Citation Nr: 1306127 Decision Date: 02/22/13 Archive Date: 02/27/13 DOCKET NO. 08-37 746 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUE Entitlement to service connection for a stomach disorder, to include gastroesophageal reflux disease (GERD). WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD M. M. Celli, Associate Counsel INTRODUCTION The Veteran served on active duty from February 1991 to August 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2007 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In July 2012, the Veteran testified before the undersigned Veterans Law Judge at a hearing held at the RO. A transcript of that hearing is associated with the claims file. The Veteran also submitted additional evidence directly to the Board with a waiver of initial RO consideration. As such, this evidence is accepted for inclusion in the record on appeal. See 38 C.F.R. §§ 20.800, 20.1304 (2012). The appeal is REMANDED to the RO via the Appeals Management Center (AMC) in Washington, DC. VA will notify the Veteran if further action is required. REMAND The Veteran contends that he has a stomach disorder that began during active duty. Specifically, the Veteran asserts that he began having stomach problems, which included regurgitation and vomiting, while stationed at Fort Gordon, Georgia in 1996. He states that although physicians originally diagnosed a stomach flu or virus, he continued to have the same problems throughout the remainder of his active duty service. In this respect, the Veteran reports that because he was a medical specialist in service, he was seen in his own internal medical clinic. He asserts that although acid reflux was first diagnosed in 2000, he had been having the same symptoms since the in-service illness in 1996. The Veteran further asserts that he did not seek treatment immediately following separation from service because he did not have health insurance. The Veteran's DD-214 shows the Veteran's military occupation specialty was medical specialist. A January 1996 service treatment record shows the Veteran complained of having diarrhea symptoms for four days, stomach cramping for three days, and nausea and vomiting for one day. It was noted that the Veteran had a prior medical history of cramping resolved, with diarrhea and vomiting. The assessment was gastroenteritis. A follow-up January 1996 service treatment record reflects that the Veteran reported continued symptoms of nausea and diarrhea, and the assessment was gastroenteritis. A September 2000 emergency department assessment form demonstrates the Veteran complained of dizziness, nausea, and vomiting. The diagnosis was vertigo versus a stomach flu. A January 2004 private treatment progress note indicates the Veteran complained of a one-month history of acid reflux. The assessment was GERD. A May 2006 private treatment record reflects an impression of acute gastritis, and in July 2007, a private physician reported that he had been treating the Veteran for GERD since October 2006. A July 2011 private treatment record reflects a prior medical history of diseases of the esophagus, esophageal reflux, and a July 2012 prescription indicates the Veteran was taking Lansoprazole for certain stomach and esophagus problems. The record does not show that a VA examination was performed in connection with the Veteran's claim. Generally, a VA examination is necessary prior to final adjudication of a claim when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifested during an applicable presumptive period for which the Veteran qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for VA to make a decision on the claim. 38 U.S.C.A. § 5103A(d)(2) (West 2002 & Supp. 2012); 38 C.F.R. § 3.159(c)(4)(i) (2012); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Here, the record reflects multiple diagnoses for the Veteran's stomach symptoms, to include a diagnosis of GERD in July 2007, and as such, the Board finds the evidentiary requirement of demonstrating a current disability has been satisfied. Hickson v. West, 12 Vet. App. 247, 253 (1999). Additionally, service treatment records demonstrate complaints of stomach problems during active duty. Further, the Veteran has testified that he has continued to experience the same symptoms since his separation from service. The Veteran is competent to testify to symptomatology capable of lay observation. See Charles v. Principi, 16 Vet. App. 370, 374 (2002); Layno v. Brown, 6 Vet. App. 465, 469 (1994). As a result, the Board finds that a remand for a VA examination is warranted in order to ascertain whether any current stomach disorder is etiologically related to active duty. See McLendon, 20 Vet. App. at 83; 38 C.F.R. § 3.159(c)(4). Finally, at the July 2012 Board hearing, the Veteran testified that he received additional treatment for his symptoms at the Eisenhower Army Medical Center in July 1996. As the current claims file does not include these records, they should be obtained on remand. 38 C.F.R. § 3.159(c)(2); Bell v. Derwinski, 2 Vet. App. 611 (1992). Accordingly, the case is REMANDED for the following actions: 1. The RO/AMC should obtain and associate with the record any additional service treatment records from the Eisenhower Army Medical Center, to specifically include records dated in July 1996. All actions to obtain the requested records should be documented fully in the claims file. If any cannot be located or no such records exist, a memorandum of unavailability should be associated with the claims file and the Veteran should be provided a copy of the memorandum. 2. Then, schedule the Veteran for a VA examination for the purpose of ascertaining the nature and etiology of any current stomach disorder. The claims file should be made available to the examiner in conjunction with the examination. Any medically indicated tests should be accomplished, and all pertinent symptomatology and findings must be reported in detail. Based on the physical examination of the Veteran and review of the claims file, to include the Veteran's service treatment records, private treatment records, and Veteran's lay testimony pertaining to his symptoms during and after service, the examiner should give an opinion as to whether it is at least as likely as not (50 percent probability or more) that any diagnosed stomach disorder is related to active duty. In formulating the opinion, the term "at least as likely as not" does not mean "within the realm of possibility." Rather, it means that the weight of the medical evidence both for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against it. A complete rationale should be provided for any opinion or conclusion expressed. 3. After undertaking the development above, readjudicate the Veteran's claim. If any benefit sought on appeal remains denied, provide a Supplemental Statement of the Case to the Veteran and an appropriate period of time in which to respond. Then, return the appeal to the Board. The Veteran has the right to submit additional evidence and argument on the matter 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. 2012). _________________________________________________ ROBERT C. SCHARNBERGER 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).