Citation Nr: 1007267	
Decision Date: 02/26/10    Archive Date: 03/05/10

DOCKET NO.  06-22 741	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Waco, Texas


THE ISSUES

1.  Entitlement to a disability evaluation in excess of 10 
percent for hemorrhoids.

2.  Entitlement to service connection, to include on a 
secondary basis, for prostate disability.

3.  Entitlement to service connection, to include on a 
secondary basis, for lumbar disc disease with sciatic 
radiculopathy.

4.  Entitlement to service connection, to include on a 
secondary basis, for colon disability.

5.  Entitlement to service connection, to include on a 
secondary basis, for bladder disability.


REPRESENTATION

Appellant represented by:	Vietnam Veterans of America

WITNESS AT HEARING ON APPEAL

Appellant


ATTORNEY FOR THE BOARD

D. Schechner, Associate Counsel


INTRODUCTION

The Veteran served on active duty from July 1970 to June 
1972.  

This matter comes before the Board of Veterans' Appeals 
(Board) on appeal from an August 2005 rating decision of the 
Department of Veterans Affairs Regional Office in Waco, 
Texas.

In December 2008, the Board issued a decision on these 
issues.  In September 2009, the Court accepted a Joint Motion 
for Remand filed by the parties, vacating and remanding the 
matters to the Board for further development.  

The Board notes that the Joint Motion specifically indicated 
that the December 2008 Board decision should not be disturbed 
to the extent the decision reopened the claims for service 
connection for prostate disability and for lumbar disc 
disease with sciatic radiculopathy.  The Board has 
characterized those issues on the title page accordingly.

In his October 2008 brief, the Veteran's representative 
raised new claims: 1) service connection for gastroesophageal 
reflux disease (GERD), claimed as secondary to medications 
prescribed for service-connected hemorrhoids; and 2) 
entitlement to an earlier effective date for a compensable 
evaluation for hemorrhoids.  The Board refers these claims to 
the RO for appropriate development and adjudication.

In the December 2008 decision, the Board referred a new claim 
of entitlement to a total disability rating based on 
individual unemployability due to service-connected 
disability to the RO for appropriate action in light of the 
representative's statements.  The Board again refers this 
issue for development.

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

Pursuant to the September 2009 Joint Motion for Remand, the 
issues on appeal require further development.  The parties 
correctly noted that the most recent VA treatment records 
included in the claims file are from October 2005, while the 
Veteran and his representative have referred to treatment 
since that time.  The VA has a duty to assist claimants, to 
include obtaining supporting records that the Veteran 
identifies.  38 U.S.C.A. § 5103A(b)(1).

Regarding the claim for an increased rating for service-
connected hemorrhoids, the Veteran was last afforded a VA 
examination specific to this disability in June 2005.  In 
light of the recent statements of the Veteran, the Board 
finds that the June 2005 examination results are too remote 
in time with respect to the current severity of the disorder, 
and that the Veteran must be scheduled for a new examination 
for his hemorrhoids.

Additionally, the Board finds that additional medical 
evidence is needed to determine the exact nature and severity 
of the Veteran's other claimed disabilities.

The Veteran has stated that his lumbar disability may have 
stemmed from an injury in service during basic training, in 
addition to claiming it as secondary to service-connected 
hemorrhoids.  As there is evidence of a current disability 
and the complete service treatment records are unavailable, 
the Veteran should be afforded a VA spine examination for 
this claim to determine the etiology of the lumbar 
disability.

Regarding the claims for service connection for bladder and 
prostate disabilities, the Veteran has stated that these 
disabilities may have had their onset in service.  Again, as 
the complete service treatment records are unavailable, the 
Veteran should be afforded a VA genitourinary examination to 
determine the etiology of these conditions.

Accordingly, the case is REMANDED for the following actions:

1.  With any necessary identification of 
the appropriate facility or facilities 
from the Veteran, the RO should obtain all 
of the Veteran's VA medical records for 
the period from October 2005 to the 
present.

2.  The RO should contact the Veteran and 
request that he identify the names, 
addresses and approximate dates of 
treatment for all private health care 
providers who may possess additional 
records pertinent to the claims on appeal.  
With any necessary authorization from the 
Veteran, the RO should attempt to obtain 
and associate with the claims files any 
medical records identified by the Veteran 
which have not been secured previously.  

3.  The Veteran should be scheduled for a 
VA medical examination (one general 
medical examination for all claims would 
be sufficient - if a separate 
proctological or genitourinary evaluation 
is needed, it should be so indicated by 
the examiner) to:  

(a) determine the current severity of 
his hemorrhoids; 

(b) determine the exact nature and 
severity of any lumbar disability.  The 
examiner should provide an opinion as 
to whether it is at least as likely as 
not that any lumbar disability 
identified is etiologically related to 
service or was caused or chronically 
worsened by service-connected 
hemorrhoids;

(c) determine the exact nature and 
severity of any colon disability.  The 
examiner should provide an opinion as 
to whether it is at least as likely as 
not that any colon disability 
identified is etiologically related to 
service or was caused or chronically 
worsened by service-connected 
hemorrhoids;

(d) determine the exact nature and 
severity of any bladder disability.  
The examiner should provide an opinion 
as to whether it is at least as likely 
as not that any bladder disability 
identified is etiologically related to 
service or was caused or chronically 
worsened by service-connected 
hemorrhoids; and

(e) determine the exact nature and 
severity of any prostate disability.  
The examiner should provide an opinion 
as to whether it is at least as likely 
as not that any prostate disability 
identified is etiologically related to 
service or was caused or chronically 
worsened by service-connected 
hemorrhoids.

The claims files must be made available to 
the examiners, to allow for consideration 
of previous examination results, to 
include those from June 2005 and February 
2006.

Inform the examiner(s) that the term "at 
least as likely as not" does not mean 
merely within the realm of medical 
possibility, rather that 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 
causation as it is to find against it.  
The examiner(s) should discuss the 
rationale of all opinions offered, whether 
favorable or unfavorable.

4.  After completing the above 
development, the RO should readjudicate 
the claims on appeal, considering any new 
evidence secured.  If the disposition 
remains unfavorable, the RO should furnish 
the Veteran and his representative with a 
supplemental statement of the case (SSOC) 
and afford the applicable opportunity to 
respond.  Thereafter, subject to current 
appellate procedures, the case should be 
returned to the Board for further 
appellate consideration, if appropriate.

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 case must be afforded expeditious treatment.  The law 
requires that all claims that are remanded by the Board of 
Veterans' Appeals or by the Court for additional development 
or other appropriate action must be handled in an expeditious 
manner.  See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009).


_________________________________________________
Thomas H. O'Shay
Acting Veterans Law Judge, Board of Veterans' Appeals

Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the 
Board is appealable to the Court.  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) (2009).