BVA9502892 DOCKET NO. 93-08 702 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Boston, Massachusetts THE ISSUE Entitlement to service connection for an organic stomach disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and his wife ATTORNEY FOR THE BOARD K. J. Alibrando, Associate Counsel INTRODUCTION The veteran served on active duty from March 1966 to August 1969. This appeal arises from a May 1991 rating decision in which the RO denied service connection for a stomach condition on the basis that service connection was already in effect for post-traumatic stress disorder (PTSD) with psychophysiological gastrointestinal reaction. In May 1992, the veteran raised the issues of entitlement to service connection for tinnitus, a foot disorder and malaria, and increased ratings for PTSD and hearing loss. As those issues have not been properly developed on appeal and are not inextricably intertwined with the issue before us, they are referred to the RO for appropriate action. REMAND The veteran contends that the RO erred by not granting service connection for an organic stomach disability separately from his service connected PTSD with psychophysiological gastrointestinal reaction. A review of the record shows that by rating action of May 1970, service connection was granted for psychophysiological gastrointestinal reaction on the basis of the service medical records which showed complaints of gastrointestinal distress with a diagnosis of possible peptic ulcer disease which could not be confirmed. A March 1970 VA examination included a diagnosis of psychophysiological gastrointestinal reaction. The postservice medical records show that the veteran continued to have subjective complaints of gastrointestinal distress with a diagnosis of duodenal ulcer in November 1987. By rating action of May 1988, service connection was granted for PTSD with psychophysiological gastrointestinal reaction, evaluated as 30 percent disabling from October 1987. Subsequent medical records show that the veteran continues to receive treatment for PTSD and to have complaints of gastrointestinal distress. A June 1990 upper GI series report included an impression of active ulcer duodenal cap, while a September 1990 upper GI series report noted that there was no evidence of any active duodenal ulcer disease. The most recent VA examination was conducted in May 1991. No additional testing was conducted and the examiner did not express an opinion regarding the relationship between the veteran's psychiatric and stomach disorders. The Board also notes that the RO has not addressed the issue of entitlement to secondary service connection for a stomach condition under the provisions of 38 C.F.R. § 3.310. The VA has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1993). Fulfillment of the statutory duty to assist includes conducting a thorough and contemporaneous medical examination, one which takes into account the records of prior medical treatment, so that the evaluation of the claimed disability will be a fully informed one. Green v. Derwinski, 1 Vet.App. 121 (1991). The RO should afford the veteran a VA gastroenterology examination. Finally, the VA has a duty to acknowledge and consider all regulations which are potentially applicable to the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). Under the circumstances of this case, we find that additional development is required. Accordingly, the case is REMANDED to the RO for the following: 1. The RO should contact the veteran and request him to furnish the names and addresses of all health care providers from whom he has received treatment for his stomach disorder from August 1991 to the present time. Where appropriate, consent forms for the release to the VA of any private medical records should be obtained from the veteran. Thereafter, the RO should obtain legible copies of all identified treatment records, including all VA outpatient records, and associate them with the claims folder. 2. After the above-mentioned records have been obtained, the veteran should be afforded a special VA gastrointestinal examination. The examination request should include a notation to the examiner that the veteran has had complaints of gastrointestinal distress which were attributed to his psychiatric disorder throughout the years. The examiner should determine whether the veteran has an organic stomach disability and the date of onset. He/she should also express an opinion as to whether the gastrointestinal symptoms in service represented the onset of any currently diagnosed organic stomach disability. Finally an opinion should be rendered as to whether any organic stomach disability is etiologically related to the service connected psychiatric disorder. Such tests as the examiner deems necessary should be performed. The claims folder must be made available to the physician prior to the examination so that he/she may review pertinent aspects of the veteran's medical history. 3. The RO should adjudicate the issue of entitlement to secondary service connection for an organic stomach disability. When the above developments have been completed, the case should be reviewed by the RO. If the decision remains adverse to the appellant, he and his representative should be afforded a supplemental statement of the case, to include all applicable criteria, and afforded a reasonable opportunity to respond. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration. I. S. SHERMAN Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).