Citation Nr: 1328265 Decision Date: 09/05/13 Archive Date: 09/16/13 DOCKET NO. 10-02 037 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUES 1. Entitlement to a rating higher than 30 percent for Crohn's disease. 2. Entitlement to an initial rating in excess of 10 percent for anal-rectal fistulas. 3. Entitlement to an initial rating in excess of 10 percent for anemia and headaches prior to March 4, 2008, and in excess of 30 percent from March 4, 2008 forward. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Shamil Patel, Counsel INTRODUCTION The Veteran served on active duty from November 1982 to July 1984. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburgh, Pennsylvania. The RO continued a 30 percent rating for service-connected Crohn's disease. It also granted service connection for anal-rectal fistulas and anemia with headaches and fatigue. Each condition was assigned a 10 percent rating effective August 22, 2006. In January 2010, the RO increased the assigned rating for anemia with headaches and fatigue to 30 percent effective March 4, 2008. The Veteran's Virtual VA file has also been reviewed as part of her appeal. The issue of entitlement to an increased rating for alopecia areata has been raised by the record, specifically in correspondence dated January 2009 and received in June 2009, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. 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 In a June 2013 brief, the Veteran's representative argued that the Veteran's disabilities had worsened since they were last examined by VA, and that the examinations were too old to evaluate her disabilities. The Veteran was afforded VA examinations for her conditions in October 2007. Private treatment records associated with the claims file are dated through May 2009. In light of the assertion that the Veteran's conditions have worsened, and given the fact that the medical evidence does not cover the period from May 2009 forward, the case must be remanded for additional examinations. 38 C.F.R. § 3.327(a) (2012); see also Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992) (holding that when a Veteran claims that a disability is worse than when last examined by VA, and the available evidence is too old to adequately evaluate the current state of the condition, VA must provide a new examination); Allday v. Brown, 7 Vet. App. 517, 526 (1995) (where the record does not adequately reveal the current state of the claimant's disability, fulfillment of the statutory duty to assist requires a contemporaneous medical examination, particularly if there is no additional medical evidence adequately addressing the level of impairment of the disability since the previous examination). As the claim is being remanded, any recent treatment records should be obtained. Accordingly, the case is REMANDED for the following action: 1. Ask the Veteran to identify all medical care providers that have treated her for her Crohn's disease, anal-rectal fistulas, and anemia with headaches since May 2009, including, but not limited to, Henry Ford Hospital and Medical Centers and/or Henry Ford Health System. Make arrangements to obtain all records that she adequately identifies. 2. Thereafter, schedule the Veteran for a VA examination to determine the current level of impairment due to her service- connected Crohn's disease. The claims folder should be made available to the examiner for review in conjunction with the examination and the examiner should acknowledge such review in the examination report. The examiner should include a comprehensive history of the Veteran's symptoms along with their severity. The examiner must then address whether the Veteran's Crohn's disease is (i) moderately severe, with frequent exacerbations, (ii) severe, with numerous attacks per year and malnutrition, the health only fair during remissions, or (iii) pronounced, resulting in marked malnutrition, anemia, and general debility, or with serious complication as liver abscess. The examiner must provide a comprehensive report and provide a detailed explanation of the rationale for each opinion expressed. 3. Schedule the Veteran for a VA examination to determine the current severity of her anemia. The claims folder should be made available to the examiner for review in conjunction with the examination and the examiner should acknowledge such review in the examination report. All studies indicated should be performed, and in particular, a laboratory study should be performed to determine the Veteran's current hemoglobin level. All the results from the indicated studies should be made available to the examining physician in conjunction with the completion of his or her examination report. The examiner should identify all manifestations of the Veteran's disability, including any high output congestive failure, dyspnea on mild exertion, dyspnea at rest, cardiomegaly, tachycardia, or syncope. The examiner must provide a comprehensive report and provide a detailed explanation of the rationale for each opinion expressed. 4. Schedule the Veteran for a VA examination to determine the severity of her anal-rectal fistulas. The claims folder should be made available to the examiner for in conjunction with the examination and the examiner should acknowledge such review in the examination report. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner should elicit a complete history of symptomatology from the Veteran, the pertinent details of which should be included in the examination report. Following examination of the Veteran and review of the claims file, the examiner should identify all current manifestations of the service-connected anal-rectal fistualas, to include the frequency (constant or occasional) and extent (slight, moderate, extensive) of any leakage; the frequency of any involuntary bowel movements; whether the condition necessitates wearing a pad; and whether there is complete loss of sphincter control. The examiner must provide a comprehensive report and provide a detailed explanation of the rationale for each opinion expressed. 5. Next, the VA examination reports should be reviewed to ensure that they are in complete compliance with the directives of this remand. If any report is deficient in any manner, it should be returned to the examiner for corrective action. 6. Finally, readjudicate the claims on appeal. If the claims are not granted to the Veteran's satisfaction, send her and her representative an SSOC and give them an opportunity to respond before returning the file to the Board for further appellate consideration of these claims. 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. 2012). _________________________________________________ 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).