Citation Nr: 21007819 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 17-18 173 DATE: February 10, 2021 REMANDED Entitlement to an initial disability rating in excess of 20 percent for duodenal ulcer and gastroesophageal reflux disease (GERD) is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from January 1984 to June 1988. In February 2019, the Board of Veterans’ Appeals (Board) remanded the appeal for additional evidentiary development. Increased initial rating for duodenal ulcer and GERD The Veteran contends he is entitled to an initial rating in excess of 20 percent for service-connected duodenal ulcer and GERD. His symptoms are rated under Diagnostic Code (DC) 7346-7305. DC 7305 (the criteria under which he is currently rated) provides a 20 percent rating for moderate symptoms with recurring episodes of severe symptoms two or three times a year averaging 10 days in duration; or with continuous moderate manifestations. A higher 40 percent rating requires moderately severe symptoms; less than severe but with impairment of health manifested by anemia and weight loss; or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. 38 C.F.R. § 4.114, DC 7305. Alternatively, DC 7346 provides an increased 30 percent rating for persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal arm or shoulder pain, productive of considerable impairment of health. Id. at DC 7346. The Veteran underwent a VA examination in January 2020. The report reflects that he presented with symptoms of pyrosis, reflux, regurgitation, substernal pain, sleep disturbance caused by esophageal reflux, nausea, and vomiting; the examiner noted the average duration of the Veteran’s episodes of sleep disturbance, nausea, and vomiting was less than one day, and that these episodes occurred four or more times per year. The examiner further noted that the Veteran had an active diagnosis of peptic ulcer disease; however, no discussion was provided of specific symptoms resulting from that disease. In a January 2021 Informal Hearing Presentation (IHP), the Veteran’s representative argued that the VA examiner “focused primarily on [the Veteran’s] GERD and did not meaningfully discuss his service-connected duodenal ulcer.” The representative requested that the Veteran be provided an updated examination to take into consideration any symptoms stemming from his duodenal ulcer disorder. On review, the Board agrees that an updated examination is required. In short, the Board finds that the examination report does not contain enough information to properly evaluate the Veteran’s disability. Specifically, the criteria for an increased 30 percent rating under DC 7346, noted above, is not addressed—there is no determination as to whether the Veteran’s symptoms constitute “persistent epigastric distress” or are “productive of considerable impairment of health.” Additionally, the examiner did not opine as to whether the Veteran’s symptoms resulted in incapacitating episodes such as are contemplated under DC 7305. The Board is not free to substitute its own judgment regarding medical matters. See Colvin v. Derwinski, 1 Vet. App. 171 (1991). Although further delay is regrettable, an updated examination is required. The matters are REMANDED for the following action: 1. Obtain all VA medical records pertaining to the Veteran dating from July 2020 to the present. 2. Ask the Veteran to identify and provide authorization to obtain any outstanding, relevant private medical records. After securing the necessary authorization (if provided by the Veteran), these records should be requested. If any records are not available, the Veteran should be notified. If necessary, the Agency of Original Jurisdiction (AOJ) must ensure that any records obtained are translated into English. 3. Schedule the Veteran for a VA examination by an appropriate clinician to determine the current nature and severity of the Veteran’s duodenal ulcer and GERD, to include any associated complications or diagnoses. The clinician should provide a full description of the disability and report all signs and symptoms necessary for evaluating the disability under the relevant rating criteria. The clinician should specifically respond to the following: • Review and comment on any pertinent VA and private treatment records pertaining to the Veteran’s duodenal ulcer and GERD, including recent records documenting “severe” symptoms. • To the extent possible, identify which symptoms are attributable to the Veteran’s duodenal ulcer disorder and which are attributable to his GERD. • Evaluate the Veteran’s symptomatology under the criteria provided in both DC 7305 and DC 7346. This includes (but is not limited to) opinions as to whether the Veteran’s duodenal ulcer and GERD result in incapacitating episodes—and if so, the duration of such episodes; and opinions as to whether the Veteran’s duodenal ulcer and GERD result in “persistently recurrent epigastric distress” and/or “considerable impairment of health.” A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Minot, 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.