Citation Nr: 21002487 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 13-34 401 DATE: January 13, 2021 REMANDED Entitlement to a disability rating in excess of 10 percent for service-connected hypertrophic gastritis, post-operative laparotomy, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1986 until May 1990. This matter was recently before the Board in May 2019 when it was remanded the matter for further development. For the reasons detailed below, the claim is remanded again because there has not been substantial compliance with the prior remand instructions. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to a disability rating in excess of 10 percent for service-connected hypertrophic gastritis, post-operative laparotomy, is remanded. The Board cannot make a fully-informed decision on the claim because the nature and severity of the Veteran’s disability remain unclear and the VA opinion obtained in January 2020 is inadequate. The January 2020 VA medical opinion obtained after the recent remand is inadequate, because it is internally inconsistent and unclear regarding the Veteran’s current gastrointestinal conditions. On page two of the opinion, the examiner states that “current findings indicate that gastritis has returned” and “I am unable to determine which symptoms are due to his GERD and which are due to his gastritis since symptoms for both overlap and would require speculation.” However, on page five of the same opinion, the examiner states, “[b]ased on the current objective studies (upper GI of 12/29/17) the Veteran’s only present GI disorder is esophageal reflux. There are no present findings of esophagitis or hypertrophic gastritis.” The examiner then stated, “[s]ince the only current GI condition is GERD, the present GI symptoms are attributed to the Veteran’s GERD.” On remand, a clarifying medical opinion must be obtained. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Additionally, updated treatment records should be obtained on remand. See Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from December 2018 to the present. 2. Schedule the Veteran for an examination (or telehealth interview, etc., if appropriate) by an appropriate clinician to determine the current severity of his service-connected hypertrophic gastritis. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner is instructed to specifically respond to the following: (a.) Identify all stomach disorders currently affecting the Veteran. In addition, the examiner should identify all stomach disorders, if any, that were present during the period under review (since 2012) and have resolved. Finally, in light of the Veteran’s medical history showing various GI diagnoses, the examiner should comment on whether any current diagnosis should have been originally diagnosed as the Veteran’s service-connected condition. (b.) To the extent possible, differentiate symptoms associated with the Veteran’s service-connected hypertrophic gastritis, and those associated with all other nonservice-connected stomach disorders, to include GERD and ulcerative esophagitis. If the examiner is unable to distinguish certain symptoms, an explanation as to why this is the case should be provided. (c.) The examiner should specifically identify whether the Veteran’s hypertrophic gastritis manifests in small nodular lesions, multiple small eroded or ulcerated areas, and/or severe hemorrhages or large ulcerated or eroded areas. All provided opinions must be supported by complete rationale. If the examiner cannot provide an opinion without resorting to speculation, the examiner should say why. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. Collins, 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.