Citation Nr: 0621841 Decision Date: 07/24/06 Archive Date: 08/10/06 DOCKET NO. 04-28 469A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to service connection for an anal fissure. 2. Entitlement to service connection for a back disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L. Jeng, Associate Counsel INTRODUCTION The veteran had active duty from October 1985 to October 1988. This matter comes before the Board of Veterans' Appeals (Board) from a June 2004 rating decision. In September 2005, the veteran appeared at a hearing at the RO before the undersigned. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The service medical records show that in March 1988, the veteran was seen for bright red blood in his stool. Impressions of probable constipation and hemorrhoids were noted. The examination report at service discharge noted hemorrhoids. A letter from D. H. Gibbs, M.D., dated in March 2003, noted that he treated the veteran for anal fissure disease. Dr. Gibbs noted the veteran's assertion that he had the same problems in service and he was told he had hemorrhoid disease. Dr. Gibbs noted that while he could not conclusively state that the veteran had anal fissures during service, it was plausible that the veteran's current symptoms are identical to the ones he had in service. He also noted that the veteran did not currently have external hemorrhoids. Also, upon examination of the veteran's medical records, J.K. Dhar, M.D. noted in a letter dated in November 2004 that the veteran's anal fissure disease is related to service. The service medical records show in August 1988, the veteran complained of upper back pain from lifting tools in a motor pool. Records from August 1989 show that the veteran was involved in a motor vehicle accident, after which, he complained of neck pain and left shoulder pain. An X-ray of the cervical spine revealed that of the portion demonstrated, there was normal alignment with significant paravertebral soft tissue swelling. Medical records show post-service treatment for his back. The record also reflects that in September 1999, the veteran slipped at work and he complained of low back pain. Upon examination of the veteran's medical records, J.K. Dhar, M.D. noted, in a letter dated in November 2004, that the veteran's low back disorder is related to service. VA's duty to provide a medical examination or obtain a medical opinion is triggered only when necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(d) (West 2002); 38 C.F.R. § 3.159(c)(4) (2005). A medical examination or opinion is necessary to make a decision on a claim if all of the lay and medical evidence of record (1) contains competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability; and (2) indicates that the disability or symptoms may be associated with the claimant's active naval, or air service; but (3) does not contain sufficient medical evidence for VA to make a decision on the claim. In this case, the Board believes that a medical opinion based upon a complete review of the claims folder is necessary in order to determine the etiology of the veteran's current anal fissure disease and back disorder. At his September 2005 hearing, the veteran indicated that he filed a worker's compensation claim following his 1999 injury to his back. The veteran's application for workers compensation is in the claims folder. On remand, any other records associated with the veteran's workers compensation claim should be obtained. Accordingly, the case is REMANDED for the following action: 1. After obtaining any necessary information and authorization from the veteran, his workers' compensation decision from the September 1999 accident and any additional records associated with the claim should be obtained. 2. Thereafter, the RO should schedule the veteran for a VA examination to determine the nature and etiology of any anal fissure and/or back disability. The claims folder, to include a copy of this Remand, must be made available to and reviewed by the examiner prior to completion of the examination report, and the examination report must reflect that the claims folder was reviewed. Any indicated studies should be performed. If an anal fissure is identified, the examiner should provide an opinion as to whether there is a 50 percent probability or greater that it is related to service. The rationale for all opinions expressed must also be provided. The examiner should also reconcile his/her opinion with those of Drs. Gibbs and Dhar. If a back disorder is identified, the examiner should also provide an opinion as to whether there is a 50 percent probability or greater that it is related to service. The examiner should provide bases and support for any opinion and reconcile any opinion with the service medical records, 1989 and 1999 post service treatment reports and workers' compensation records if available. He/she should also address Dr. Gibb's opinion. 3. Then, the RO should readjudicate the claims. If the benefits sought on appeal remain denied, the veteran and his representative should be provided a supplemental statement of the case (SSOC). Allow an appropriate period of time for response. Thereafter, the claims should be returned to this Board for further appellate review, if in order. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. 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 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2005). _________________________________________________ THOMAS J. DANNAHER 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) (2005).