Citation Nr: 22018487
Decision Date: 03/29/22	Archive Date: 03/29/22

DOCKET NO. 17-49 794
DATE: March 29, 2022

REMANDED

Entitlement to service connection for ulcerative colitis, to include as secondary to service-connected posttraumatic stress disorder (PTSD) and chronic anxiety disorder, is remanded.

REASONS FOR REMAND

The Veteran served on active duty from August 1974 to August 1977.  

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

In October 2021, the Board remanded this matter for further development. That development having been completed, this matter has returned to the Board for further appellate review.

The Board remanded this matter to obtain a VA opinion addressing secondary service connection.  The November 2021 examiner provided a negative nexus opinion, finding there was no evidence of aggravation of the Veteran's ulcerative colitis beyond its natural course due to her service-connected PTSD and anxiety disorders, stating that, "Stress, anxiety, etc. may possibly cause occasional flares."  See November 2021 Medical Opinion Disability Benefits Questionnaire.

The United States Court of Appeals for Veterans Claims (Court) held in the case of Ward v. Wilkie, 31 Vet. App. 233 (2019), that aggravation pursuant to 38 C.F.R. § 3.310 does not require a permanent worsening of the condition.  Rather, the Court explained, "aggravation" is any incremental increase in disability attributable to the service-connected disability, i.e., any additional impairment of earning capacity that is above the degree of disability existing before the increase, regardless of its permanence.  Id. 

As the incorrect standard was applied, the Board finds that the November 2021 opinion is inadequate.  See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate).  Accordingly, a remand is required to obtain a new examination and opinion.  

Finally, as this matter is being remanded, the Veteran's updated VA treatment records should be obtained.  

The matters are REMANDED for the following action:

1. Make arrangements to obtain the Veteran's VA treatment records, from October 2021, forward.

2. Thereafter, schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of her ulcerative colitis.  The entire claims file must be reviewed by the examiner in conjunction with the opinion.  The examiner should confirm in the examination report that he or she has reviewed the folder in conjunction with the examination.  The examination should be performed in accordance with the appropriate Disability Benefits Questionnaire.

Following a review of the claims files, the VA examiner should opine as to whether it is at least as likely as not that the Veteran's ulcerative colitis (i) was caused (in whole or in part) or (ii) aggravated (any incremental increase in disability or any additional impairment of earning capacity regardless of its permanence) by her service-connected PTSD and anxiety disorder.  The examiner must provide separate opinions and rationales for secondary causation and secondary aggravation.

* The examiner should elicit as much information as possible from the Veteran regarding the onset and continuation of her ulcerative colitis symptoms as related to her PTSD and anxiety symptomatology.

A complete rationale for all opinions expressed must be set forth by the examiner.

 

 

P.M. DILORENZO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	S. M. Stedman, 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.