Citation Nr: 18146037
Decision Date: 10/30/18	Archive Date: 10/30/18

DOCKET NO. 16-28 537
DATE:	October 30, 2018
REMANDED
Entitlement to service connection for a throat disorder, to include as secondary to the service-connected gastrointestinal (GI) disability is remanded.
Entitlement to an initial rating in excess of 20 percent for duodenal ulcer, post gastrectomy syndrome, bile reflux gastritis and hiatal hernia with gastrointestinal reflux disorder (GERD) is remanded.
REASONS FOR REMAND
The Veteran had active military service from January 1964 to May 1965.  This matter is on appeal from a May 2015 rating decision.
1. Entitlement to service connection for a throat disorder, to include as secondary to the service-connected GI disability, is remanded.
As an examination for the Veteran's service-connected GI disability could reasonably and concievably show a throat disorder secondary to such disability, on account of the anatomical proximity of the two disorders, a remand of this service-connected claim is required.  38 C.F.R. § 3.159(c)(4).
2. Entitlement to an initial rating in excess of 20 percent for duodenal ulcer, post gastrectomy syndrome, bile reflux gastritis and hiatal hernia with GERD is remanded.
Private treatment records received in December 2016 suggest that the Veteran's disability may have increased in severity (e.g., loss of weight) since he was last examined by VA.  The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his GI disability. 
The matters are REMANDED for the following action:
1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), make efforts to obtain all records identified by the Veteran, including any outstanding VA treatment records. 
2. Schedule the Veteran for a VA examination by an appropriate clinician to determine the etiology of any diagnosed throat disorder, as well as the current severity of the Veteran’s service-connected duodenal ulcer, post gastrectomy syndrome, bile reflux gastritis and hiatal hernia with GERD.  The most up-to-date Disability Benefits Questionnaire(s) should be utilized.
For any throat disorder diagnosed, the examiner is requested to review the record and offer an opinion as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnosed throat disorder is caused or aggravated by the service-connected GI disability.  (If a throat disorder is found to have been aggravated by the service-connected GI disability, the examiner should quantify the approximate degree of aggravation.)  A complete rationale should be given for all opinions and conclusions expressed.
Regarding the service-connected GI disability, the examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria.  To the extent possible, the examiner should identify any symptoms and functional impairments due to the Veteran's GI disability alone and discuss the effect of the Veteran’s duodenal ulcer, post gastrectomy syndrome, bile reflux gastritis and hiatal hernia with GERD on any occupational functioning and activities of daily living.  If it is not possible to provide an opinion regarding symptoms or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training.
 
A. C. MACKENZIE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	L. Barstow, Counsel