BVA9506162 DOCKET NO. 91-18 955 ) DATE ) ) Received from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for irritable bowel syndrome, claimed as a disability manifested by gastrointestinal pain. 2. Entitlement to service connection for a disability manifested by right leg pain. 3. Entitlement to service connection for a right knee disorder. 4. Entitlement to an increased evaluation for the residuals of a fusion of the distal interphalangeal joint of the right ring finger, currently evaluated as 10 percent disabling. 5. Entitlement to a compensable evaluation for bilateral corneal abrasions. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Joseph Horrigan, Counsel INTRODUCTION The veteran served on active duty from October 1967 to January 1989. This matter came before the Board of Veterans' Appeals (Board) from an October 1989 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. The case was remanded by the Board in July 1991 for further development, to include an examination to determine whether the veteran had a psychophysiologic reaction. Subsequent thereto, the veteran has moved to an area which falls under the jurisdiction of the Waco, Texas, Regional Office. For reasons made evident below, all the certified issues with the exception of that of service connection for irritable bowel syndrome, claimed as disability manifested by gastrointestinal pain, will be discussed in the REMAND section of this decision. CONTENTIONS OF APPELLANT ON APPEAL It is essentially contended, by and on behalf of the veteran, that he developed a chronic disorder causing gastrointestinal discomfort while on active duty. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence favors the veteran's claim for service connection for irritable bowel syndrome, claimed as a disability manifested by gastrointestinal pain. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's claim for service connection for gastrointestinal disability has been obtained. 2. The veteran developed irritable bowel syndrome during military service. CONCLUSION OF LAW Irritable bowel syndrome was incurred in service 38 U.S.C.A. § § 1110, 1131, 5107, 7104 (West 1991); 38 C.F.R. §§ 3.102, 3.303 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds that the veteran's claim of service connection for gastrointestinal disability is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, the veteran's claim is plausible. The service medical records reveal that the veteran was seen occasionally during service for gastrointestinal complaints which included nausea, cramping, vomiting, diarrhea, constipation, bloating, and gas with abdominal distention. Assessments included gastroenteritis, viral gastritis, abdominal discomfort related to gas pains, and questionable gaseous abdominal distention. Abdominal X-rays of June 1980 were normal as was an Upper Gastrointestinal series of September 1985. On December 4, 1987, the veteran was seen with complaints of recurrent low abdominal discomfort, increased flatulence, and loose stools after meals, of several years' duration. It was noted that an earlier Upper Gastrointestinal series had been normal. The assessment was questionable irritable bowel syndrome and the same assessment was reported after follow up on December 14, 1987. During an internal medicine consultation on December 21, 1987 the veteran gave a history of digestive problems since 1981. Symptoms included retained gas and abdominal discomfort but no definite pain. Bowel movements were normal although he could go for two to three days without one. Physical evaluation revealed no abdominal masses or tenderness and a rectal evaluation was negative, including guaiac. A barium enema was negative. The impression was irritable bowel syndrome. After evaluation in November 1988 for complaints of stomach bloating and gas, the assessment was questionable irritable bowel syndrome. On the Report Of Medical Examination prior to separation from service the veteran's abdomen and viscera were evaluated as normal. In the Report of Medical History, he answered in the affirmative regarding frequent indigestion and stomach, liver, or intestinal trouble. It was reported that stomach problems, gastritis, and indigestion were treated with Metamucil and Mylicon in 1980-1981 with non responsive results and were still symptomatic. On VA examination in September 1990 the veteran gave a history of periodic left upper quadrant bloating discomfort and pain since about 1980 which was briefly relieved by passing stool or flatus. He also belched frequently but this did not relieve the pain. This symptom occurred about two to three times a month and could be prevented by not eating. Fatty or greasy food did not appear to cause or aggravate the pain and the veteran took no medication. There was no dysphagia, odynophagia, hematemesis, melena, hematochezia or sensation of blockage on swallowing. Bowel movements occurred every one, two, or three days and diarrhea was not a problem. Evaluation revealed no abdominal scars, masses, organomegaly, tenderness, distention, or evidence of free peritoneal fluid. Bowel sounds were normal and there was no abdominal or femoral bruit. Stool was negative for blood and a rectal examination was normal. The diagnosis was stomach pain, etiology unknown-the evidence available to the examiner suggested that aerophagia may be the cause. On VA intestinal examination in July 1994, the veteran complained of abdominal symptoms which were primarily excessive bloating with gas and excessive flatus. These symptoms usually came on shortly after eating and eating beans and milk products were reported to cause excessive gas. The only helpful medication found to help was lactate. Bowel movements were described as normal with usually one movement a day and an occasional second one. Diarrhea was denied. Evaluation of the abdomen revealed slight gaseous distention particularly in the left upper quadrant with no tenderness or palpable abdominal masses. A barium enema showed a normal appearing colon and mild hepatomegaly. The diagnosis was probable irritable colon syndrome with aerophagia; history also suggested probability of lactose intolerance. The above evidence shows that the veteran had considerable treatment during service for gastrointestinal symptoms such as abdominal bloating, pain, gas and distention. Evaluations revealed no chronic organic gastrointestinal pathology and the possibility of irritable bowel syndrome was noted on several occasions during service. On VA examination in October 1990, the veteran was noted to have gastrointestinal complaints similar to those reported in service and the examiner opined that the evidence suggested aerophagia. During a July 1994 VA examination, similar gastrointestinal complaints were reported and the diagnosis included probable irritable colon syndrome with aerophagia. In the Board's opinion, the evidence in this case supports a grant of service connection for irritable bowel syndrome. ORDER Service connection for irritable bowel syndrome, claimed as a disability manifested by gastrointestinal pain, is granted. REMAND In its remand of July 1991, the Board instructed the RO to take adjudicatory action on claims of entitlement to service connection for disabilities secondary to the veteran's right ring finger disability, including disability of the right little finger and damage to the right ulnar nerve. It does not appear that this instruction has been accomplished by the RO. In view of the foregoing and given the duty to assist the veteran in the development of his claim under 38 U.S.C.A. § 5107, this case is remanded to the RO for the following action: 1. The RO should contact the veteran and request that he provide the names, addresses, and approximate dates of treatment of all health care providers who have treated him at any time since discharge for his eye and right hand disabilities. When the veteran responds and provides any necessary authorizations, the RO should obtain copies of all clinical records reflecting such treatment. All documentation obtained should be associated with the claims folder. 2. Then, the veteran should be afforded a VA ophthalmologic examination to determine the current degree of severity of his bilateral corneal abrasions. Any necessary special studies should be obtained and all pertinent clinical findings reported in detail. The claims folder must be made available to the examiner prior to the evaluation so that the pertinent clinical record can be reviewed in detail. 3. The veteran should also be afforded VA orthopedic and neurological examinations to determine the current severity of the veteran's right ring finger disability, as well as the nature, etiology, and severity of his claimed disabilities of the right little finger and right ulnar nerve. All necessary special studies, including electromyographic and nerve conduction velocity studies, should be performed and all pertinent clinical findings reported in detail. The claims folder must be made available to the examiners prior to their evaluations so that they may study the pertinent clinical records in detail. At the conclusion of the evaluations, the examiners should correlate their findings and express their opinion, with complete rationale, as to the medical probability that any right little finger, ulnar nerve pathology and/or other disability found is related to the veteran's service-connected residuals of a right ring finger fusion. 4. Then, after any further development deemed appropriate, the RO should again adjudicate the issues of entitlement to increased evaluations for the residuals of a fusion of the distal interphalangeal joint of the right ring finger and the residuals of bilateral corneal abrasions. The RO should also adjudicate the claims of entitlement to service connection for right little finger and right ulnar nerve disabilities and any other pertinent disability as secondary to the veteran's service connected right ring finger disorder. The rating decisions should reflect consideration of all potentially applicable criteria. If the benefits sought are not granted to his satisfaction, the veteran and his representative should be provided a supplemental statement of the case in regard to all issues in appellate status and afforded a reasonable opportunity to respond. Thereafter, the case should be returned to the Board for further consideration, if appropriate. By this remand, the Board intimates no opinion as to the outcome warranted in this case. No action is required of the veteran until he is so informed by the RO. The issues of entitlement to service connection for right leg and knee disabilities will be held in abeyance pending resolution of the above development. BARBARA B. COPELAND 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).