Citation Nr: 0812492 Decision Date: 04/15/08 Archive Date: 05/01/08 DOCKET NO. 06-35 623 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Reno, Nevada THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder (PTSD). 2. Entitlement to service connection for chronic neck pain. 3. Entitlement to service connection for residuals of finger injury (right 4th digit laceration). 4. Entitlement to service connection for restrictive lung disease. 5. Whether new and material evidence has been submitted to reopen a service connection claim for migraine headaches. 6. Entitlement to service connection for migraine headaches. 7. Whether new and material evidence has been submitted to reopen a service connection claim for a back condition. 8. Entitlement to service connection for a back condition. 9. Whether new and material evidence has been submitted to reopen a service connection claim for dyspepsia. 10. Entitlement to service connection for dyspepsia. REPRESENTATION Appellant represented by: Nevada Office of Veterans' Services WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD S. Richmond, Associate Counsel INTRODUCTION The veteran had active military service from April 1985 to February 1993. This matter comes to the Board of Veterans' Appeals (Board) from a March 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Reno, Nevada, which denied service connection for PTSD, chronic neck pain, residuals of a finger injury, and restrictive lung disease. The service connection claims for migraine headaches, a back condition, and dyspepsia also were denied on the basis that the veteran had not submitted new and material evidence to reopen the claims. Irrespective of the RO's actions, the Board must decide whether the veteran has submitted new and material evidence to reopen the claims of service connection for migraine headaches, a back condition, and dyspepsia. Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). In February 2008, the veteran testified before the undersigned Veterans Law Judge at a Board hearing at the RO. A transcript of the hearing is of record. After the case was certified to the Board, the veteran submitted additional evidence that had not been considered by the RO with a waiver of RO consideration. On April 2, 2008, this appeal was advanced on the Board's docket pursuant to 38 U.S.C.A. § 7107 and 38 C.F.R. § 20.900(c). The issues of service connection for chronic neck pain and restrictive lung disease are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. Service connection for a back condition, migraine headaches, and digestive problems was denied in September 2001. 2. Evidence received since the September 2001 RO decision is not cumulative or redundant of previously submitted evidence, and raises a reasonable possibility of substantiating the service connection claims for back condition, migraine headaches, and digestive problems. 3. Resolving all doubt in favor of the veteran, the record shows more than one medical finding of PTSD related to combat in service, the veteran's consistent reports of being left behind to salvage parts from a truck when he experienced hostile fire and was frightened, and personnel records showing the veteran was under constant threat from enemy air and ground attacks for a number of months in Southwest Asia during the Persian Gulf War. 3. Resolving all doubt, the medical evidence shows a relationship between the veteran's present low back disability and service. 4. Resolving all doubt, the medical evidence shows a relationship between the veteran's residuals of finger injury and service. 5. Resolving all doubt, the medical evidence shows a relationship between the veteran's migraine headaches and service. 6. Resolving all doubt, the medical evidence shows a relationship between the veteran's present dyspepsia and service. CONCLUSIONS OF LAW 1. Evidence added to the record since the September 2001 RO decision is new and material and the claim of entitlement to service connection for a back condition is reopened. 38 U.S.C.A. §§ 5108, 7104 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.156, 20.200, 20.201, 20.302, 20.1103 (2007). 2. Evidence added to the record since the September 2001 RO decision is new and material and the claim of entitlement to service connection for migraine headaches is reopened. 38 U.S.C.A. §§ 5108, 7104 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.156, 20.200, 20.201, 20.302, 20.1103 (2007). 3. Evidence added to the record since the September 2001 RO decision is new and material and the claim of entitlement to service connection for digestive problems (claimed as dyspepsia) is reopened. 38 U.S.C.A. §§ 5108, 7104 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.156, 20.200, 20.201, 20.302, 20.1103 (2007). 4. PTSD was incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159, 3.102, 3.303, 3.304, 4.125 (2007). 4. A lumbar spine disability was incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159, 3.102, 3.303 (2007). 5. Residuals of a right finger injury (right 4th distal laceration) were incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159, 3.102, 3.303 (2007). 6. Migraine headaches were incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159, 3.102, 3.303 (2007). 7. Dyspepsia was incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159, 3.102, 3.303 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Notice and Assistance The veteran's claims to reopen service connection for migraine headaches, a back condition, and dyspepsia based on new and material evidence, those claims on the merits, as well as service connection claims for PTSD and residuals of finger injury have been considered with respect to VA's duty to notify and assist. Given the favorable outcome noted below, no conceivable prejudice to the veteran could result from this adjudication. See Bernard v. Brown, 4 Vet. App. 384, 393 (1993). New and material evidence The RO originally denied service connection for a back condition, migraine headaches, and digestive problems (dyspepsia) in September 2001 on the basis that there was no evidence these conditions were related to service. The veteran filed a notice of disagreement with that decision in March 2002 and was issued a statement of the case in December 2002. However, he did not file a substantive appeal, VA-Form 9. Thus, the September 2001 rating decision is final. See 38 U.S.C.A. § 7105; 38 C.F.R. §§ 20.201, 20.202, 20.302(a). Prior unappealed decisions are final. 38 U.S.C.A. § 7105. However, if new and material evidence is presented or secured with respect to a claim that has been disallowed, VA shall reopen the claim and review the former disposition of the claim. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156(a); Manio v. Derwinski, 1 Vet. App. 145 (1991). Under 38 C.F.R. § 3.156(a), new evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence cannot be cumulative or redundant of the evidence already of record when the last final denial of the claim was made, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is "new and material," the credibility of the new evidence must be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). In September 2005, the veteran filed to reopen the claims for service connection for a back condition, migraine headaches, and digestive problems. Evidence considered since the last final RO decision in September 2001 includes VA medical records dated from 2002 to 2007 showing treatment for a lumbar spine disability, migraine headaches, and dyspepsia, and a VA medical opinion relating the back and headache conditions to service. This evidence is new because it was not submitted previously, and the RO did not consider it in its previous decision. 38 C.F.R. § 3.156(a). The evidence also is material because it shows disabilities involving the back, migraine headaches, and dyspepsia, and a relationship between the veteran's present back condition and migraine headaches and service, as well as chronic stomach complaints since service. This raises a reasonable possibility of substantiating the service connection claims for a back condition, migraine headaches, and digestive problems. 38 C.F.R. § 3.156(a). Accordingly, the Board finds that the evidence is both new and material and serves to reopen the veteran's claims. Service connection In seeking VA disability compensation, a veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C.A §§ 1110, 1131. "Service connection" basically means that the facts, shown by the evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. This may be accomplished by affirmatively showing inception or aggravation during service or through the application of statutory presumptions. Where chronicity of a disease is not shown in service, service connection may yet be established by showing continuity of symptomatology between the currently claimed disability and a condition noted in service. A veteran may also establish service connection if all of the evidence, including that pertaining to service, shows that a disease first diagnosed after service was incurred in service. 38 C.F.R. § 3.303. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). PTSD The veteran seeks service connection for PTSD. He testified about an incident in service when he was unable to secure his gas mask after a chemical alarm went off, noting that he was terrified. He further testified that during a convoy a tank broke down and that, since he was a mechanic, he and another person stayed behind to salvage a few parts while the convoy went ahead of them. He said that, while they were trying to salvage the parts, they were engaged by the enemy and they started returning fire. He said that he was terrified and that an air patrol came along and helped them out and took out the enemy Iraqi patrol. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (conforming with the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (4th ed.)) (DSM-IV); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 U.S.C.A. § 1154; 38 C.F.R. § 3.304(f). If it is determined through military citation or other supportive evidence that a veteran engaged in combat with the enemy, and the claimed stressors are related to combat, the veteran's lay testimony regarding the reported stressors must be accepted as conclusive evidence as to their actual occurrence and no further development or corroborative evidence will be necessary. See 38 C.F.R. § 3.304(f). An August 1991 letter from the Department of the Army shows the veteran was deployed to Southwest Asia on two occasions; the first dates were from December 13, 1990 to May 11, 1991 for Operation Desert Shield; the second time was from July 16, 1991 to August 13, 1991 to assist in the redeployment of equipment from Southwest Asia. Service personnel records show the veteran had duty in an imminent danger pay area of Southwest Asia from December 14, 1990 to May 11, 1991 and July 12, 1991 to August 12, 1991. The DD-Form 214 also shows his military occupational specialty (MOS) was Track Vehicle Repairer and that he earned, in pertinent part, the Southwest Asia Service Medal with three Bronze Service Stars, the Kuwait Liberation Medal, and the Army Commendation Medal. The Army Commendation Medal certificate notes that the veteran distinguished himself by exemplary conduct, selfless service, and superb performance of duty during a period of constant threat from enemy air and ground attacks. The dates noted on the certificate are January 16, 1991 to March 10, 1991. The personnel records corroborate the veteran's testimony regarding his experiences in service, particularly his exposure to areas of Southwest Asia where he was under constant threat from enemy attacks. His MOS in service of Track Vehicle Repairer further corroborates his recount of having to salvage parts from a truck in service. This evidence provides credible supporting information that the claimed in-service stressor occurred. Thus, the determinative issue is whether the veteran has PTSD related to his in-service stressors. The unfavorable evidence consists of an April 2001 VA examination report, which noted the veteran's reports of being exposed to shells and rockets and a poor memory of dates. The veteran indicated that his nerves were bad and that when he got upset his brain would go faster than his mouth. The examiner diagnosed the veteran with depressive disorder and dementia, not otherwise specified, and noted that the numerous symptoms the veteran presented did not fit into any one category, except perhaps somatization disorder or possibly even malingering. The examiner noted that the diagnosis of depressive disorder and dementia was given because these encompassed most of the veteran's symptoms. The examiner also noted that the veteran suffered from slow to dull mentation and that some brain damage was suspected. The claims file was not reviewed. VA medical records dated from June 2001 to August 2002 note the veteran's reports of not being able to get his gas mask on in service after a chemical alarm went off and his continuous nightmares of chemical alarms; but show only diagnoses of depression (rather than PTSD), without stating whether this was related to service. A February 2002 VA medical record specifically noted that there was no evidence to support a PTSD diagnosis. An October 2004 VA medical record shows the veteran reported the gas mask failure incident in service after a chemical alarm went off. When asked about his education, the date, the month, and the year, he stated that he did not know. The examiner found that there was a large inconsistency between the veteran's inability to recall even the date and his ability to describe his job in the service in detail and that a firm impression was impossible due to the veteran's vague answers to questions. The veteran also has some inconsistent statements of record: On a July 2001 VA medical record, the veteran was asked if he had shot anyone while participating Desert Storm and he responded that he had fired shots but did not know if he had shot anyone. This is inconsistent with later statements in February 2002 and January 2005. The February 2002 VA medical record notes the veteran reported that he did not fire his weapon but saw friendly fire casualties. The January 2005 VA medical record notes the veteran reported that while on guard duty in Kuwait, he and some other soldiers opened fire on a water tanker but later found out it was a friendly vehicle and that they had accidentally killed a civilian. He reported firing an M-16 at that time. The favorable evidence consists of a January 2002 VA medical record, on which the veteran reported his daily "flash backs" about possible chemical exposures during the war and his feeling like he might die at that time. The impression was major depressive disorder, likely related to symptoms of PTSD. A January 2005 VA medical record notes the veteran had continued nightmares and poor concentration and reported that he sometimes went "back to the war zone." The impression was PTSD. An August 2006 VA medical record notes the veteran reported a total change in personality since his return from two tours in Southwest Asia. He reported that he had nightmares regularly and had found himself choking his girlfriend in his sleep and that he also had auditory hallucinations of combat yelling. The impression was that the veteran had Gulf War combat experiences and that he had not been ready until now to deal with the trauma of his duty. The diagnosis was PTSD and major depressive disorder, recurrent. In September 2006, a VA medical record shows the veteran had combat-induced PTSD and significant anxiety related to his combat duty. He still saw and heard shouts from duty years and avoided similar events. A December 2006 VA medical record shows the veteran had a history of PTSD after Desert Storm in 1991 but was not diagnosed with PTSD until 2006. A January 2007 VA medical record also shows an assessment of chronic PTSD with depression. A May 2007 VA examination report shows the veteran noted the incident when he could not get the gas mask on and his reports of having psychiatric problems since service. The report also noted that the veteran was in a war zone in the Persian Gulf and was in a convoy when he was dropped off with another comrade to retrieve parts from a broken down tank. Upon that incident, small fire was exchanged. The veteran was very frightened and returned fire. Air support came in and knocked out the opposing jeep. This was found to be a traumatic episode contributing to the veteran's PTSD. The examiner noted the veteran's nightmares and flashbacks to the occurrences in Desert Storm and the Persian Gulf. The diagnosis was PTSD, service-connected. The record shows some inconsistencies as to whether the veteran has a present diagnosis of PTSD and also some evidence that puts the veteran's credibility into question. The April 2001 record, which notes no diagnosis of PTSD shows the examiner did not review the claims file in making this assessment, and thus could not have reviewed the personnel records showing exposure to dangerous situations. Therefore, this opinion is not probative. See Elkins v. Brown, 5 Vet. App. 474, 478 [rejecting medical opinion as "immaterial" where there was no indication that the physician reviewed the claimant's service medical records or any other relevant document that would have enabled him to form an opinion on service connection on an independent basis]. The veteran's vague answers to dates on the October 2004 medical record could potentially be explained by the VA medical assessment in August 2006 that the veteran had not been ready until then to deal with the trauma he experienced in the Persian Gulf. Also, regarding the inconsistent statements about whether or not he fired his weapon and/or shot anyone, he mentioned on the January 2005 record, when he reported that he and some others accidentally shot and killed a civilian, that he was afraid of getting into trouble. This could explain his not mentioning this in the earlier July 2001 and February 2002 reports. The evidence of record is both positive and negative regarding stressors and a diagnosis of PTSD. Given that the record shows more than one medical finding of PTSD related to combat in service, that the veteran has consistently reported the event of being left behind to salvage parts from a truck when he experienced hostile fire and was frightened, his MOS being Track Vehicle Repairer, and personnel records showing the veteran was under constant threat from enemy air and ground attacks for a number of months in Southwest Asia during the Persian Gulf War, the evidence is in equipoise regarding whether or not the veteran has a current diagnosis of PTSD related to his service. When the evidence is in equipoise, the law requires that the veteran be given the benefit of the doubt and, accordingly, service connection for PTSD is warranted. 38 C.F.R. § 3.102. Back condition The record shows a present back disability. A January 2007 VA x-ray examination report of the lumbosacral spine shows slight levescoliosis, mild spondylosis throughout, and mild disk space narrowing at L5-S1. Vertebral body heights were maintained; the impression was right sacroiliac joint narrowing and sclerosis, and mild disk space narrowing at L5- S1. The overall diagnoses included intervertebral disk syndrome of the lumbar spine, degenerative disk disease of the lumbar spine, L5-S1, right sacroiliac joint narrowing and sclerosis, lumbar spine, and chronic thoracolumbar sacroiliac ligamentous sprain/strain. Service medical records show the veteran was seen for emergency care and treatment in November 1986 for complaints of low back pain for three days after lifting heavy equipment. On objective evaluation, the back was symmetrical, heel and toe walking was within normal limits, straight leg raising was negative to 90 degrees sitting, and deep tendon reflexes were 2+. The veteran complained of recurrent back pain again in August 1990 and on his discharge examination in August 1992. It was noted at discharge that he had a history of low back pain for three years without radiation. An April 1994 military medical record, one year after discharge from active duty, notes that the veteran's spinal cord was crooked and painful after standing or sitting any length of time and that his back "cracked" when in Germany. As the record shows evidence of a present low back disability and complaints of low back pain in service, the determinative issue is whether there is any relationship between these. Post-service VA medical records dated from 2001 to 2007 show recurrent complaints of chronic low back pain. A January 2008 VA medical opinion notes that the veteran was evaluated for low back pain due to lifting in service and that the current low back pain was at least as likely as not related to the injury in military service. This is the only medical opinion of record addressing the etiology of the veteran's lumbar spine disability. The medical evidence in this case is favorable to the veteran's claim. Specifically, the evidence shows the presence of a current lumbar spine disability, in-service complaints of low back pain, chronic complaints of back pain since service, and a medical opinion relating the present low back disability to service. Any remaining doubt is resolved in the veteran's favor. 38 C.F.R. § 3.102. Therefore, service connection for a lumbar spine disability is warranted. Finger injury (right 4th digit laceration) The record shows some present impairment in the right fourth finger. A May 2007 VA examination report shows the veteran could not bend the tip of the fourth digit and had swelling, effusion, tenderness, muscle spasm, and joint laxity on the distal digit, metaphysis of the phalanx of the ring finger on the right hand. A January 2008 VA medical opinion further noted that the veteran had loss of flexion of the distal interphalangeal joint. The service medical records show that in March 1987, the veteran was status post fall with injury to right proximal interphalangeal joint 4th digit. No fracture was seen on x- ray examination. In April 1987, the veteran was seen for emergency care and treated because his baby finger was lacerated by a wall locker door. The veteran stated that his finger got caught between the wall lockers. The objective findings showed a cut on palmar side of index finger and incomplete flexion and extension. On follow up examination later that month, it was noted that the locker fell on the right 4th finger causing laceration and swelling. The veteran had complaints of increased pain. The x-ray report showed an old non-displaced healed fracture involving the distal metaphysis of the proximal phalanx of the ring finger of the right hand. The finger had full range of motion. As the record shows present limitation of flexion in the right ring finger and an in-service injury, the determinative issue is whether there is any relationship between these. The May 2007 VA examiner noted the in-service injury and that the veteran had an old fracture to the right ring finger and probably at the same time had an injury to the flexor tendon of the ring finger, on which he has intermittent difficulty bending the tip. A January 2008 VA medical opinion concludes that the veteran's existing loss of flexion in the distal interphalangeal joint of the right 4th finger was probably related to the veteran's in-service laceration to that joint. There are no other medical opinions of record addressing the etiology of the veteran's current right finger condition. The record shows present limitation of flexion in the right fourth finger, in-service injury to the right fourth finger, and a medical statement that these are probably related. All doubt is resolved in the veteran's favor, and service connection for residuals of finger injury (right 4th digit laceration) is warranted. 38 C.F.R. § 3.102. Migraine headaches The record shows a present disability of migraine headaches. An August 1997 private medical record notes complaints of bilateral occipital headaches. An April 2001 VA examination report shows a diagnosis of common migraine headache, moderately severe. July 2001 and November 2001 VA medical records note findings of chronic migraines. On the July 2001 record the veteran described the headaches as throbbing and uncontrolled frontal headaches that came abruptly with nausea and vomiting almost daily. He indicated that he usually had a headache on awakening from sleep. A November 2001 computed tomography (CT) scan of the head showed no intracranial abnormalities demonstrated. In August 2006, a VA medical record shows a diagnosis of migraine headaches. An October 2006 VA medical record notes an impression of migraine-type headaches, transformed and worsened since last visit in 2002. A CT scan of the head again was negative. VA medical records dated in January 2007 and May 2007 also show diagnoses of migraine headaches. The service medical records show the veteran was seen for a head injury in April 1988. He complained of a laceration to the back of his head after hitting his head on pipes. He had some blurred vision but no loss of consciousness. On follow- up examination two days later he complained of serious headaches, that noise bothered him, and that his head hurt over the irritated area. He also noted that he felt dizzy when he got up from a chair the previous night. The assessment was status post mild head trauma. The veteran complained of headaches again in August 1990, September 1990, and November 1992, but these complaints were associated with upper respiratory infections and sinus symptoms. As the record shows current diagnoses of migraine headaches and in-service complaints of headaches after a head injury, the determinative issue is whether these are related. A July 2001 VA medical record notes that the veteran reported the onset of his headaches was during his tour in the Persian Gulf. An August 2006 VA medical record notes that the veteran described migraine headaches that started 20 years ago and came intermittently. An October 2006 VA medical record also notes the veteran believed he started having headaches after Desert Storm. His first headache was a throbbing sensation and had progressed over the years to a daily-type headache. A May 2007 VA examination report notes that the service medical records showed the veteran hit his head on pipes sustaining a laceration. The veteran admitted to blurred vision following this with no loss of consciousness. He also stated that he had been having migraine headaches ever since. Throughout his service medical record and history, his headaches had been treated with Motrin 800 mg twice daily. The diagnosis was migraine headaches, service-connected. A January 2008 VA medical opinion notes that during active duty in 1988, the veteran was evaluated for mild head trauma and residual headaches. The physician found that the veteran's headaches may, at least as likely as not, be related to the head injury suffered during military service. The medical evidence in this case is at least equally- balanced in terms of whether the veteran's present migraine headaches are related to his service. Specifically, the record shows a current diagnosis of migraine headaches, in- service injury to the head with residual headaches, complaints of headaches since service, and two medical findings, which more or less relate the veteran's present headaches to his service. All doubt is resolved in the veteran's favor, and service connection for migraine headaches is warranted. 38 C.F.R. § 3.102. Dyspepsia The record shows the veteran has been having post-service abdominal complaints since 1996. A November 1996 private medical record notes the veteran had been having right upper quadrant pain radiating to the back for about two and a half weeks. Associated with this he had nausea and food intolerance. He had noticed no change in the color of his stool or urine and as far as he could determine had not been jaundiced. He was admitted into the hospital with this abdominal pain and an ultrasound of the gallbladder revealed numerous stones and a contracted gall bladder. The impression was acute cholecystitis with cholelithiasis. An open cholecystectomy was performed later that month. An April 2001 VA examination report shows complaints of constant lower abdominal pain, which was described as an aching-type pain. The veteran reportedly had gall bladder surgery three years prior but had continued pain. He also stated that within 30 to 60 minutes after eating he would have a loose bowel movement. The diagnosis was gastritis, duodenitis, and diarrhea, etiology unknown. A separate April 2001 VA medical record shows chronic dyspepsia and evidence of gastritis and duodenitis. The veteran reported that he had nausea in the early morning and vomited from time to time and that these symptoms had been present for 10 years. A December 2001 VA medical record notes the upper gastrointestinal (GI) series showed there was very fast gastric emptying; therefore, the stomach was never optimally distended and it was possible for small lesions to go undetected. Prominent mucosal folds were noted throughout the stomach; this was found to be non-specific but possibly seen with gastritis. A few punctuate collections of barium were present in the stomach and were very suspicious for small erosions. There were no other abnormalities of the stomach demonstrated. Thickened mucosal folds in the post bulbar region of the duodenum were consistent with the presence of duodenitis; there were no other abnormalities of the duodenum seen. The assessment was duodenitis. In November 2004, an upper GI serious notes a history of dyspepsia, gastritis, and nausea. There were no abnormalities seen. A November 2005 VA medical record notes complaints of nausea every morning and that he had clips from gall bladder surgery. A May 2007 VA examination report confirms a diagnosis of dyspepsia and duodenitis. The service medical records show complaints of stomach aches in August 1990 with diarrhea, vomiting, and abdominal cramping. On objective evaluation, the abdomen was soft and not distended. There was mild tenderness over the left lower quadrant and increased bowel sounds. The assessment was acute gastroenteritis. At discharge from service in August 1992, the veteran reported gall bladder trouble or gall stones. He indicated that he did not know whether he had stomach, liver, or intestinal trouble. As the record shows a present diagnosis of dyspepsia and in- service stomach complaints, the determinative issue is whether these are related. A May 2007 VA examiner reviewed the veteran's claims file and noted his chronic complaints of stomach pains. On diagnosis, the examiner noted dyspepsia, service-connected. There are no other medical opinions of record. The record shows evidence of a present diagnosis of dyspepsia since 2001, in-service complaints of stomach problems, complaints of chronic stomach problems since service, and a medical finding that the present diagnosis of dyspepsia is service-connected. Although the veteran was seen in 1996 for other medical problems such as gall bladder surgery that could potentially be the cause for the stomach pains at that time, the later findings of dyspepsia were noted by the May 2007 examiner to be service-connected. Accordingly, service connection for dyspepsia is warranted. 38 C.F.R. § 3.102. ORDER Entitlement to service connection for PTSD is granted, subject to the rules and payment of monetary benefits. Entitlement to service connection for residuals of finger injury (right 4th digit laceration) is granted, subject to the rules and payment of monetary benefits. New and material evidence has been submitted to reopen a service connection claim for migraine headaches, and the claim is reopened. Entitlement to service connection for migraine headaches is granted, subject to the rules and payment of monetary benefits. New and material evidence has been submitted to reopen a service connection claim for a back condition, and the claim is reopened. Entitlement to service connection for a back condition is granted, subject to the rules and payment of monetary benefits. New and material evidence has been submitted to reopen a service connection claim for dyspepsia, and the claim is reopened. Entitlement to service connection for dyspepsia is granted, subject to the rules and payment of monetary benefits. REMAND Additional development is necessary before the service connection claims for chronic neck pain and restrictive lung disorder can be resolved. The service medical records show the veteran had a laceration to the back of the head in April 1988 after hitting his head on pipes. He had no loss of consciousness but some blurred vision. Four years after discharge from service in August 1997, a private medical record notes the veteran developed some neck pain when he was working doing something that involved a tire on a trailer. The pain went up into the head and down to the spinal cord. On examination, the veteran had cervical paraspinous muscle spasm. A November 2001 VA x-ray examination report shows at C2-C3 and C3-C4 there was a very slight dimunition of disk space height; there were no other abnormalities demonstrated. A March 2002 VA medical record shows degenerative disc disease of the cervical spine. As the record shows an in-service injury to the head that could have affected the neck, chronic complaints of neck pain since four years after service, and a present diagnosis of degenerative disc disease in the cervical spine, a medical opinion is necessary to determine whether these are related. Regarding the restrictive lung disease complaints, the veteran has asserted exposure to chemicals in service as responsible for his present complaints. A private post- service medical record dated in November 1998 notes the veteran had some persistent effusion in the left lower lobe of the lung that had worsened. He had previously been treated for pneumonia. Post-service VA medical records show complaints of shortness of breath in April 2001. A March 2002 VA medical record shows the veteran had restrictive pulmonary function tests and chronic dyspnea on exertion, which started after Desert Storm. An August 2002 VA pulmonary function test notes a mild restrictive defect. A December 2004 VA pulmonary function test also notes a mild and stable restriction. The service medical records show an assessment of upper respiratory infection in April 1990. The veteran also had service in Southwest Asia during the Persian Gulf War from December 13, 1990 to May 11, 1991, and July 16, 1991 to August 13, 1991. As the record shows evidence of a chronic lung condition since 1998, findings of an upper respiratory infection in service, as well as service in Southwest Asia during the Persian Gulf War, a medical opinion should be provided to determine whether there is any relationship between these facts. Specifically, the examiner should determine whether there is any direct relationship between any present complaints and service; or any evidence that the veteran's lung disorder might be an undiagnosed illness. Additional factors to consider include the veteran's past smoking history. A November 1996 private medical record notes the veteran smoked a pack per day for 12 years. A March 2005 VA pulmonary clinic note also notes a remote history of tobacco abuse before he quit in 1999. Accordingly, the case is REMANDED for the following action: 1. Schedule the veteran for a VA orthopedic examination to determine the etiology of his present degenerative disc disease in the cervical spine. The examiner should state whether it is at least as likely as not that the degenerative disc disease in the cervical spine is related to service. The examiner should specifically note the in-service head injury in April 1988. The claims folder must be made available to the examiner for review in conjunction with the examination. The examiner must provide a detailed rationale for all medical opinions. 2. Schedule the veteran for a VA pulmonary examination to determine the etiology of his present restrictive lung disease complaints. Specifically the examiner should state whether the veteran's present restrictive lung complaints can be attributed to a known diagnosis; and if so, whether it is at least as likely as not that this diagnosis is related to his service. The claims folder must be made available to the examiner for review in conjunction with the examination. The examiner must provide a detailed rationale for all medical opinions. 3. Any additional development deemed appropriate should be accomplished. The claims should then be readjudicated. If either of the claims remains denied, issue a supplemental statement of the case (SSOC) containing notice of all relevant actions taken, to include a summary of the evidence, and applicable law and regulations considered pertinent to the issues currently on appeal. An appropriate period of time should be allowed for response. The appellant has the right to submit additional evidence and argument on the 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. 2007). ______________________________________________ RONALD W. SCHOLZ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs