Citation Nr: 18156682 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 03-26 210 DATE: December 11, 2018 REMANDED Entitlement to service connection for a chest disorder is remanded. Entitlement to service connection for fracture of the body is remanded. Entitlement to service connection for a kidney disorder is remanded. Entitlement to service connection for a gastrointestinal disorder is remanded. Entitlement to service connection for residuals of Giardia lamblia infection is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1971 to June 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2002 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2004, the Board remanded the claims for development. In an August 2008 decision, the Board denied the Veteran’s claims. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In a July 2009 Order, pursuant to a Joint Motion for Remand, the Court vacated and remanded the August 2008 decision back to the Board. The Board thereafter remanded claims for further development in October 2010 and September 2016. 1. Entitlement to service connection for a chest disorder is remanded. The Veteran has not yet been afforded a VA examination for his chest disorder, despite the prior Board remand directing such an examination, and such should be scheduled. See Stegall v. West, 11 Vet. App. 268 (1998). 2. Entitlement to service connection for a kidney disorder is remanded. 3. Entitlement to service connection for a gastrointestinal disorder is remanded. 4. Entitlement to service connection for residuals of Giardia lamblia infection is remanded. The August 2017 VA examiner opined that the Veteran’s gastrointestinal disorders were not related to his active duty service or residuals of his in-service Giardia lamblia infection based, in part, on medical literature. However, in November 2018, the Veteran’s representative cited to medical articles in support of the claim discussing Giardia lamblia and the long-term consequences of infections, including the development of gastrointestinal disorders. As for the Veteran’s diagnosed kidney disorder, the August 2017 VA examiner did not consider whether such was due to his in-service Giardia lamblia infection. Therefore, an addendum opinion is needed on remand. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 5. Entitlement to service connection for an acquired psychiatric disorder is remanded. A remand is warranted for the Veteran’s claim of entitlement to service connection acquired psychiatric disorder, as the July 2017 VA examiner’s opinion is inadequate. Specifically, the examiner did not provide sufficient rationale for his opinion, failed to address all of the Veteran’s psychiatric diagnoses of record, and inaccurately stated that the Veteran first underwent psychiatric evaluation in 2004, when in fact a March 1998 record shows that he received a provisional diagnosis of a nervous condition. Accordingly, an addendum opinion is necessary. 6. Entitlement to service connection for fracture of the body is remanded. Finally, while the RO received correspondence from the Social Security Administration (SSA) that there were no medical records for the Veteran, his attorney has provided updated correspondence noting that he is in receipt of SSA disability benefits. See July 2017 correspondence. Another effort to obtain these records should be made on remand. Any outstanding treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding relevant private treatment records. 3. Make a second attempt to obtain the Veteran’s disability benefit determination and medical records from SSA. See July 2017 correspondence. 4. Then schedule the Veteran for a VA examination to determine the nature and etiology of any chest disorder. All indicated tests and studies should be performed and all findings reported in detail. Following a review of the claims file, the examiner is asked to address the following: (a) Identify all chest disorders present since September 2002. (b) For each disorder so diagnosed, please opine as to whether it is at least as likely as not (50 percent or greater probability) that such disorder had its onset in service or is otherwise related to service, to include as a result of the documented sternal contusion and complaints of chest/substernal pain therein. See March and April 1971 service treatment records. A complete rationale should be given for all opinions and conclusions expressed. 5. Then refer the claims file to an examiner for preparation of an addendum opinion as to the etiology of the Veteran’s gastrointestinal and kidney disorders, and any residuals of his in-service Giardia lamblia infection. The entire claims file should be made available to the examiner. No additional examination is necessary, unless the examiner determines otherwise. Following a review of the claims file, the examiner is asked to address the following: (a)Identify all gastrointestinal and kidney disorders, as well as any residuals of a Giardia lamblia infection diagnosed since September 2002, to include gastritis, hiatal hernia, gastric ulcers, duodenitis, and chronic renal disease. If any of the diagnoses are not warranted, please reconcile these findings with the diagnoses of record in the April 2007 VA treatment record and August 2017 VA examination reports. (b) For each disorder so diagnosed, please opine as to whether it is at least as likely as not (50 percent or greater probability) that such disorder had its onset in service or is otherwise related to service, to include as a result of the documented reports of abdominal/epigastric pain and Giardia lamblia infection therein. See March and April 1971 service treatment records. In addressing these questions, please consider and discuss the medical articles, “Extra-intestinal and long term consequences of Giardia duodenalis infections,” “Development of functional gastrointestinal disorders after Giardia lamblia infection,” and the MedicineNet article cited by the Veteran’s representative in November 2018. See https://ncbi.nlm.nih.gov/pubmed/24379622; https://ncbi.nlm.nih.gov/pubmed/19383162; https://www.medicinenet.com/giardia_lamblia/article.htm#what_signs_and_symptoms_does_giardiasis_cause. A complete rationale should be given for all opinions and conclusions expressed. 6. Then refer the claims file to an examiner for preparation of an addendum opinion as to the etiology of the Veteran’s psychiatric disorder. The entire claims file should be made available to the examiner. No additional examination is necessary, unless the examiner determines otherwise. Following a review of the claims file, the examiner is asked to address the following: (a) Identify all psychiatric disorders diagnosed since September 2002, to include psychosis, psychotic disorder not otherwise specified (NOS), major depressive disorder, depressive disorder NOS, and schizophrenic disorder. If any of the diagnoses are not warranted, please reconcile these findings with the diagnoses of record in the March 2004, July 2004, April 2006, March 2010, and February 2013 VA treatment records. (b) If a personality disorder is diagnosed, please opine as to whether it is at least as likely as not (50 percent probability or greater) that any other currently diagnosed acquired psychiatric disorder was superimposed upon his personality disorder during service. If so, please identify the disorder so superimposed. (c) For each psychiatric disorder diagnosed other than personality disorder, please opine as to whether it is at least as likely as not (50 percent probability or greater) that such disorder had its onset in service or is otherwise related to service, to include as a result of the documented April 1971 report of frequent trouble sleeping, frequent/terrifying nightmares, depression/excessive worry, and nervous trouble therein, as well as the April 1971 provisional diagnosis of inadequate personality and diagnosis of passive aggressive personality. If the criteria for a diagnosis of a psychotic disorder are met, please state, to the best of your ability, whether the prodromal period for such disorder as likely as not had its onset during the Veteran’s period of active service. Please note the Veteran’s treatment of a nervous condition in 1998 (contained in an August 8, 2001 VA 10-10 Forms entry in VBMS), as well as his report in a March 2004 VA psychiatric treatment record of seeking psychiatric treatment at that facility “about 20 years ago.” (d) If psychosis is diagnosed, including schizophrenic disorder, please opine as to whether it is at least as likely as not (50 percent probability or greater) that such disorder was present within one year of the Veteran’s separation from service (by June 1972). If so, please indicate the level of severity of the disability at the time of its onset. A complete rationale should be given for all opinions and conclusions expressed. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.S. Mahoney, Associate Counsel