Citation Nr: 1237753 Decision Date: 11/05/12 Archive Date: 11/09/12 DOCKET NO. 09-25 051 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Providence, Rhode Island THE ISSUES 1. Entitlement to an initial compensable rating for gastroesophageal reflux disease (GERD). 2. Entitlement to service connection for residuals of a right hand injury. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Sarah Richmond, Counsel INTRODUCTION The Veteran had active military service from February 2006 to June 2006, July 2006 to October 2007, and September 2009 to November 2010. This matter comes to the Board of Veterans' Appeals (Board) from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Providence, Rhode Island. In January 2008, the RO denied service connection for residuals of a right hand injury. The RO continued this denial in a June 2008 rating decision, but granted service connection for GERD assigning a noncompensable (0 percent) rating, effective October 23, 2007. 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 RO granted service connection for GERD in a June 2008 rating decision and assigned a noncompensable rating, effective October 23, 2007. The Veteran appealed this rating and contends that his GERD is worse than the rating assigned. The Veteran was last evaluated for this disability in December 2007, at which time he underwent a general VA examination and was noted to have minimal GERD. Since that time, the Veteran has been deployed again and had a period of active duty service from September 2009 to November 2010. September 2010 service treatment records during that time show the Veteran complained that his GERD had worsened. He reported that his GERD caused severe heartburn and that the symptoms had gradually worsened over the past year while deployed. The fulfillment of the duty to assist includes the conduct of a thorough and contemporaneous medical examination. Green v. Derwinski, 1 Vet. App. 121, 124 (1991). However, the mere passage of time between the last examination and the Board's review does not automatically render the examination inadequate; there must be evidence of a change in the condition or allegation of worsening of the condition. Palczewski v. Nicholson, 21 Vet. App. 174, 182 (2007). As the record shows the Veteran's GERD has potentially worsened since it was last evaluated in December 2007, another examination is warranted to determine the present severity of the GERD. The Veteran also seeks service connection for residuals of a right hand injury. The service treatment records show the Veteran injured his hand in September 2007 when he reportedly fell while mopping and his hand went through a window. He suffered a laceration to the back of the right hand that was measured as 1cm and was slightly distal to the 5th knuckle. After service in February 2008, he complained of unspecified wrist and joint pain. The Veteran underwent VA examination in January 2008. It was noted that the Veteran injured his right wrist with a laceration of the dorsum and wrist sprain in military service. There was a well-healed scar on the dorsum. The diagnosis was normal examination of the right wrist and the examiner determined that the wrist sprain had completely healed. Thereafter, as noted, the Veteran underwent an additional period of service from September 2009 to November 2010. The RO has not reviewed the new evidence of record pertaining to the claims on appeal, including the new service treatment records. It appears that the Veteran has waived RO jurisdiction over some of the evidence submitted since that time, but not all of it. For this reason, the RO should prepare a supplemental statement of the case with consideration of all relevant evidence received since the statement of the case in June 2009. See 38 C.F.R. § 19.37. An additional examination is also warranted to address the Veteran's right hand claim. Although a right hand disorder was not diagnosed on VA examination in January 2008, the examiner did note the presence of a scar on the dorsum. Also, the Veteran stated in November 2008 that he was experiencing soreness and stiffness in his right hand. Finally, efforts should be undertaken to ensure that the Veteran's complete VA treatment records have been obtained from the Providence, Rhode Island VA Medical Center (VAMC). Accordingly, the case is REMANDED for the following action: 1. Make arrangements to obtain the Veteran's treatment records from the VAMC in Providence, Rhode Island, pertaining to GERD and the right wrist and hand, dated since November 2010. 2. Thereafter, schedule the Veteran for a VA GERD examination to address the impairment associated with his GERD. The claims folder should be made available to and reviewed by the examiner. All necessary tests should be performed. The examiner should identify and describe in detail all residuals attributable to the Veteran's service-connected GERD now or in the recent past, including the following: (a) State whether there is persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. (b) State whether there are two or more symptoms of the above criteria in (a) but with less severity. (c) State whether there are symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. The examiner must provide a comprehensive report including complete rationale for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. 3. Schedule the Veteran for a VA orthopedic and scar examination of his right wrist and hand. The claims file must be made available to, and reviewed by, the examiner. All appropriate testing should be conducted. The examiner should perform a thorough orthopedic and scar evaluation of the Veteran's right wrist and hand and identify all current disabilities. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any current right wrist and hand disability (including any scars) had its clinical onset during active service or is related to any in-service disease, event, or injury. The examiner should consider the Veteran's in-service injury in September 2007 when he fell while mopping and his hand went through a window, and his lay assertions regarding any symptoms since military service. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. If the examiner is unable to answer any question without a resort to speculation, then he or she should so indicate and provide a rationale for why an answer could not be provided. 4. Next, review the medical opinions obtained above to ensure that the remand directives have been accomplished. If all questions posed are not answered or sufficiently answered, return the case to the examiner(s) for completion of the inquiry. 5. Finally, readjudicate the claims on appeal with consideration of all additional evidence added to the record since the evidence listed in the June 2009 SOC. If either of the benefits remain denied, issue the Veteran and his representative a Supplemental Statement of the Case and allow for a reasonable period to respond. 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. 2011). _________________________________________________ P.M. DILORENZO 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) (2012).