Citation Nr: 18160126 Decision Date: 12/21/18 Archive Date: 12/21/18 DOCKET NO. 13-16 065 DATE: December 21, 2018 REMANDED Entitlement to service connection for hemorrhoids is remanded. Entitlement to service connection for a stomach condition is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1977 to July 1984. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a July 2011 rating decision. In March 2018, the Board denied the claims for service connection for hemorrhoids and a stomach condition. The Veteran appealed the March 2018 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a September 2018 Order, the Court vacated the portion of the Board’s March 2018 decision as it pertained to the Veteran’s claims for service connection for hemorrhoids and a stomach condition and remanded those matters for action consistent with the terms of a Joint Motion for Remand (JMR). The Board notes that the JMR indicated the Board’s remand of entitlement to service connection for pes planus was not before the Court. Additionally, the JMR indicated that Veteran was no longer pursuing his claim for entitlement to service connection for a left hip disability and, as such, the Court dismissed that claim. The parties to the JMR found that the March 2018 Board decision relied upon an inadequate February 2017 VA examination, which did not follow a prior Board remand to address the Veteran’s complaints of bloody stools. The parties to the JMR specifically held that the February 2017 VA examination did not “substantively engage” with the Veteran’s prior complaints of bloody stools. Additionally, the JMR found that the Board erred in finding that the Veteran had no symptoms associated with GERD or a stomach disorder as the Veteran has reported that he had continuous symptoms since leaving service. Thus, the JMR found the Board failed to provide an analysis regarding the Veteran’s statements that he had stomach pain since leaving service. In a December 2018 statement in support of claim, the Veteran stated that the VA examinations provided him were inadequate as those examinations also disregarded his reports that his symptomology had been the same since his separation from service. Thus, in light of the above, the Board finds that a remand is warranted to afford the Veteran additional VA examinations regarding his hemorrhoids and claimed stomach disorder, as indicated above. The matters are REMANDED for the following action: 1. Associate with the record any VA clinical documentation not already of record pertaining to treatment of the Veteran. 2. Thereafter, schedule the Veteran for a VA medical examination by a physician (M.D.) to determine the nature and etiology of any hemorrhoid disability. Any studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, to include the Veteran’s service treatment records, post-service medical records, and lay statements. The examiner should address the Veteran’s in-service complaints of hemorrhoids. See March 1984 service treatment record. Additionally, the examiner should substantively engage with the Veteran’s prior complaints of bloody stools. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent probability or more) that the disability manifested in service or is otherwise casually or etiologically related to his military service. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. Thereafter, schedule the Veteran for a VA examination to determine the nature and etiology of any diagnosed stomach disorder. Any studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, to include the Veteran’s service treatment records and post-service medical records. The examiner should: (a.) Identify any diagnosed stomach disorder; (b.) If there is a diagnosis of a stomach disorder, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that such a disability had onset in service or within one year following separation from service, or was causally related to service. The Veteran’s lay assertions as to onset and continuity and symptomatology should be recorded and considered. Specifically, the examiner should address the Veteran’s in-service complaints of stomach pain, and the in-service diagnosis of gastritis. See August 1979 VA treatment record, November 1981 service treatment record, October 1982 service treatment record, June 1983 service treatment record, March 1984 service treatment record. The examiner is also asked to substantively engage with the Veteran’s reports of continuous symptoms since service. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. (Continued on the next page)   A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Parrish, Associate Counsel