BVA9506325 DOCKET NO. 93-13 357 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for a chronic gastrointestinal disorder. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Alice A. Booher, Counsel INTRODUCTION The veteran had active service from August 1978 to May 1985, from April 1986 to May 1987, and from December 1990 to May 1991. The veteran's primary military occupational specialty was in biomedical equipment and information systems. This case is before the Board of Veterans' Appeals (Board) on appeal from a rating action by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, in March 1993. REMAND The veteran and his representative have pointed out that, as noted in the Statement of the Case issued by the RO in May 1993, the rating decision that denied service connection for the disability at issue was based on incomplete service medical records. In fact, the only service medical records in the file are those submitted by the veteran. It is averred that additional records are available, including a separation examination conducted at Fort Stewart, Georgia. It is also argued that the VA has not fulfilled its obligation to assist the veteran in the development of his claim. Evidence of record shows that in his claim for benefits, filed in 1992, the veteran reported that both he and his wife had been experiencing gastrointestinal problems since June 1991, shortly after his return from Operation Desert Storm; that they had experienced intermittent diarrhea, excessive gas and stomach cramps; and that although he had been evaluated at his own expense, no definitive cause had been found. The report of evaluation by Paul L. Yudelman, M.D, commencing in July 1991 shows a two month history of diarrhea following the veteran's return from the Middle East. Dr. Yudelman suggested the possibility of chronic infective diarrhea caused by C. difficile, Campylobacter jejuni or Giardia, as well as possible inflammatory bowel disease. Some laboratory test results are associated with the report, indicating that stool samples were negative for pathogens. Additional testing was recommended. Of record are VA outpatient treatment records from October and November 1992 showing complaints of intermittent diarrhea, gas, cramps and fever. The veteran reported that this had occurred over the past year, since his return from Operation Desert Storm, and that at least 70 percent of his Reserve group was experiencing similar symptoms. After a VA examination in December 1992, the diagnoses were spastic colon and gastritis. Based on the evidence of record, the Board finds that additional development is required. The case is REMANDED for the following actions: 1. The RO should try to obtain the veteran's complete service medical records for all periods of service, including during Operation Desert Storm. In that regard, he has stated that he underwent a separation examination at Fort Stewart, Georgia, the report of which is not on file. Inasmuch as the veteran apparently is still a member of a reserve component, he should be asked to identify the unit to which he is currently (or was last) attached. His reserve unit should be contacted for any available service medical records or for information as to where his medical records would be maintained. Any leads obtained should be pursued. 2. The veteran should be requested to provide additional information as to all private physicians or facilities by which he has been seen for gastrointestinal problems since separation from active service. With the veteran's consent, copies of his complete records should be requested from all identified medical care providers. The RO also should contact Dr. Yudleman for copies of any records pertaining to the veteran subsequent to those now on file, including the results of any additional laboratory tests and any colonoscopy or other diagnostic procedures. 3. The veteran's complete VA outpatient, inpatient and examination records, (including but not limited to outpatient records from the VA facility in Fort Myers, Florida) should be obtained and attached to the claims folder. 4. Inasmuch as the bases are not clear for the diagnoses of gastritis and spastic colon by the VA on examination in 1992, the veteran should be examined by a specialist in gastroenterology who has not previously examined him, in accordance with the VA Physician's Guide for Disability Evaluation Examinations, to determine, to the extent possible, the nature and etiology of any current gastrointestinal disorders. Any other indicated specialist examinations should be performed as should all indicated laboratory and other diagnostic studies. The claims folder, including any additional evidence obtained, and a separate a copy of this remand, should be made available to the examiner prior to the examination. If the veteran has additional information regarding the problem similar to his that purportedly was determined by the Walter Reed Army Medical Center to be caused by an uncommon bacteria in the gastrointestinal tract (as mentioned in his VA Form 9), he should convey specifics to the examiner. who should follow up, as appropriate. The rationale for any diagnoses should be explained. 5. Thereafter, the RO should review the case. A determination should be made as to whether the veteran is claiming disability from exposure to "environmental agents" in the Persian Gulf. (His VA Form 9 reflects his belief that he was exposed to tainted food while in Saudi Arabia.) If so, the case should be processed in accordance with VBA Circular 20-92-29, December 7, 1992, as revised, and any other applicable directives. Additionally, the RO must consider whether the evidence shows disability due to "undiagnosed illness" as contemplated by the provisions of 60 Fed. Reg. 6665-66 (February 3, 1995) (to be codified at 38 C.F.R. § 3.317). If service connection remains denied, the RO should provide a comprehensive supplemental statement of the case, to which the veteran and his representative should be afforded the opportunity to respond. The case should then be returned to the Board for further appellate review. The veteran need do nothing further until so notified. JANE E. SHARP 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) (1994).