Citation Nr: 20047536 Decision Date: 07/16/20 Archive Date: 07/16/20 DOCKET NO. 15-20 834 DATE: July 16, 2020 REMANDED Entitlement to service connection for an ulcer is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1969 to February 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2018, the Veteran testified at a Board video conference hearing before the undersigned Veterans Law Judge. A transcript of this hearing is of record. This matter was last before the Board in July 2018, when it was remanded for further development. Entitlement to service connection for ulcer is remanded The Veteran contends that his ulcer was aggravated due to being in stressful situations in Vietnam. The Veteran’s service treatment records show that an ulcer was noted on the Veteran’s March 1969 pre-induction examination. Upper GI testing in July 1969 showed hyperactive duodenal cap. During service, the Veteran was treated on several occasions for symptoms, to include anemia and melena. He was placed on a limited profile in February 1971 for peptic ulcer disease. His separation examination was normal. In accordance with the July 2018 remand directives, an examination was obtained in September 2019. However, the opinion provided by the examiner is not fully responsive to the remand directives. Specifically, the examiner’s statement that “there was no evidence of any exacerbation during service” is inconsistent with the Veteran’s service treatment records. The Board regrets the additional delay but finds that a remand is warranted for substantial compliance with its prior remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Send the claims file to a VA physician to obtain a medical opinion concerning the Veteran’s ulcer claim. If an examination is deemed necessary to respond to the questions one should be scheduled. After review of the claims file, the physician should respond to the following: (a.) Is it at least as likely as not that the Veteran’s pre-existing stomach disability underwent a permanent worsening during service (versus a temporary flare-up of symptoms)? Please explain why or why not, to include addressing the service treatment records noting the Veteran had anemia, vomited blood, and had melena (Feb. 1971 and Nov. 1971 entries) and placement on a limited profile in February 1971 due to peptic ulcer disease. (b.) If the disability was permanently worsened during service (aggravated), was that worsening undebatably the result of natural progression of the stomach disease (versus being the result of events in service)? Please explain why or why not. (c.) If the stomach condition was permanently worsened beyond normal progression during service, is the reported partial gastrectomy and vagotomy in the 1980s related to or the result of a maturation of the in-service stomach disability? Please explain why or why not. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Asare, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.