Citation Nr: 1319058 Decision Date: 06/12/13 Archive Date: 06/21/13 DOCKET NO. 09-41 517 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to service connection for a stomach disorder (claimed as ulcers), to include as due to service-connected posttraumatic stress disorder (PTSD). REPRESENTATION Veteran represented by: Lester S. Milligan, ED.S. ATTORNEY FOR THE BOARD L. Edwards, Associate Counsel INTRODUCTION The Veteran had active service from September 1969 to May 1971. This matter comes before the Board of Veterans' Appeals (BVA or Board) from a March 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. A timely notice of disagreement was received in May 2009; a statement of the case was issued in September 2009; and a VA Form 9 was received in October 2009. The Veteran now resides in Alabama, so the matter is now handled by the RO in Montgomery, Alabama. The Veteran requested a hearing before the Board; however, he withdrew that request in May 2013. The Board notes that this appeal originally included the claims of entitlement to service connection for PTSD and diabetes mellitus, type 2; these issues were granted in a October 2012 rating decision, and as such, are no longer on appeal. The appeal is REMANDED to the Department of Veterans Affairs Regional Office. VA will notify the Veteran if further action is required. REMAND The Veteran seeks entitlement to service connection for a stomach disorder, claimed as ulcers. In a July 2008 statement, the Veteran stated that thinking about his time in Korea caused him to drink and have stomach problems. Importantly, the Board notes that the Veteran was granted service connection for PTSD in an October 2012 rating decision. The Board is required to consider all issues raised either by the claimant or by the evidence of record. Robinson v. Mansfield, 21 Vet. App. 545, 552 (2008). When determining service connection, all theories of entitlement, direct and secondary, must be considered. Szemraj v. Principi, 357 F.3d 1370, 1371 (Fed. Cir. 2004). Unfortunately, although it will result in an additional delay in adjudicating the Veteran's claim, a remand is in order to provide full consideration of all potential theories of entitlement. Evidence, in the form of a statement from the Veteran's private physician, indicates the Veteran was diagnosed and treated for peptic ulcer disease since early 1970. See January 2009 statement from Dr. H. The Board therefore finds a remand is necessary to obtain a medical opinion regarding the nature and etiology of the claimed stomach disorder. Also, attempts should be made to obtain all records from Dr. H's office since the 1970s concerning treatment the Veteran received for peptic ulcer disease. Additionally, given the Veteran's more recent theory of secondary service connection, he should be sent a new letter notifying him of the information and evidence necessary to substantiate a claim of service connection on a secondary basis to comply with the Veterans Claims Assistance Act of 2000 (VCAA). See Pub. L. No. 106-475, 114 Stat. 2096 (2000); 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2011); see also Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd, Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). Finally, all updated VA and private treatment records should be obtained and associated with the claims file. In particular, the Board notes that a January 2009 letter indicates the Veteran has been treated in a private clinic for his peptic ulcer disease. These records should be obtained and associated with the claims file. Accordingly, the case is REMANDED for the following actions: 1. Send a new VCAA notice letter to the Veteran. The letter should notify him of the information and evidence necessary to substantiate his claim of a stomach disorder, to include as due to PTSD. Notice regarding secondary service connection must be included. The letter should also contain notice of the manner in which both disability ratings and effective dates are assigned for awards of disability benefits. See Dingess/Hartman, 19 Vet. App. at 473. The Veteran should be given an opportunity to respond to the notice, and any additional information or evidence received should be associated with the claims file. 2. Obtain and associate with the claims file all updated treatment records. Also, obtain treatment records from the Arlington Clinic. Also, take appropriate steps to obtain treatment records since the 1970's from Dr. H concerning any treatment the Veteran received for peptic ulcer disease. (See Dr. H's January 2009 letter) All attempts to secure this evidence must be documented in the claims file. If the records are not obtainable, the RO must notify the Veteran and (a) identify the specific records the RO is unable to obtain; (b) briefly explain the efforts that the RO made to obtain those records; and (c) describe any further action to be taken by the RO with respect to the claim. The Veteran must then be given an opportunity to respond. 3. Afford the Veteran an in-person examination for his stomach disorder. Any and all indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The examiner should identify all current stomach disorders. The examiner should specifically state whether the Veteran currently has peptic ulcer disease or any other ulcer disease. For each stomach disorder and/or ulcer disorder diagnosed, the examiner should offer comments and an opinion addressing whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent) that the Veteran's current stomach disorder is causally or etiologically due to service, had its onset during service, or is proximately due to or aggravated (an increase in severity beyond natural progression) by his service-connected PTSD. In rendering these opinions, the examiner should consider the Veteran's statements regarding the onset of his stomach disorder and the duration of any associated symptoms. The examiner should also address Dr. H's report of treating the Veteran for peptic ulcer disease since the 1970's. If it is not possible to provide the requested opinion without resort to speculation, the examiner should state why speculation would be required in this case (e.g., if the requested determination is beyond the scope of current medical knowledge, actual causation cannot be selected from multiple potential causes, etc.). If there are insufficient facts or data within the claims file, the examiner should identify the relevant testing, specialist's opinion, or other information needed to provide the requested opinion. All opinions should be supported by a clear rationale, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. The claims folder must be provided to the examiner for review. The examiner must state in the examination report that the claims folder has been reviewed. 4. The RO should then readjudicate the claim. If the benefits sought are not granted, the Veteran and his representative should be furnished a supplemental statement of the case and be afforded an opportunity to respond. Thereafter, the case should be returned to the Board, if appropriate. The Board intimates no opinion as to the ultimate outcome of this case. The Veteran 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. 2012). _________________________________________________ K. OSBORNE 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).