Citation Nr: 21077387 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 00-12 232A DATE: December 29, 2021 REMANDED Entitlement to a rating in excess of 30 percent for a duodenal ulcer, with gastroesophageal reflux disease (GERD) and hoarseness, is remanded. Entitlement to a rating in excess of 10 percent for a left hip disability, on the basis of limitation of extension, is remanded. Entitlement to a rating in excess of 10 percent for a left hip disability, on the basis of limitation of abduction, is remanded. REASONS FOR REMAND The Veteran served in the U.S. Army, on active duty from June 1977 to June 1997. These matters were previously before the Board in August 2020, when it denied the issues on appeal. The Veteran appealed those denials to the Court of Appeals for Veterans Claims (Court). In July 2021, the Court granted a Joint Motion for Partial Remand (JMPR), reversing the Board's prior decisions and remanding the above claims for further consideration. Specifically, the Court noted that the Board erred by improperly considering the ameliorative effects of medication when evaluating the severity of the Veteran's GERD. Additionally, the Board erred when it failed to consider whether the Veteran was entitled to separate compensable ratings for GERD and hoarseness, related to his service-connected duodenal ulcer. Finally, the Court noted that the Board relied on an inadequate December 2015 VA examination in denying an increased rating of his left hip disabilities. Specifically, the examiner did not provide an estimated range of motion measurement during flareups. Lastly, the issues of service connection for chronic diarrhea, to include as secondary to a service-connected hemorrhoid disability, entitlement to a compensable rating for a hemorrhoid disability, an increased rating for sinusitis, a compensable rating for pterygium, an increased rating for epididymitis with prostatitis and benign prostatic hypertrophy, a compensable rating for erectile dysfunction, an increased rating for pseudofolliculitis barbae, an increased rating for left knee scars, and a rating in excess of 100 percent for depression, are not ripe for adjudication. In the July 2021 JMPR, the Veteran expressly waived his right to adjudication of those issues. Accordingly, the issues on appeal are as above. While the Board regrets further delay, it finds that a remand for addendum VA opinions is necessary. 1. Entitlement to a rating in excess of 30 percent for a duodenal ulcer, with gastroesophageal reflux disease (GERD) and hoarseness, is remanded. The Board cannot make a fully informed decision on the issue of entitlement to a disability rating in excess of 30 percent for a duodenal ulcer, with GERD and hoarseness, at this time. Specifically, the Veteran's duodenal ulcer is rated under Diagnostic Code (DC) 7346-6516, 38 C.F.R. § 4.114. A review of the record reflects that the Veteran's GERD has largely been controlled by medication. However, the Board notes that DC 7346-6516 does not account for the ameliorative effects of medication. In assigning a disability rating, the Board may not consider the ameliorative effects of medication where such effects are not explicitly contemplated by the rating criteria. See Jones v. Shinseki, 26 Vet. App. 56 (2012). The nature and severity of the Veteran's symptoms without the ameliorative effects of medication are not shown by the record, and because such is primarily a medical question, the Board finds that a remand for a new VA examination is necessary. 2. Entitlement to a rating in excess of 10 percent for a left hip disability, on the basis of limitation of extension, is remanded is remanded. 3. Entitlement to a rating in excess of 10 percent for a left hip disability, on the basis of limitation of abduction, is remanded is remanded. The Board finds the December 2015 VA examination is inadequate. Specifically, the Veteran reported flareups five days per week, which limited him to standing for five minutes at a time and his walking to one block. However, the examiner was unable to say without resorting to mere speculation whether he suffered from additional functional loss due to pain, weakness, fatiguability, or incoordination after repeated use over time or during his reported flareups. It does not appear that the examiner attempted to elicit any additional information from the Veteran regarding his functional loss after repeated use over time or during flareups. As discussed in the July 2021 JMPR, the December 2015 VA examiner did not provide an estimated range of motion loss due to flareups or repeated use. Further, the examiner did not indicate a reason for their inability to do so, whether it was due to lack of knowledge or information in the medical community at large, or due to unprocured testing. The Board finds that a retrospective opinion is necessary to determine whether the Veteran suffered from additional functional loss during flareups or repeated use of his left hip. Sharp v. Shulkin, 29 Vet. App. 26 (2017); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matters are REMANDED for the following action: 1. Invite the Veteran to submit additional evidence and argument in support of his claims. 2. Obtain an addendum opinion by an appropriate clinician to determine the severity of his service-connected duodenal ulcer, with GERD and hoarseness. The examiner should specifically note the medication the Veteran takes to control his GERD, and comment, to the extent possible, on the additional symptoms and related impairment that would be present throughout the appeal period without the relief provided by medication used to treat the condition. 3. Obtain a retrospective opinion to address the nature and severity of the left hip conditions for the period prior from January 15, 2014 to June 5, 2017. The examiner is specifically asked to address the following: Considering the Veteran's reported history and the evidence of record, please provide an opinion describing functional impairment of the Veteran's left hip conditions from January 15, 2014 to June 5, 2017, accounting for pain, incoordination, weakened movement, and excess fatigability on use, and, to the extent possible, report such impairment in terms of additional degrees of limitation of motion. Consider the Veteran's statements as to the frequency and severity of his flare-ups at his December 2015 VA examination. Specifically, that flares occur five days per week, lasting all day, and that he could only stand for five minutes and walk up to one block. If unable to provide such an opinion without resorting to speculation, please provide a rationale for this conclusion. The examiner must include a discussion of any specific facts that cannot be determined if unable to opine without speculation. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. McDonald