Citation Nr: 1323276 Decision Date: 07/22/13 Archive Date: 08/01/13 DOCKET NO. 12-22 572 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES 1. Entitlement to service connection for distal esophagitis. 2. Entitlement to service connection for peptic duodenitis. 3. Entitlement to service connection for gastritis. (The following issues will be subject of a separate decision: (1) entitlement to service connection for a cervical spine disorder; (2) entitlement to a higher initial rating for irritable bowel syndrome (currently rated as 10 percent disabling from November 4, 1981, and 30 percent disabling in combination with service-connected gastroesophageal reflux disease from August 28, 2009); (3) entitlement to an effective date prior to August 28, 2009, for the grant of service connection for gastroesophageal reflux disease, (4) entitlement to service connection for a bilateral knee disorder; and (5), entitlement to service connection for a low back disorder.) REPRESENTATION Appellant represented by: Michael Eby WITNESS AT HEARING ON APPEAL The appellant ATTORNEY FOR THE BOARD S. Higgs, Counsel INTRODUCTION The Veteran served on active duty from November 1977 to October 1981. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. In January 2013, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge pursuant to the provisions of 38 U.S.C.A. § 7107(e) (West 2002). The hearing addressed these three issues. A transcript of the proceeding is of record. 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 has denied the Veteran's claims for service connection for esophagitis, peptic duodenitis, and gastritis, in part, based on an August 2011 VA examiner's finding that the Veteran does not have such disorders. The August 2011 VA examiner's opinions relied on a upper gastrointestinal series (UGIS) study showing the absence of these three claimed conditions and on a March 10, 1982, normal UGIS and normal cholecystogram. However, the August 2011 VA examiner appears to have overlooked a March 10, 1982, esophagogastroduodenoscopy report that includes impressions of distal esophagitis, acute gastritis (more severe in the prepyloric area), and focal acute duodenitis, as well as March 13, 1982, hospital discharge diagnoses of esophagitis, acute gastritis, and peptic duodenitis. Moreover, since the time of the August 2011 VA examination, the Veteran underwent a VA gastrointestinal work-up in June 2012 with an EGD study and stomach biopsy resulting in a diagnosis of gastritis. Therefore, the Board finds that a follow-up medical opinion is necessary. Additionally, in light of the June 2012 gastrointestinal work-up, an attempt should be made to obtain any additional VA medical records possibly pertaining to follow-up treatment. See Bell v. Derwinski, 2 Vet. App. 611, 613 (1992) (holding that relevant VA treatment records are considered to be constructively contained in the claims folder and must be obtained before a final decision is rendered). Accordingly, the case is REMANDED for the following action: 1. The RO/AMC should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for distal esophagitis, gastritis, and peptic duodenitis. After acquiring this information and obtaining any necessary authorization, the RO/AMC should obtain and associate these records with the claims file. The RO/AMC should obtain any outstanding VA medical records dated from June 2012 to the present. 2. Once all identified and available medical records have been received, the RO/AMC should obtain a follow-up medical opinion from an appropriately qualified clinician for the purpose of determining whether the Veteran has esophagitis, gastritis, or peptic duodenitis, and if so, the etiology of the disorder(s). The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records; private treatment records from March 9, 1982, to March 13, 1982, including a March 10, 1982, esophagogastroduodenoscopy report that includes impressions of distal esophagitis, acute gastritis (more severe in the prepyloric area) and focal acute duodenitis; the March 13, 1982, hospital discharge diagnoses of distal esophagitis, acute gastritis, and peptic duodenitis; an August 2011 VA gastrointestinal examination report; and, records of a June 2012 VA gastrointestinal work-up. If the VA clinician finds that the requested opinions cannot be provided without further examination of the Veteran, such an examination should be scheduled. The VA clinician should indicate whether it is at least as likely as not (whether there is a 50 percent or greater probability) that the Veteran has had esophagitis, gastritis, or peptic duodenitis at any time since October 1981 and whether the disorder has been present since 2009. For each diagnosed condition (esophagitis, gastritis, and/or peptic duodenitis), the clinician should indicate whether the disorder began during active service or is otherwise related to his military service, including his symptomatology therein. He or she should also state whether it is at least as likely as not that the disorder was caused or chronically worsened by the Veteran's service-connected gastroesophageal reflux disease, irritable bowel syndrome, or major depression and anxiety. In all conclusions, the examiner should identify and explain the medical basis or bases with identification of the relevant evidence of record. He or she should provide a fully reasoned explanation for his or her opinions, as a matter of medical probability, based on established medical principles and his or her clinical experience and medical expertise. 3. After completing the above actions, the RO/AMC should conduct any other development as may be indicated by a response received as a consequence of the actions taken in the preceding paragraphs. 4. When the development requested has been completed, the case should be reviewed by the RO on the basis of additional evidence. If the benefits sought are not granted, the Veteran and his representative should be furnished a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. Thereafter, subject to current appellate procedure, the case must be returned to the Board for further consideration, if otherwise in order. No action is required of the Veteran until he is otherwise notified by the RO. By this action, the Board intimates no opinion, legal or factual, as to any ultimate disposition warranted in this case. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These matters 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). _________________________________________________ JESSICA J. WILLS 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).