Citation Nr: 0815171 Decision Date: 05/08/08 Archive Date: 05/14/08 DOCKET NO. 03-20 276A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for hemorrhoids. 2. Entitlement to service connection for hypertension. 3. Entitlement to service connection for fibromyalgia. 4. Entitlement to service connection for headaches claimed as due to undiagnosed illness. 5. Entitlement to service connection for muscle pain claimed as due to undiagnosed illness. 6. Entitlement to service connection for joint pain claimed as due to undiagnosed illness. 7. Entitlement to service connection for fatigue and sleep disturbance claimed as due to undiagnosed illness and/or as secondary to service connected musculoskeletal disorders. 8. Entitlement to service connection for gastroesophageal reflux disease (GERD) claimed as due to undiagnosed illness and/or as secondary to nonsteroidal inflammatory drugs (NSAIDS) prescribed as treatment for service connected musculoskeletal disorders. 9. Entitlement to specially adapted housing allowance or special home adaptation grant. 10. Entitlement to an automobile allowance or specially adapted equipment. REPRESENTATION Appellant represented by: National Veterans Organization of America, Inc. ATTORNEY FOR THE BOARD T. Mainelli, Counsel INTRODUCTION The veteran served on active duty from January 1975 to December 1995. This case comes before the Board of Veterans' Appeals on appeal from adverse rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In March 2008, the veteran withdrew his request for a hearing before the Board. The claims of service connection for muscle pain, joint pain, fatigue with sleep disturbance and GERD, as well as the claims for specially adapted housing allowance, special home adaptation grant, an automobile allowance and specially adapted equipment, are addressed in the REMAND following this decision and are REMANDED to the RO, via the Appeals Management Center (AMC) in Washington, D.C. The veteran and his representative will be notified if any further action on their part is required. FINDINGS OF FACT 1. The veteran's hemorrhoids first manifested in service. 2. The veteran's hypertension first manifested after the first post-service year and is not shown to have had its origins in service. 3. The veteran does not have a current disability of fibromyalgia. 4. The veteran's clinically diagnosed vascular-type migraine headaches first manifested many years after service year and are not shown to have had its origins in service. CONCLUSIONS OF LAW 1. Hemorrhoids were incurred during active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002 & Supp. 2007); 38 C.F.R. § 3.303(b) (2007). 2. Hypertension was not incurred in or aggravated by active service, and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1110, 1112, 1113, 1117, 1131, 1137 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317 (2007). 3. Fibromyalgia was not incurred in or aggravated by active service, and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1110, 1112, 1113, 1117, 1131, 1137 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317 (2007). 4. A headache disorder was not incurred in or aggravated by active service, and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1110, 1112, 1113, 1117, 1131, 1137 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of a pre-existing injury or disease in the line of duty. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.306. In order to prevail on the issue of service connection on the merits, there must be medical evidence of a (1) current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247, 253 (1999). In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection for certain chronic disorders, such as arthritis, cardiovascular-renal disease (including hypertension) and other organic diseases of the nervous system, may be established based on a presumptive basis by showing that either disability manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. The veteran served in the Southwest Asia Theater of operations during the Persian Gulf War. Thus, he is deemed a "Persian Gulf veteran" for the purposes of 38 C.F.R. § 3.317. Service connection may be established for a Persian Gulf veteran who exhibits objective indications of chronic disability which cannot be attributed to any known clinical diagnosis, but which instead results from an undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2011. 38 C.F.R. § 3.317(a)(1). Objective indications of a chronic disability include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. A disability referred to in this section shall be considered service connected for the purposes of all laws in the United States. 38 C.F.R. § 3.317(a)(2)-(5). Effective March 1, 2002, an amendment changed the law affecting compensation for disabilities occurring in Persian Gulf War veterans. 38 U.S.C.A. §§ 1117, 1118. Essentially, these changes revised the term "chronic disability" to "qualifying chronic disability," and involved an expanded definition of "qualifying chronic disability" to include: (a) an undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. 38 U.S.C.A. § 1117(a)(2)(B); 38 C.F.R. § 3.317. The term "medically unexplained chronic multi-symptom illness" means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). With claims based on an undiagnosed illness, VA does not require the veteran to provide competent evidence linking a current disability to an event during service. Gutierrez v. Principi, 19 Vet. App. 1 (2004). Signs or symptoms that may be a manifestation of an undiagnosed illness or a chronic multi-symptom illness include: fatigue, unexplained rashes or other dermatological signs or symptoms, headache, muscle pain, joint pain, neurological signs and symptoms, neuropsychological signs or symptoms, signs or symptoms involving the upper or lower respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 U.S.C.A. § 1117(g); 38 C.F.R. § 3.317(b). Section 1117(a) of Title 38 of the United States Code authorizes service connection on a presumptive basis only for a disability arising in Persian Gulf veterans due to an "undiagnosed illness" and may not authorize presumptive service connection for any diagnosed illness, regardless of whether the diagnosis may be characterized as poorly defined. VAOPGCPREC 8-98 (Aug. 3, 1998). VA may compensate veterans pursuant to 38 C.F.R. § 3.317 for a disability which has no known clinical diagnosis. The fact that the signs or symptoms exhibited by the veteran could conceivably be attributed to a known clinical diagnosis under other circumstances not presented in the particular veteran's case does not preclude compensation under § 3.317. Id. A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997). See also Bostain v. West, 11 Vet. App. 124, 127 (1998) citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992) (a layperson without the appropriate medical training and expertise is not competent to provide a probative opinion on a medical matter, to include a diagnosis of a specific disability and a determination of the origins of a specific disorder). Lay testimony is competent, however, to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994). When a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). If the evidence for and against a claim is in equipoise, the claim will be granted. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). A. Hemorrhoids The veteran's service medical records document his treatment for multiple non-thrombosed hemorrhoids in January 1994. At this time, he reported a prior history of hemorrhoids normally controlled with use of Preparation H. VA compensation and Pension examination in July 2002 found asymptomatic Grade I hemorrhoids. On appeal, the veteran reports recurrent hemorrhoids with rectal bleeding since his discharge from service. The veteran descriptions of hemorrhoids with rectal bleeding, self-treated with over-the-counter medications, beginning prior to January 1994 with persistent recurrences thereafter, is both competent and credible evidence supporting this claim. Jandreau, 492 F.3d 1372 (Fed. Cir. 2007). His report of persistently recurrent hemorrhoids in service and thereafter is confirmed, in part, by clinical findings in service and after service. The Board, resolving reasonable doubt in favor of the veteran, finds that the veteran's currently diagnosed hemorrhoids first manifested in service. 38 U.S.C.A. § 5107. B. Hypertension The Board notes that the RO has denied a claim of service connection for hypertension on the merits, having noted a prior final denial in June 1999 but not providing a specific discussion as to whether the new and material standard applies to the claim. On November 9, 2000, the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000) (codified as amended at 38 U.S.C.A. § 5102, 5103, 5103A, 5107, became law. Among other things, the VCAA eliminated the concept of a well-grounded claim and superseded the decision of the United States Court of Appeals for Veterans Claims (Court) in Morton v. West, 12 Vet. App. 477 (1999), which had held that VA could not assist in the development of a claim that was not well grounded. The law also provided that under certain circumstances claims that had been denied as not well grounded and became final during the period from July 14, 1999, to November 9, 2000, may be re-adjudicated as if the denial had not been made. The RO's June 1999 RO rating decision effectively denied service connection for hypertension as not well grounded, as the evidence did not reflect a diagnosis of hypertension in service or within one year from service, and there was no competent evidence of a nexus between the veteran's hypertension and events in service. See Caluza v. Brown, 7 Vet. App. 498 (1995). On the facts of this case, the Board finds that the June 1999 RO rating decision may be readjudicated de novo pursuant to the provisions of the VCAA. The veteran's medical records document current treatment for hypertension. The first requirement for a current disability, therefore, has been met. The second requirement for service connection is evidence of in-service incurrence of an injury or disease. The veteran's service medical records show no diagnosis or signs of hypertension during his service. See, e.g., 38 C.F.R. § 4.104, Diagnostic Code 7101, NOTE 1 (2007) (hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days; the term hypertension means that diastolic blood pressure is predominantly 90 mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm. or greater with a diastolic blood pressure of less than 90mm.) Overall, the Board must find that the service medical records provide highly probative evidence against this claim, failing to indicate this disorder or the start of this disorder during service. Post-service, it is significant that the veteran did not have any documented treatment for hypertension within his first post-service year. His initial VA compensation and pension examination in February 1996 indicated a blood pressure reading of 128/84, and did not report a prior history of treatment for hypertension, providing evidence against this claim. Similarly, clinical records from Wilshire Hall Medical Center (WHMC) document blood pressure readings of 139/81, 141/81 and 138/78 in April 1996 with no history of hypertension treatment noted. This evidence provides further strong evidence against the claim. As hypertension was not shown to have manifested within one year from service, the presumptive provisions of 38 C.F.R. § 3.309(a) do not apply. Furthermore, as hypertension is a known clinical diagnosis, the undiagnosed illness provisions of 38 C.F.R. § 3.317 also do not apply. A June 1998 VA clinical record indicates that the veteran was seen with a one month history of high blood pressures. He had blood pressure readings of 155/101 in the left arm, and 143/97 in the right arm. He denied a prior history of medication treatment. He was diagnosed with "new onset" hypertension (HTN). Such evidence and history provided by the veteran provides more evidence against this claim. The United States Court of Appeals for the Federal Circuit has determined that such a lapse of time is a factor for consideration in deciding a service connection claim. Maxson v. Gober, 230 F.3rd 1330, 1333 (Fed. Cir. 2000). This is highly probative evidence against a finding of continuity of symptomatology since service with the veteran's own statements indicating that hypertension began in 1998, after service. The third requirement for establishing service connection is medical evidence of a nexus between the claimed in-service disease or injury and the current disability. There is no medical evidence of record suggesting that the veteran's current hypertension either first manifested in service and/or is causally related to service. This is also highly probative evidence against the claim. The Board notes that a VA examiner in April 1999 reported that the veteran has had hypertension since 1996. A review of that examination report indicates that the examiner was merely relating the treatment history reported by the veteran and did not intend to provide a medical opinion in the case. This statement, therefore, has no probative value in this case. See LeShore v. Brown, 8 Vet. App. 406, 409 (1995) ("evidence which is simply information recorded by a medical examiner, unenhanced by any additional medical comment by that examiner, does not constitute 'competent medical evidence.'") See generally Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (medical opinion has no probative value if the based on a rejected factual basis). The Board acknowledges the veteran's assertions that he was first treated for hypertension in service and immediately following service at WHMC. His assertions are not corroborated by the medical evidence of record and contradict the history he provided to his treating physician in 1998. The Board places greater probative weight to the clinical findings and documented medical history rather than the veteran's sometimes inconsistent and uncorroborated report of treatment for hypertension since service. Thus, the preponderance of the evidence establishes that the veteran did not receive treatment for hypertension in service or within one year therefrom. There is also no evidence that the veteran is trained or educated in medicine; therefore, he is not competent to offer an opinion as to the nature and etiology of his hypertension. Routen, 10 Vet. App. at 86; 38 C.F.R. § 3.159(a). As such, the Board finds that both service and post-service medical records provide evidence against the claim, outweighing the veteran's contentions. Accordingly, the Board finds that the preponderance of the evidence is against the claim of service connection for hypertension. 38 U.S.C.A. § 5107(b). The appeal, therefore, is denied. C. Fibromyalgia The Board must deny the veteran's claim of service connection for fibromyalgia on the basis that there is no competent evidence of a currently diagnosed disability. The veteran essentially attributes his muscle and joint pains to a diagnosis of fibromyalgia which, if confirmed, would be subject to presumptive service connection under 38 C.F.R. § 3.317. However, the record is devoid of a competent medical diagnosis of fibromyalgia. In fact, the VA compensation and pension examination in July 2002 found that the veteran's clinical findings were inconsistent with a diagnosis of fibromyalgia, providing evidence against this claim. As addressed below, the Board finds that an additional VA examination is necessary to determine the underlying pathology for his report of muscle and joint pains (if any). However, the specific diagnosis of fibromyalgia has been ruled out. The only evidence in this case that the veteran manifests fibromyalgia consists of the personal opinion of the veteran himself. However, his self-diagnosis cannot be considered competent evidence supporting his claim. Routen, supra. The preponderance of the evidence is against his claim and, therefore, the appeal must be denied. D. Headaches With respect to this issue, the Board must deny the veteran's claim of service connection for headaches due to an undiagnosed illness. The Board notes that none of the veteran's available service medical records makes any reference to a chronic headache disorder. The service medical records are significant only for the veteran's report headaches while undergoing a course of isoniazid (INH) treatment in 1986. He specifically denied a history of headaches in subsequent medical histories provided in March 1991 and December 1991. This is highly probative evidence against the claim. The veteran's post-service medical records are void for treatment for any chronic headache disorder contemporaneous in time to the veteran's separation from service. In October 2001, the veteran claimed chronic headaches since his service in the Persian Gulf. A VA compensation examination in July 2002 noted the veteran's history of episodic headaches since serving in the Persian Gulf from 1990 to 1991 for which he had not sought treatment. The examiner's impression indicated that the veteran's headaches are from a known clinical diagnosis of vascular migraine-type headaches. In October 2003, however, the veteran sought VA clinical treatment for a 6-month history of headaches which cleared with Oxycodone treatment. This is highly probative evidence against this claim, including competent medical evidence attributing the veteran's symptoms to a known clinical diagnosis which precludes consideration of presumptive service connection under 38 C.F.R. § 3.317. In reviewing the record, the Board notes that it must make a determination regarding the credibility and weight to assign to the veteran's assertions of persistent headaches since service. As held above, the veteran's report of hypertension treatment since service is unreliable and inconsistent with the record. His current recollections regarding the onset and persistence of his headaches is similarly inconsistent with the medical documentation of record, which shows no complaint or treatment for a headache disorder until many years after service. The Board finds that the veteran's current recollections of recurrent or persistent headaches since his return from the Persian Gulf are not credible, as being inconsistent with the evidentiary record as a whole. His personal opinion as to the onset and etiology of his headache disorder is insufficient to support his service connection claim. Routen, supra. The evidence in this case is not so evenly balanced so as to allow application of the benefit-of- the-doubt rule. Gilbert, 1 Vet. App. 49 (1990); 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. D. The Duty to Notify and the Duty to Assist As provided for by the VCAA, VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2007). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the Court held that, upon receipt of an application for a service- connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) also requires VA to notify a claimant that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. In this case, two separate pre-adjudicatory RO letters in March 2002 advised the veteran of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence. He was specifically advised of multiple forms of medical and non-medical evidence which could be capable of substantiating his claim based upon an undiagnosed illness. A post-adjudicatory RO letter in March 2006 advised him that a disability rating and an effective date for the award of benefits will be assigned should service connection be awarded. At this time, he was advised of multiple forms of evidence that may be capable of substantiating his claims and notified that the intent of the letter was to ensure that he had the opportunity to submit any additional evidence he may have. The pre-adjudicatory notice provided to the veteran was deficient with respect to specifically advising him to submit all evidence and information in his possession, and providing him the criteria for establishing a disability rating and an effective date for the award of benefits after the initial AOJ adjudication. However, these deficiencies were cured with readjudication of the claims in a June 2007 Supplemental Statement of the Case (SSOC). See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006) (where notice was not provided prior to the AOJ's initial adjudication, this timing problem can be cured by the Board remanding for the issuance of a VCAA notice followed by readjudication of the claim by the AOJ) see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as an SOC or SSOC, is sufficient to cure a timing defect). In Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007), the United States Court of Appeals for the Federal Circuit held that any error by VA in providing the notice required by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)(1) is presumed prejudicial, and that once an error is identified as to any of the four notice elements the burden shifts to VA to demonstrate that the error was not prejudicial to the appellant. The Federal Circuit stated that requiring an appellant to demonstrate prejudice as a result of any notice error is inconsistent with the purposes of both the VCAA and VA's uniquely pro-claimant benefits system. Instead, the Federal Circuit held in Sanders that all VCAA notice errors are presumed prejudicial and require reversal unless VA can show that the error did not affect the essential fairness of the adjudication. To do this, VA must show that the purpose of the notice was not frustrated, such as by demonstrating: (1) that any defect was cured by actual knowledge on the part of the claimant, see Vazquez-Flores v. Peake, 22 Vet. App. 37, 48 (2008) ("Actual knowledge is established by statements or actions by the claimant or the claimant's representative that demonstrate an awareness of what was necessary to substantiate his or her claim.") (citing Dalton v. Nicholson, 21 Vet. App. 23, 30-31 (2007)); (2) that a reasonable person could be expected to understand from the notice what was needed; or (3) that a benefit could not have been awarded as a matter of law. Sanders, 487 F.3d at 889. Additionally, consideration also should be given to "whether the post-adjudicatory notice and opportunity to develop the case that is provided during the extensive administrative appellate proceedings leading to the final Board decision and final Agency adjudication of the claim ... served to render any pre-adjudicatory section 5103(a) notice error non-prejudicial." Vazquez-Flores, 22 Vet. App. at 46. In this case, the Board finds that the late curing of the notice errors did not affect the essential fairness of the adjudications. The service connection claim for hemorrhoids is granted in full and, thus, no prejudice accrues to this claim. The pre-adjudicatory notice provided in March 2002 provided extensive notice of the types of medical and non- medical evidence that may be capable of substantiating his claim which essentially notified the veteran to submit all pertinent evidence he may have. The more explicit post- adjudicatory notice provided in March 2006 gave him ample opportunity to submit all evidence in his possession, if he was not already aware of that requirement. As the claims for hypertension, fibromyalgia and headaches are denied, the failure to provide the veteran timely notice of the criteria for establishing a disability rating and effective date of award is non-prejudicial as the issues are moot. VA has a duty to assist the veteran in the development of the claims. This duty includes assisting the veteran in the procurement of service medical records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained the veteran's service medical records and all private and VA treatment records identified by the veteran as capable of substantiating the claims. The Board notes that the veteran completed a records request form for medical records associated with his service in the Air National Guard from 1970-72, and the Army National Guard from 1972-75. There has been no allegation or suggestion that any of the veteran's claimed disabilities have any bearing on events during these time periods. As such records have no relevance to the claims at hand, VA has no duty to attempt to obtain them on behalf of the veteran. The Board has held above that the preponderance of the evidence establishes that there have not been persistent or recurrent symptoms of headaches and hypertension since service, and there is no competent evidence that any current disability is associated with an event during service. As such, there is no duty to obtain medical opinion on the claims. Wells v. Principi, 326 F. 3d. 1381, 1384 (Fed. Cir. 2003); McLendon v. Nicholson, 20 Vet. App. 79, 84-86 (2006). The Board finds that, regarding these two issues, there is enough evidence of record to adjudicate both issues at this time. The service and post-service medical record are found to provide, overall, extensive evidence against both claims, clearly indicating that neither disorder began during service to the point that a VA examination is not warranted. VA did provide examination to determine whether the veteran manifested fibromyalgia. Significantly, the veteran and the representative in this case have not identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claims that has not been obtained. Hence, no further notice or assistance to the veteran is required to fulfill VA's duty to assist him in the development of the claims. ORDER Service connection for hemorrhoids is granted. Service connection for hypertension is denied. Service connection for fibromyalgia is denied. Service connection for a headache disorder is denied. REMAND The Board finds that additional development is necessary to decide the claims of service connection for multiple joint and muscle pain, GERD, and fatigue with sleep disturbance. The veteran has asserted on several occasions that he manifests a generalized arthritis which first manifested in service. Currently, service connection is in effect for traumatic degenerative joint disease of both knees, both shoulders, the left hip and the right great toe. A VA compensation and pension examination in February 1996 commented that the veteran's extensive degenerative joint disease, particularly of the knees, in an individual of his age raised the question as to whether he had an underlying metabolic problem. The examiner, therefore, recommended further testing to determine whether a possible metabolic disorder was associated with his arthropathy. It does not appear from the record that such an investigation has been conducted. The Board, therefore, finds that further medical examination and opinion is necessary to decide the case. McLendon, 20 Vet. App. at 84-86. The Board next notes that the RO has denied service connection claims for GERD and fatigue with sleep disturbance on direct and presumptive bases. The veteran has also claimed that his GERD is caused by or aggravated by NSAIDS prescribed to treat his service connected musculoskeletal disorders. Furthermore, a July 2002 VA compensation and pension examiner provided a vague opinion that the veteran's fatigue was more than likely secondary to chronic joint pain with sleep disturbance secondary to joint pain. The RO has not considered these claims on secondary bases, which is a theory of entitlement currently before the Board. See Schroeder v. West, 212 F.3d 1265 (Fed. Cir. 2000). As the veteran has not been provided notice of the criteria for establishing secondary service connection under 38 C.F.R. § 3.310, and the RO has not adjudicated this aspect of the claims, the Board must remand the case for additional development and readjudication. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993) (where the Board addresses a question that has not been addressed by the agency of original jurisdiction, the Board must consider whether the veteran has been prejudiced thereby). On the facts of this case, the Board also finds that clarifying medical opinion is necessary to decide these claims. McLendon, supra. The Board further notes that a successful conclusion to the service connection claims above could have an effect on the veteran's claims of entitlement to specially adapted housing allowance, special home adaptation grant, an automobile allowance and/or specially adapted equipment. In order to avoid any potential prejudice to the veteran, and in the interests of judicial economy, the Board will defer adjudication of the latter claims pending further development and adjudication of the service connection claims. See Harris v. Derwinski, 1 Vet. App. 180 (1991); Gurley v. Nicholson, 20 Vet. App. 573 (2007). Beyond the above, it is important to note that the veteran is already receiving a total 100% rating since 2001. The veteran may wish to withdraw the service connection claims in light of this fact. In any event, until such time as the veteran withdraws these claims, in writing, the Board must adjudicate all claims, fully. Accordingly, the case is REMANDED for the following: 1. Notify the veteran of the types of evidence and/or information that may be capable of substantiating service connection claims for GERD and fatigue with sleep disturbance claims on a secondary basis under 38 C.F.R. § 3.310. 2. Obtain the veteran's clinical records from the Frank M. Tejeda VA Medical Center since April 2007. 3. After completion of the above, schedule the veteran for appropriate VA examination to determine the nature and etiology of his muscle and joint pains. The claims folder must be made available to the examiner for review, and the examiner should be directed to review the February 2006 VA examiner's comment that the veteran may have a possible metabolic disorder responsible for his arthropathy. The examiner should be requested to perform all necessary laboratory tests to clarify the nature and etiology of the veteran's muscle and joint pains. The examiner should obtain clarification from the veteran which muscle groups and/or muscle joints have been causing him pain. Following examination, the examiner should be requested to provide opinion on the following questions: Whether the veteran demonstrates objective indications of muscle and joint pains (which are not currently service connected) attributable to a diagnosed illness, an undiagnosed illness, or a medically unexplained chronic multi-symptom illness. If a known diagnosis is rendered, the examiner should offer an opinion as to whether it is as likely as not that such disorder is related to the veteran's active service, to include clarifying opinion as to whether any of the veteran's symptoms are attributable to an underlying metabolic disorder that first manifested in service or is related to service. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it. The reasoning for the opinions expressed should be fully set forth. If the requested opinions cannot be rendered without resort to speculation, the examiner should so state. 4. The veteran should also be afforded appropriate VA examination to determine the likely etiology of his GERD. The claims folder must be made available to the examiner for review. Following examination and review of the claims folder, the examiner should provide opinion as to whether it is at least as likely as not (probability of 50% or greater) that the veteran's GERD first manifested in service, and/or is causally related to service. Alternatively, the examiner should provide opinion as to whether it is at least as likely as not that any current GERD impairment is caused or aggravated by the veteran's use of NSAIDS to treat his service-connected musculoskeletal disabilities and, if so, the examiner should attempt to quantify the degree of additional impairment resulting from the aggravation. Aggravation is defined for legal purposes as a worsening of the underlying condition versus a temporary flare-up of symptoms. The reasoning for the opinions expressed should be fully set forth. If the requested opinions cannot be rendered without resort to speculation, the examiner should so state. 5. The veteran should also be afforded appropriate VA examination to clarify the nature and etiology of the veteran's fatigue with sleep disturbance. The claims folder must be made available to the examiner for review, and the examiner should be directed to review the July 2002 VA examiner's opinion that the veteran's fatigue was more than likely secondary to chronic joint pain with sleep disturbance secondary to joint pain. The examiner should provide opinion as to whether it is at least as likely as not (probability of 50% or greater) that any current fatigue with sleep impairment is caused or aggravated by the veteran's use of NSAIDS to treat his service-connected musculoskeletal disabilities and, if aggravated, the examiner should attempt to quantify the degree of additional impairment resulting from the aggravation. Aggravation is defined for legal purposes as a worsening of the underlying condition versus a temporary flare-up of symptoms. The reasoning for the opinions expressed should be fully set forth. If the requested opinions cannot be rendered without resort to speculation, the examiner should so state. 6. The RO should review the medical opinions obtained. To help avoid future remand, the RO must ensure that all requested actions have been accomplished (to the extent possible) in compliance with this REMAND. If any action is not undertaken, or is taken in a deficient manner, appropriate corrective action should be undertaken. See Stegall v. West, 11 Vet. App. 268 (1998). 7. Thereafter, readjudicate the claims on appeal with consideration of secondary service connection under 38 C.F.R. § 3.310 for the service connection claims involving GERD and fatigue with sleep impairment. If any claim remains denied, the veteran and his representative should be provided a supplemental statement of the case (SSOC) and an appropriate time to respond thereto. 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). ______________________________________________ JOHN J. CROWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs