veteran was diagnosed with gastro colic reflex. The examiner opined that it was less likely than not that the Veteran's current gastrointestinal problems were incurred in or caused by the Veteran's military service. The examiner reasoned "No chronic diagnosis is made for gastrointestinal issues located in the C-File. Objective exam is normal. Symptoms are subjective only. A Nexus has not been established. 2 STRs in the C-File with c/o vomiting and or diarrhea, separation exam is silent for GI complaints. No chronicity of care in the C-File. [Veteran] states he is currently diagnosed (2021) with gastro colic reflex." The examiner's opinion failed to comply with the Board's remand directive to the extent it failed to address the Veteran's competent and credible lay assertion that diarrhea started in service and continued after his separation. Stegall v. West, 11 Vet. App. 268, 271 (1998). Furthermore, when summarizing the medical history of the Veteran's current condition, the examiner noted that the onset of the Veteran's disorder was in 1968 due to the food and his issues with diarrhea during his service in the Republic of Vietnam. However, when providing the nexus opinion, she discounted the Veteran's report of vomiting and diarrhea in service without explaining why his symptoms during military service could not have caused the Veteran's current gastrointestinal problems. Additionally, the examiner's conclusion that the Veteran does not have chronic diagnosis related to gastrointestinal issues conflicts with the examination sheets, where she diagnosed the Veteran with irritable bowel syndrome, ulcerative colitis, Crohn's disease, and gastro colic reflex. For these reasons, the Board finds the December 2021 medical opinion inadequate, and remand to obtain another opinion is necessary before the claim can be adjudicated. The matters are REMANDED for the following action: Forward the claims file to an appropriate VA examiner to provide an opinion regarding the etiology of the Veteran's gastrointestinal issues. A new examination is not required unless deemed necessary. The examiner should review the claims file in its entirety and answer the following question: Is the ulcerative colitis, Crohn's disease, gastro colic reflex, and any other diagnosed gastrointestinal disease at least as likely as not etiologically related to the Veteran's military service, including the noted in-service symptomatology of vomiting and diarrhea? In providing the opinion, the VA examiner is to address the October 1967 and December 1969 service treatment records, the Veteran's competent and credible lay assertion that diarrhea started in service and has continued since service separation, and the fact that the July 1970 Report of Medical History and July 1970 Report of Medical Examination were negative for gastrointestinal issues. Additionally, in providing the requested opinion, consider the Veteran's description of his in-service symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? Sarone Solomon Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Imam, 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.