Citation Nr: 0830558 Decision Date: 09/10/08 Archive Date: 09/16/08 DOCKET NO. 04-11 320 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to service connection for a gastrointestinal disorder, claimed as ulcerative colitis, to include as secondary to service-connected PTSD. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Jason R. Davitian, Counsel INTRODUCTION The veteran served on active duty from November 1990 to June 1991, with five months prior service. This case is before the Board of Veterans' Appeals (BVA or Board) on appeal from a September 2002 rating decision of the Department of Veterans Affairs (VA) Regional Office in Montgomery, Alabama, which denied service connection for ulcerative colitis on a direct basis. An October 2007 rating decision denied service connection for ulcerative colitis as secondary to service-connected PTSD. 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 Veterans Claims Assistance Act of 2000 (VCAA) requires, among other things, that VA assist a claimant in providing the claimant a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2006). In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, one factor for consideration is whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability. 38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159(c)(4). With respect to this factor, the Court of Appeals for Veterans Claims has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In the present case, the veteran has submitted evidence indicating that his service-connected PTSD (evaluated as 100 percent disabling) may aggravate his ulcerative colitis. In July 2008, the veteran's representative submitted a printout from MedicineNet.com indicating that psychological stress can increase the symptoms of ulcerative colitis. Several VA Axis I diagnoses of PTSD are accompanied by Axis III diagnoses of history of ulcerative colitis or history of irritable bowel syndrome. VA outpatient clinical records dated in January 2004 and October 2004 relate that the veteran was informed that the medication prescribed for his PTSD could result in gastrointestinal symptoms such as constipation, nausea and diarrhea. In light of the foregoing, a VA examination is warranted to determine the relationship between the veteran's service- connected PTSD and the severity of his claimed gastrointestinal disorder. In addition, during a February 2006 hearing before a Decision Review Officer, the veteran stated that he had a pending application for benefits from the Social Security Administration (SSA). On remand, the veteran should be asked the outcome of this claim. If the veteran has been awarded SSA benefits which relates to his gastrointestinal illness, a copy of the SSA decision and all supporting medical records should be obtained. Accordingly, the case is REMANDED for the following action: 1. Ask the veteran whether he received SSA benefits based on his gastrointestinal illness. If he answers yes, obtain all relevant determinations and medical records from SSA. 2. Arrange for an examination to determine the nature, extent and etiology of any diagnosed gastrointestinal disorder. The claims file must be made available to the examiner. Following a review of the relevant medical evidence in the claims file, the medical history (including that set forth above), and the results of the clinical evaluation and any tests that are deemed necessary, the examiner is asked to address whether it is at least as likely as not (50 percent or more likelihood) that any diagnosed gastrointestinal disorder was caused or aggravated by service or the currently service- connected PTSD, including medication used to treat the PTSD. The examiner is requested to provide a rationale for all opinions expressed. If the examiner finds it impossible to provide any part of the requested opinion without resort to pure speculation, he or she should so indicate. 3. Then, readjudicate the veteran's claims for service connection for ulcerative colitis, to include as secondary to PTSD. If the benefit sought on appeal remains denied, provide the veteran with an SSOC. The SSOC should contain notice of all relevant actions taken on the claim, to include a summary of the evidence and applicable law and regulations considered pertinent to the issue. An appropriate period of time should be allowed for response. 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. 2008). _________________________________________________ JONATHAN B. KRAMER 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) (2007).