CYST OF BARTHOLIN'S GLAND

Summary

The Veteran, who served in the United States Navy from July 2017 to April 2024, appeals several claims. The Board dismissed the claim for service connection for a gynecological condition, including cyst of Bartholin's Gland with dysmenorrhea, as it was granted during the pendency of the appeal. The Veteran sought earlier effective dates for service connection for hemorrhoids, gastroesophageal reflux disease (GERD), and a closed fracture of the distal right ring (4th) finger, but these claims were denied as the assigned effective date of April 16, 2024, was the earliest possible under the law. The Veteran's claims for increased ratings for hemorrhoids and GERD were also denied, as she was already receiving the maximum schedular rating for hemorrhoids and her GERD symptoms did not meet the criteria for a higher rating under either current or prior diagnostic codes. Service connection for left leg shin splints, dysuria, and eustachian tube dysfunction was granted, as the Board found the Veteran's consistent lay statements regarding onset and symptoms, coupled with the presence of these conditions during service, were sufficient to establish service connection, despite the VA examiner's conclusion that the conditions resolved prior to separation. The claim for a gastrointestinal condition, including gastroenteritis and dyspepsia, was remanded due to a pre-decisional duty to assist error by the VA examiner, who failed to provide adequate rationale or discuss the Veteran's statements.

Rationale

Claim granted during pendency of appeal; No case or controversy for Board to adjudicate

Full Decision Text

Citation Nr: A25064408
Decision Date: 07/29/25	Archive Date: 07/29/25

DOCKET NO. 240927-478205
DATE: July 29, 2025

ORDER

Entitlement to service connection for a gynecological condition, including cyst of Bartholin's Gland with dysmenorrhea, is dismissed.

An effective date prior to April 16, 2024, for the grant of service connection for hemorrhoids is denied.

An effective date prior to April 16, 2024, for the grant of service connection for gastroesophageal reflux disease is denied.

An effective date prior to April 16, 2024, for the grant of service connection for the closed fracture of the distal right ring (4th) finger is denied.

An initial compensable disability rating for the closed fracture of the distal right ring (4th) finger is denied.

An initial disability rating in excess of 20 percent for hemorrhoids is denied.

An initial disability rating in excess of 10 percent for gastroesophageal reflux disease is denied.

Entitlement to service connection for left leg shin splints is granted.

Entitlement to service connection for dysuria is granted.

Entitlement to service connection for eustachian tube dysfunction is granted.

REMANDED

Entitlement to service connection for a gastrointestinal condition, including gastroenteritis and dyspepsia, is remanded.

FINDINGS OF FACT

1. During the pendency of the Veteran's appeal, the Agency of Original Jurisdiction (AOJ) granted service connection for a gynecological condition, including cyst of Bartholin's Gland with dysmenorrhea. 

2. The Veteran's date of separation from the United States Navy is April 15, 2024. 

3. The effective date for the Veteran's hemorrhoids, gastroesophageal reflux disease, and closed fracture of the distal right ring (4th) finger is the day after her separation from service. 

4. The Veteran is currently assigned the highest schedular ratings for her hemorrhoids and closed fracture of the distal right ring (4th) finger.

5. During the period on appeal, the Veteran's gastroesophageal reflux disease has been characterized by pyrosis, reflux, and regurgitation; there is no evidence of episodes of epigastric distress or esophageal stricture.

6. The Veteran's left leg shin splints are related to her active-duty service.

7. The Veteran's dysuria is related to her active-duty service.

8. The Veteran's eustachian tube dysfunction is related to her active-duty service.

CONCLUSIONS OF LAW

1. The criteria for the dismissal of a claim seeking entitlement to service connection for a gynecological condition, including cyst of Bartholin's Gland with dysmenorrhea, have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for an effective date prior to April 16, 2024, for the grant of service connection for hemorrhoids have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. §§ 3.400, 3.816, 3.2500.

3. The criteria for an effective date prior to April 16, 2024, for the grant of service connection for gastroesophageal reflux disease have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. §§ 3.400, 3.816, 3.2500.

4. The criteria for an effective date prior to April 16, 2024, for the grant of service connection for the closed fracture of the distal right ring (4th) finger have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. §§ 3.400, 3.816, 3.2500.

5. The criteria for an initial compensable disability rating for the closed fracture of the distal right ring (4th) finger have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.114, Diagnostic Code 5230.

6. The criteria for an initial disability rating in excess of 20 percent for hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.114, Diagnostic Code

7. The criteria for an initial disability rating in excess
 initial compensable disability rating for the closed fracture of the distal right ring (4th) finger have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.114, Diagnostic Code 5230.

6. The criteria for an initial disability rating in excess of 20 percent for hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.114, Diagnostic Code

7. The criteria for an initial disability rating in excess of 10 percent for gastroesophageal reflux disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.114, Diagnostic Codes 7206, 7399-7346.

8. The criteria for Entitlement to service connection for left leg shin splints have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303

9. The criteria for Entitlement to service connection for dysuria have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303

10. The criteria for Entitlement to service connection for eustachian tube dysfunction have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active-duty service from July 2017 to April 2024.

In the September 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the April and September 2024 agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding the service connection claim for a gastrointestinal condition, including gastroenteritis and dyspepsia any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Dismissal

The Board may dismiss any appeal which does not allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. The Board shall decide all questions pertaining to its jurisdictional authority to review a particular case. The Board may dismiss any case over which it determines it does not have jurisdiction. 38 C.F.R. § 20.104 (c).

1. Entitlement to service connection for a gynecological condition, including cyst of Bartholin's Gland with dysmenorrhea

In the Veteran's September 2024 VA Form 10182, the Veteran indicated she wished to appeal the AOJ's May 2024 decision with regard to service connection for gynecological condition(s).

In a September 26, 2024, rating decision, the Veteran's service connection claim for a gynecological condition was granted. Turning to the Veteran's 10182, it specifically says that she is seeking service connection for dysmenorrhea which was denied in May 2024. While the 10182 was submitted the day following the decision which granted service connection for a gynecological condition, it is presumed the Veteran was not aware that it had been granted. When an appealed claim for service connection is granted during the pendency of the appeal, the appeal ends. Grantham v. Brown, 114 F.3d 1156, 1158-59
 to service connection for gynecological condition(s).

In a September 26, 2024, rating decision, the Veteran's service connection claim for a gynecological condition was granted. Turning to the Veteran's 10182, it specifically says that she is seeking service connection for dysmenorrhea which was denied in May 2024. While the 10182 was submitted the day following the decision which granted service connection for a gynecological condition, it is presumed the Veteran was not aware that it had been granted. When an appealed claim for service connection is granted during the pendency of the appeal, the appeal ends. Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). There remains no case or controversy for the Board to adjudicate with regard to service connection for gynecological condition, including cyst of Bartholin's Gland with dysmenorrhea. Accordingly, the claim is dismissed. 38 U.S.C. § 7105 (d).

Effective Dates

Except as otherwise provided, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. The effective date upon receipt of new and material evidence after a final disallowance will be the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (q)(2). If a claim is filed within one year after separation from service, service connection will be effective as of the day after separation. 38 C.F.R. § 3.400 (b)(2).

A decision assigning an effective date for a service-connected disability becomes final when the decision is not appealed, and an appellant can only attempt to overcome finality of the decision by a request for revision based on clear and unmistakable error, or by a claim to reopen based upon new and material evidence. However, because the proper effective date for an award based on claim to reopen could be no earlier than the date on which that claim was received, only a request for revision based on clear and unmistakable error could result in the assignment of an earlier effective date. See Rudd v. Nicholson, 20 Vet. App. 296, 299 (2006).

1. An effective date prior to April 16, 2024, for the grant of service connection for hemorrhoids 

2. An effective date prior to April 16, 2024, for the grant of service connection for gastroesophageal reflux disease

3. An effective date prior to April 16, 2024, for the grant of service connection for the closed fracture of the distal right ring (4th) finger

The Veteran seeks earlier effective dates for the grants of service connection for hemorrhoids, gastroesophageal reflux disease (GERD), and the closed fracture of the distal right ring (4th) finger. After a review of the evidence of record, the Board concludes that earlier dates are not possible. 

As noted above, the assigned effective date of any claim sought within a year of separation will be the day after separation. The Veteran filed her claim in August 2023, prior to her separation from the United States Navy. The Veteran's date of separation is April 15, 2024. The claims were granted in April 2024, shortly after her separation, with the assigned effective dates for all three disorders in question, the date following her separation, April 16, 2024.

The Veteran has provided no argument as to why earlier effective dates should be assigned. However, there is no possible date earlier than the one assigned under the law. 

Thus, earlier effective dates for the grants of service connection for hemorrhoids, gastroesophageal reflux disease (GERD), and the closed fracture of the distal right ring (4th) finger cannot be granted. The Veteran's claims are denied. 

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Increased Ratings

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R., Part 4. The ratings are intended to compensate impairment in earning capacity due to a service-connected disease or injury. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the
 the distal right ring (4th) finger cannot be granted. The Veteran's claims are denied. 

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Increased Ratings

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R., Part 4. The ratings are intended to compensate impairment in earning capacity due to a service-connected disease or injury. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of a veteran. 38 C.F.R. § 4.3.

In cases where rating criteria are amended during the course of the appeal, the Board must consider both the former and current schedular criteria. Should an increased rating be warranted under new, revised criteria, the award may not be made effective before the effective date of change. See Kuzma v. Principi, 341 F.3d 1327, 1328 (Fed. Cir. 2003).

4. An initial compensable disability rating for the closed fracture of the distal right ring (4th) finger

5. An initial disability rating in excess of 20 percent for hemorrhoids

6. An initial disability rating in excess of 10 percent for gastroesophageal reflux disease

The Veteran generally asserts that higher ratings should be assigned for her hemorrhoids, gastroesophageal reflux disease (GERD), and the closed fracture of the distal right ring (4th) finger. After a review of the evidence of record the Board finds that the claims should be denied as the Veteran receives the highest ratings possible for her right 4th finger and hemorrhoids, and her GERD is not manifested by symptoms which would necessitate a higher rating under the schedular criteria. 

Right 4th Finger

The Veteran's right finger is assigned a noncompensable rating under Diagnostic Code (DC) 5230. Under DC 5230, the maximum rating is noncompensable. 38 C.F.R. § 4.71a. While there are higher ratings available for disabilities involving the other digits of the hand, the Veteran's right finger disability cannot be rated higher.

Considering the evidence above, the Board concludes that a higher rating for the Veteran's right finger is not possible, and her claim is denied.

Hemorrhoids

The Veteran's hemorrhoids are rated under DC 7336, a noncompensable evaluation is assigned for mild or moderate hemorrhoids; a 10 percent rating is assigned for large or thrombotic, irreducible hemorrhoids with excessive redundant tissue evidencing frequent recurrences; and a 20 percent evaluation is assigned for hemorrhoids with persistent bleeding and with secondary anemia or with fissures. The maximum disability evaluation permitted for hemorrhoids is 20 percent. 38 C.F.R. § 4.114, Diagnostic Code 7336.

As noted, a 20 percent evaluation is currently in effect for the Veteran's service-connected hemorrhoids throughout the pendency of the appeal. The Board concludes that a higher rating for the Veteran's hemorrhoids is not possible, and her claim is denied.

Gastroesophageal Reflux Disease (GERD)

The Veteran's GERD is currently assigned a 10 percent rating under DC 7399-7346. Notably, during the appeal period, the diagnostic code for GERD changed to 7206. As such the Board will also be consiering the claim with the newer diagnostic code.

Under the pre-May 19, 2024, criteria, GERD is to be rated by analogy to Diagnostic Code 7346, for hiatal hernia. Under that Diagnostic Code, a 10 percent rating is assigned for two or more of the symptoms for a 30 percent evaluation of less severity. A 30 percent rating is assigned for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 60 percent rating is assigned for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health.

For reference, "considerable" is defined as "large in extent or degree." Merriam-Webster's Collegiate Dictionary 267 (11th ed. 2012). "Severe" is defined as "very painful or harmful." Id. at 1140.


 evaluation of less severity. A 30 percent rating is assigned for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 60 percent rating is assigned for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health.

For reference, "considerable" is defined as "large in extent or degree." Merriam-Webster's Collegiate Dictionary 267 (11th ed. 2012). "Severe" is defined as "very painful or harmful." Id. at 1140.

The May 19, 2024, amendments added Diagnostic Code 7206 for rating GERD. Under Diagnostic Code 7206, a 10 percent rating is assigned for documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic. A 30 percent rating is assigned for documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilation no more than two times per year. A 50 percent rating is assigned for documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following: (1) dilation three or more times per year, (2) dilation using steroids at least one time per year, or (3) esophageal stent placement. Finally, an 80 percent rating is assigned for documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the following symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by 38 C.F.R. § 4.112 (a) and treatment with either surgical correction of esophageal stricture(s) or percutaneous esophago-gastrointestinal tube (PEG tube).

Under Note (4) to Diagnostic Code 7206, recurrent esophageal stricture is defined as the inability to maintain target esophageal diameter beyond four weeks after the target diameter has been achieved. Note (5) defines refractory esophageal stricture as the inability to achieve target esophageal diameter despite receiving no fewer than five dilation sessions performed at two-week intervals.

Under 38 C.F.R. § 4.112 (a), substantial weight loss means involuntary loss greater than 20 percent of an individual's baseline weight sustained for three months with diminished quality of self-care or work tasks. Baseline weight is defined as the clinically documented average weight for the two-year period preceding the onset of illness or, if relevant, the weight recorded at the veteran's most recent discharge physical. 38 C.F.R. § 4.112 (b). If neither of these weights is available or currently relevant, then VA is to use ideal body weight as defined by either the Hamwi formula or Body Mass Index (BMI) tables, whichever is most favorable to the veteran. Id. 

Undernutrition is defined as a deficiency resulting from insufficient intake of one or multiple essential nutrients, or the inability of the body to absorb, utilize, or retain such nutrients. 38 C.F.R. § 4.112 (c). Undernutrition is characterized by failure of the body to maintain normal organ functions and healthy tissues. Signs and symptoms may include loss of subcutaneous tissue, edema, peripheral neuropathy, muscle wasting, weakness, abdominal distention, ascites, and BMI below normal range. Id. 

The Veteran did not make any specific arguments as to why an increased rating is warranted.

The Veteran was afforded a VA examination for GERD in September 2023. The Veteran had symptoms of pyrosis, reflux, and regurgitation. The Veteran did not have dysphagia, esophageal strictures, sleep disturbance, nausea, vomiting, hematemesis, or melena. The VA examiner did not indicate that the Veteran had any episodes of epigastric distress, or that her symptoms were productive of considerable or severe impairment of health.

After considering the relevant evidence, the Board finds that a rating in excess of 10 percent is not warranted for the Veteran's GERD. First, under the pre-May 19, 2024, rating criteria, a higher rating is not warranted because the Veteran did not exhibit symptoms consistent with a 30 percent or 60 percent rating. The September 2024 examination and medical records do not show that the Veteran's symptoms were indicated as being productive of considerable impairment of health. Thus, a 30 percent rating is not warranted. Additionally, a 60 percent rating is not warranted because the evidence fails to show vomiting, material weight loss, hematemesis, melena with moderate anemia
 were productive of considerable or severe impairment of health.

After considering the relevant evidence, the Board finds that a rating in excess of 10 percent is not warranted for the Veteran's GERD. First, under the pre-May 19, 2024, rating criteria, a higher rating is not warranted because the Veteran did not exhibit symptoms consistent with a 30 percent or 60 percent rating. The September 2024 examination and medical records do not show that the Veteran's symptoms were indicated as being productive of considerable impairment of health. Thus, a 30 percent rating is not warranted. Additionally, a 60 percent rating is not warranted because the evidence fails to show vomiting, material weight loss, hematemesis, melena with moderate anemia, or any other symptom combinations productive of severe impairment of health.

Additionally, a higher rating is not warranted under the amended rating criteria. Under Diagnostic Code 7206, a rating higher than 10 percent for GERD requires a documented history of esophageal stricture which is not evident from the record in this case. 

Accordingly, the most probative evidence of record persuasively weighs against the claim of entitlement to a higher rating for GERD. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt rule does not apply and a higher rating for GERD is not warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4 th 776 (Fed. Cir. 2021). The Veteran's claim is denied. 

Service Connection

The law provides that service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d).

Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999).

7. Entitlement to service connection for left leg shin splints

8. Entitlement to service connection for dysuria

9. Entitlement to service connection for eustachian tube dysfunction

The Veteran seeks service connection for left leg shin splints, dysuria, and eustachian tube dysfunction, which she argues began during service and have persisted since. After a review of the evidence of record, the Board concludes that the claims should be granted.

As an initial matter, the Board notes that the Veteran's service treatment records document treatment and diagnoses for each of the claimed disorders. The Veteran sought service connection prior to her separation and has maintained that the disorders are still present and symptomatic.  

VA examinations were obtained in September 2023 (for shin splints and eustachian tube dysfunction) and January 2024 (for dysuria). It is important to note that the January 2024 examination was completed without an in-person evaluation. In each of the examinations, the conclusion reached was that the in-service occurrences of the claimed disorders resolved prior to the Veteran's separation. However, none of the examiners discussed the Veteran's lay statements in their opinions. Therefore, the Board finds them to be inadequate and lacking probative weight. 

While there is little clinical evidence of record, the Veteran has provided consistent statements regarding the onset of her claimed disorders and the Board has found her to be both competent and credible as the symptoms come to her through her own senses or via a medical professional. Additionally, her left leg shin splints, dysuria, and eustachian tube dysfunction were all present during service. Considering the above evidence, the Board concludes that service connection for left leg shin splints, dysuria, and eustachian tube dysfunction is warranted. The Veteran's claims are granted.

REASONS FOR REMAND

1. Entitlement to service connection for a gastrointestinal condition, including gastroenteritis and dyspepsia, is remanded.

The Veteran also seeks service connection for a gastrointestinal condition, including gastroenteritis and dyspepsia. After a review of the evidence of record, the Board concludes that the claim must be remanded to correct a pre-decisional duty to
 via a medical professional. Additionally, her left leg shin splints, dysuria, and eustachian tube dysfunction were all present during service. Considering the above evidence, the Board concludes that service connection for left leg shin splints, dysuria, and eustachian tube dysfunction is warranted. The Veteran's claims are granted.

REASONS FOR REMAND

1. Entitlement to service connection for a gastrointestinal condition, including gastroenteritis and dyspepsia, is remanded.

The Veteran also seeks service connection for a gastrointestinal condition, including gastroenteritis and dyspepsia. After a review of the evidence of record, the Board concludes that the claim must be remanded to correct a pre-decisional duty to assist error. 

At issue is the opinion provided by the January 2024 examiner. The examiner found that the Veteran did not have a diagnosis of gastroenteritis, however, they failed to provide a rationale for the conclusion reached and there is no evidence that they reviewed the Veteran's statements or attempted to contact her for an interview. As such, the opinion is inadequate. The failure of the AOJ to obtain an adequate opinion is a pre-decisional duty to assist error. 

The matters are REMANDED for the following action:

1. Schedule the Veteran for new examinations, with an appropriate clinician, other than the January 2024 examiner, to determine the nature, extent, onset, and etiology of her claimed gastrointestinal condition, including gastroenteritis and dyspepsia. 

The complete claims file should be made available to the examiner(s).  The examiner(s) should provide opinions as to whether it is at least as likely as not  that her claimed gastrointestinal condition, including gastroenteritis and dyspepsia is etiologically related to the Veteran's period of service, or to another diagnosed disorder, to include via any prescribed medications.

The examiner(s) is reminded that the secondary service connection opinions must discuss both causation and aggravation (beyond a natural course) separately.

All opinions should be accompanied by adequate reasons and bases. If the examiner(s) cannot provide the requested opinion without resorting to mere speculation, they should provide a complete explanation stating why this is so.

Any opinion must include a discussion of the Veteran's lay statements. 

In so doing, the examiner(s) should explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that they have exhausted the limits of current medical knowledge in providing an answer to that particular question(s).

 

 

JIMMY L. BARDIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Hernan, Quincy

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.