Citation Nr: 18147718
Decision Date: 11/06/18	Archive Date: 11/05/18

DOCKET NO. 17-62 044
DATE:	November 6, 2018
REMANDED
Entitlement to service connection for hemorrhoids, including as secondary to a service-connected disability, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from February 2006 to February 2013.
Entitlement to service connection for hemorrhoids, including as secondary to a service-connected disability, is remanded.
While the Board sincerely regrets the additional delay, the claim for hemorrhoids must be remanded for another VA examination. 
The Veteran’s service treatment record (STR) dated August 2009 shows that he presented with complaints of blood in his stool. At an April 2017 VA examination, the examiner noted that the Veteran declined physical examination and stated that he did not currently have hemorrhoids. Based on the Veteran’s statement, STRs and post-service medical treatment records, the examiner concluded that there was no diagnosis of hemorrhoids because there was no pathology to render a diagnosis. The Veteran, however, clarified that he did not feel comfortable with the examiner and that he meant that he did not have hemorrhoids at the time of the examination, but he had active and inactive periods of hemorrhoids. See notice of disagreement dated May 2017. 
Alternatively, the Veteran claims that his hemorrhoids are secondary to his service-connected posttraumatic stress disorder (PTSD). However, a March 2017 VA examiner stated that she could not offer an opinion regarding the relationship between hemorrhoids and PTSD because it was beyond the purview of her practice specialty of psychology. Accordingly, a new VA examination is warranted. 
The matter is REMANDED for the following action:
1. Obtain the Veteran’s VA medical treatment records dated from May 2018 forward.
2. After obtaining any outstanding records, schedule the appropriate VA examination to determine the nature and etiology of the Veteran’s claimed hemorrhoids. The claims file must be made available to the examiner for review. All indicated tests and studies must be performed and a comprehensive history should be obtained. 
The examiner should provide an opinion as to whether it is at least as likely as not (i.e., at least 50 percent probability) that any diagnosed hemorrhoids began during the Veteran’s periods of active service from February 2006 to February 2013, including the August 2009 complaint of bloody stools, or that it is otherwise related to service.
The examiner should also provide an opinion as to whether any diagnosed hemorrhoids was either caused by or aggravated by service-connected PTSD and/or GERD).
In providing the requested opinions, the examiner should refer to the relevant evidence of record, to include the service treatment records, VA and private medical treatment records, physical examination of the Veteran and his statements.

 
Nathaniel J. Doan
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	N. Sangster, Counsel