Citation Nr: 18156931 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 16-54 718 DATE: December 11, 2018 REMANDED Entitlement to service connection for a stomach condition, to include dysphagia and diverticulitis is remanded. REASONS FOR REMAND The Veteran had active military service in the Army from January 1982 to December 1984. This appeal comes to the Board of Veterans’ Appeals (Board) from a December 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. In an August 2016 rating decision, the RO granted service connection for: left hip osteoarthritis and residual status post total hip replacement surgery with residual scar at 30 percent from September 5, 2013; right hip osteoarthritis with painful motion at 10 percent from September 5, 2013; residuals status post posterior vitreous detachment of left eye at 0 percent from September 5, 2013; right hip osteoarthritis with limitation of extension at 0 percent from September 5, 2013; and right hip osteoarthritis with limitation of flexion at 0 percent from September 5, 2013. In October 2016, the Veteran filed a timely notice of disagreement (NOD) with that decision, including the effective dates awarded, but she has not yet been issued a statement of the case (SOC). Ordinarily, the claim would be remanded for the issuance of an SOC pursuant to Manlincon v. West, 12 Vet. App. 238 (1999). However, it appears the RO has acknowledged the Veteran’s NOD and additional action is pending. See November 2016 Correspondence (acknowledging the receipt of her October 2016 NOD). Therefore, this situation is distinguishable from Manlincon, where a notice of disagreement had not been recognized, and remand is not necessary at this time. Entitlement to service connection for a stomach condition, to include dysphagia and diverticulitis, is remanded. The Veteran is seeking service connection for a stomach condition, to include dysphagia and diverticulitis. The Veteran contends that her stomach problems began when she joined the military. She had a bleeding ulcer and went to the hospital several times while she was enlisted. See December 2015 Correspondence. Service treatment records show that the Veteran had problems with her stomach, which included stomach cramps, abdominal pain and diarrhea, and gastroenteritis. For example, on the Veteran’s April 1981 Report of Medical History for enlistment, it was reported that the Veteran went to the hospital in 1981 for fainting spells and vomiting, but nothing was found. In March 1982, the Veteran complained of abdominal pain and vomiting; she was diagnosed with gastroenteritis. In July 1982 and August 1982, the Veteran complained of abdominal pain and cramps. In September 1984, the Veteran complained of upper abdominal pain and diarrhea for 2 months. In October 1984, the Veteran complained of stomach cramps and nausea. In August 2016, the Veteran was afforded a VA examination for stomach and duodenal conditions. The Veteran was diagnosed with intermittent dysphagia secondary to a lap band procedure and diverticulitis. The VA examiner opined that the Veteran’s conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner explained that the Veteran had a history of a variety of “stomach/abdomen” symptoms during her military service that were associated with acute, episodic conditions. The VA examiner found no evidence of a persistent or chronic stomach/abdomen condition or diagnosis during military service. The Veteran had intermittent dysphagia with lap band surgery and diverticulitis, but they were not related to her military service. The Board finds the August 2016 VA examination to be inadequate for not addressing the Veteran’s lay statements that her stomach problems began in service and for not addressing the Veteran’s specific instances of stomach problems while she was in service. The VA examiner merely stated that the Veteran’s symptoms were acute and not chronic or persistent without giving any further explanation. Also, the Veteran’s April 1981 Report of Medical History suggests that the Veteran may have had stomach problems prior to entering service. Therefore, the VA examiner should have addressed the theory of presumption of soundness. See 38 U.S.C. § 1111 (2012); 38 C.F.R. § 3.304(b) (2018). A remand is warranted to obtain a VA addendum medical opinion to address these matters. The matter is REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records and associate them with the claims file. 2. After the above development has been completed, obtain a VA addendum medical opinion from the same VA examiner who conducted the August 2016 VA examination, if available, to determine the nature and etiology of the Veteran’s stomach condition. If the same VA examiner who conducted the August 2016 VA examination is not available, another appropriate clinician should be used. If an opinion cannot be provided without affording the Veteran a VA examination, then a VA examination should be provided. The record, including a copy of this remand, must be made available to and reviewed by the examiner. The VA examiner should address the following: (a.) Whether there is clear and unmistakable (obvious or manifest) evidence that the Veteran’s stomach condition existed prior to the Veteran’s active duty service. (b.) If so, whether there is clear and unmistakable (obvious or manifest) evidence that the Veteran’s pre-existing stomach condition did NOT undergo an increase in severity beyond the natural scope of the disability during the Veteran’s active duty service. (c.) If the answer to (a.) and (b.), above, is in the negative, whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s stomach condition, to include dysphagia and diverticulitis, is of service onset or otherwise related to her military service. The VA examiner should discuss and comment upon the Veteran’s in-service complaints of stomach problems and findings. The VA examiner should state whether he or she finds that the in-service findings were acute or chronic and explain why. Also, the VA examiner should address the Veteran’s statement that her current stomach problems began while she was in service. (d.) A rationale for all requested opinions should be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she should provide a complete explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in the medical community at large and not those of the particular examiner. BARBARA B. COPELAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Crawford, Associate Counsel