Citation Nr: 0333177 Decision Date: 11/26/03 Archive Date: 12/10/03 DOCKET NO. 02-00 883A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to service connection for hemorrhoids. 2. Entitlement to service connection for hypertension. WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD K. Conner, Counsel INTRODUCTION The veteran served on active duty from April 1971 to June 1975, and from March 1993 to February 1999. This matter comes to the Board of Veterans' Appeals (Board) from a September 2001 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. In the September 2001 rating decision, the RO denied service connection for several disabilities, including hypertension and hemorrhoids. The veteran duly perfected an appeal regarding these issues and in June 2003, he testified at a Board hearing in Washington, DC. It is noted that in the September 2001 rating decision discussed above, the RO also denied service connection for erectile dysfunction, a bilateral wrist disorder, a bilateral foot disorder, and an upper and lower back disorder. In February 2002, the veteran submitted a Notice of Disagreement regarding these decisions. Because a Statement of the Case addressing these matters has not yet been issued, they are not yet in appellate status. Rather, according to the U.S. Court of Appeals for Veterans Claims (Court), a remand for this action is necessary. See Manlincon v. West, 12 Vet. App. 238 (1999). This matter is addressed below. Finally, it is noted that at his June 2003 Board hearing, the veteran raised a claim for an increased rating for his service-connected hearing loss. He also argued that he was entitled to an earlier effective date for a 40 percent rating for his service-connected benign prostatic hypertrophy. As the RO has not yet had the opportunity to address these matters, and inasmuch as they are not inextricably intertwined with the issues now before the Board on appeal, they are referred to the RO for appropriate action. REMAND The veteran claims entitlement to service connection for hypertension, arguing that he currently has hypertension which had its inception in service, as evidenced by elevated blood pressure readings therein. He also argues that he is entitled to service connection for hemorrhoids, as he was treated for the disorder in service and still suffers from hemorrhoids. A review of the veteran's service medical records shows that he underwent numerous periodic flying examinations between March 1972 and July 1999. Without exception, his blood pressure readings on these occasions were within normal limits, and anal examinations revealed no hemorrhoids. On reports of medical history completed in connection with these examinations, the veteran specifically denied high blood pressure and piles or rectal disease. The veteran has recently testified, however, that on occasion his blood pressure was borderline high and was retaken after a period of relaxation in order to keep him on flying status. The service medical records also show that in May 1978, while on active duty for training, the veteran was treated at St. Paul Ramsey Hospital in St. Paul, Minnesota, for internal hemorrhoids. He has also provided credible testimony, as well as an affidavit from his supervisor, to the effect that he was treated in May 1996 for another episode of hemorrhoids. The service medical records also include a December 1998 examination report which notes that the veteran's blood pressure was slightly elevated on the diastolic side at 136/102 and he was advised to monitor his blood pressure. The veteran also reported a history of hemorrhoids, but none were noted on examination. The post-service medical evidence includes a February 1999 private examination report noting a diagnosis of questionable hypertension as well as a more recent private examination report, dated in January 2002, showing an unequivocal diagnosis of hypertension, managed by Avalide and Lipitor. The post-service medical evidence is negative for findings of hemorrhoids, although the veteran has given credible testimony regarding his hemorrhoid symptomatology. A review of the record indicates that the veteran has not yet been afforded a VA medical examination in connection with his claims of service connection for hypertension and hemorrhoids. Under the Veterans Claims Assistance Ace of 2000 (VCAA), the duty to assist includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4) (2003). Given the evidence set forth above, the Board finds that an examination is necessary in connection with these claims. The Board also observes that since the Statement of the Case was issued in January 2002, numerous pieces of relevant evidence were received at the RO before the matter was certified to the Board. Due process requires that the RO consider this evidence and send the veteran an appropriate Supplemental Statement of the Case. 38 C.F.R. § 19.31 (2003). Accordingly, this case is REMANDED to the RO for the following: 1. The RO should issue a Statement of the Case regarding the issues of service connection for erectile dysfunction, a bilateral wrist disorder, a bilateral foot disorder, and an upper and lower back disorder, and provide the veteran with the appropriate time period in which to perfect his appeal. 2. The RO should contact the veteran and request that he identify the names, addresses, and approximate dates of treatment for all health care providers who may possess additional records pertinent to his claims of service connection for hypertension and hemorrhoids. After securing any necessary authorization for the release of medical information, the RO should attempt to obtain copies of any treatment records so identified that are not already of record.. 3. The veteran should be afforded a VA medical examination to determine the nature and etiology of any current hemorrhoid disability. The claims folder must be made available to the examiner for review in conjunction with the examination of the veteran. The examiner should be requested to provide an opinion as to whether it is at least as likely as not that the veteran currently has a hemorrhoid disability identified on examination which was incurred during his active service. A complete rationale for all opinions expressed by the examiner should be provided. 4. The veteran should be afforded VA cardiology examination to determine the etiology and likely date of onset of the veteran's current hypertension. The claims folder must be made available to the examiner for review in conjunction with the examination of the veteran. The examiner should be requested to provide an opinion as to the etiology and likely date of onset of the veteran's hypertension, to include stating whether it is at least as likely as not that any current hypertension was incurred during the veteran's active service. A complete rationale for all opinions expressed by the examiner should be provided. 5. After the actions requested above have been completed, the RO should again review the record considering all of the evidence of record. If the benefit sought on appeal remains denied, the veteran should be furnished a supplemental statement of the case and given the opportunity to respond thereto. The case should then be returned to the Board for further appellate consideration, if in order. The veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West 2002) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.43 and 38.02. _________________________________________________ JAMES L. MARCH Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2002).