Citation Nr: 18142724 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 08-38 447 DATE: October 17, 2018 REMANDED Entitlement to compensation under the provisions of 38 U.S.C. § 1151 for a pancreatic disability, other than brittle diabetes, is remanded. REASONS FOR REMAND The Veteran served honorably on active duty with the United States Air Force from June 1979 to June 1988. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington which, inter alia, denied the claim on appeal. The matter was most recently before the Board in May 2016, at which time it was remanded for further development. At that time, the matter was characterized as “[e]ntitlement to compensation under the provisions of 38 U.S.C. § 1151 for a pancreatic disability, to include brittle diabetes.” In an April 2018 rating decision, the RO granted entitlement to compensation under § 1151 for diabetes, based on aggravation. However, as the evidence suggests the Veteran has (or at one time had) a pancreatic disability separate and distinct from diabetes, the RO continued to adjudicate the issue of entitlement to benefits under § 1151 for a pancreatic disability. Therefore, the Board has characterized the issue on appeal accordingly. In July 2012, the Veteran testified at a hearing before a Veterans Law Judge who is no longer employed by the Board. A transcript of the hearing is associated with the claims file. In a May 2018 letter, the Veteran was offered the opportunity for another hearing but did not respond. Therefore, the Board will proceed with adjudicating the claim on appeal. Entitlement to compensation under the provisions of 38 U.S.C. § 1151 for a pancreatic disability, other than brittle diabetes, is remanded. Although the Board regrets the delay, another remand is necessary to ensure there is a complete record on which to adjudicate the Veteran’s claim. In accordance with the May 2016 remand instructions, the Veteran was afforded a VA examination in October 2016. The examiner noted that the Veteran had been diagnosed with pancreatitis in 2001 and had her gallbladder removed in 2004. The examiner did not note whether the pancreatitis diagnosis was chronic or acute. The examiner indicated that continuous medication is required for control of the Veteran’s gallbladder or pancreas condition. The examiner also indicated that the Veteran has experienced 8 or more attacks in the past 12 months of moderately severe abdominal pain, “confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies.” Nevertheless, the examiner later stated, “although the veteran has multiple subjective GI symptoms, there is no objective evidence of remote or current pancreatitis based on her lab results.” The examiner then indicated that the Veteran’s symptom of abdominal pain “could be reasonably attributed to pancreatitis” but that it was “more likely than not” that the Veteran’s gastrointestinal symptoms “are not related to her pancreas condition.” The examiner wrote that the available medical records “do not support an unequivocal diagnosis of pancreatic exocrine dysfunction” and concluded, “[t]here is no objective laboratory evidence to support a diagnosis of pancreatitis.” Overall, the Board finds the examiner’s report to be confusing and thus inadequate for purposes of adjudication. On the one hand, the examiner found that the Veteran experienced numerous attacks of abdominal pain “confirmed as resulting from pancreatitis” over the past 12 months and seemed to suggest the presence of a pancreatic condition that requires continuous medication for control. However, the examiner ultimately concluded that the evidence does not support a finding that the Veteran has pancreatitis and therefore declined to opine as to its relation to the prescription of Dilantin. For these reasons, remand for clarification of the examiner’s report is necessary. The matter is REMANDED for the following action: 1. Return the Veteran’s claims file, as well as a copy of this Remand, to the examiner who performed the October 2016 VA examination, if available. If the examiner is unavailable, provide the claims file and a copy of this Remand to a different examiner with sufficient expertise to provide an opinion in this matter. The examiner shall answer the following questions: (a) What pancreatic disabilities have been present since October 2006? In answering this question, the examiner is asked to specifically address the October 2016 examination report indicating the Veteran experienced 8 or more attacks in the past 12 months of moderately severe abdominal pain, “confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies,” as well as the finding that the Veteran’s abdominal pain “could be reasonably attributed to pancreatitis.” The examiner should also address the finding that the Veteran’s “gallbladder or pancreas condition” requires constant medication for control. (b) Did the Veteran’s reaction to Dilantin (and resulting hypersensitivity vasculitis, eosinophilia, and prednisone treatment) cause or aggravate any pancreatic disability other than diabetes? If a pancreatic disability other than diabetes was aggravated by the reaction to Dilantin, the examiner should specify the baseline severity of the pancreatic disability and the extent of the permanent, measurable increase in its severity due to the reaction to Dilantin (and resulting hypersensitivity vasculitis, eosinophilia, and prednisone treatment). A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. T. Raftery, Associate Counsel