BVA9502141 DOCKET NO. 91-42 877 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Providence, Rhode Island THE ISSUE Entitlement to service connection for gastrointestinal disability on a secondary basis. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Michael P. Vander Meer, Associate Counsel INTRODUCTION The veteran served on active duty from January 1974 to September 1978. This case is before the Board of Veterans' Appeals (Board) on appeal from a July 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Providence, Rhode Island. This case was last before the Board in September 1993, at which time it was remanded for further development. A rating decision entered in July 1994 continued to deny the benefit sought on appeal, and a Supplemental Statement of the Case was issued the same month. The appeal was returned to and redocketed at the Board in November 1994. By means of correspondence dated in April 1994, the veteran's representative, on the veteran's behalf, asserted entitlement to service connection for major depression on a secondary basis. This claim is referred to the RO for appropriate action. REMAND The veteran contends that she has a current gastrointestinal disability which is directly attributable to her having taken nonsteroidal anti-inflammatory medications in response to her service-connected right knee disability. A VA outpatient report, dated in October 1989, reflects that the veteran was apparently at that time discontinued from taking such anti-inflammatory medications. In conjunction with her claim, the veteran underwent a VA gastroenterology examination in March 1992. Thereafter, pursuant to the September 1993 remand by the Board, referred to above, the RO was directed to have the veteran examined by a gastroenterologist who had not previously examined her. However, the veteran's subsequent examination by VA in June 1994 is shown to have been performed by the same examiner who conducted the veteran's March 1992 VA examination. In addition, while the examiner, in June 1994, indicated that there was no clinical evidence, based on his examination, that the veteran had any current gastrointestinal disability, the Board notes that no diagnostic studies were performed and that the file reflects that the veteran was assessed on VA outpatient treatment in August 1993 as having severe gastroesophageal reflux disease with gastric metaplasia and that she was found to have reflux esophagitis on a February 1991 esophagogastroduodenoscopy by VA. In view of the foregoing considerations, the Board is of the opinion that another VA gastroenterology examination, as specified in greater detail below and to be conducted by an examiner who has not previously examined the veteran, should be performed before an appellate determination is rendered. Accordingly, the case is REMANDED for the following: 1. The RO should contact the veteran and request her to identify the names, addresses, and approximate dates of treatment for any health care provider(s) to include any VA medical facility other than the VA Medical Center in Providence, Rhode Island, who may possess additional records pertinent to her claim. Thereafter, in light of the response received and after obtaining any necessary authorization, the RO should take appropriate action to obtain copies of any clinical records indicated. In any event, the RO should obtain copies of all clinical records reflecting more recent treatment of the veteran at the VA Medical Center in Providence, Rhode Island. 2. Thereafter, the RO should arrange for the veteran to undergo a VA examination by a board certified gastroenterologist, if available, who has not previously examined the veteran, to determine the nature and extent of any gastrointestinal disability present. Particular consideration should be given to performing any indicated diagnostic studies. With respect to any ascertained gastrointestinal disability(ies), the examiner is specifically requested, after thoroughly reviewing the record to include reports pertaining to a February 1991 esophagogastroduodenoscopy and VA examinations performed in March 1992 and June 1994, to offer an opinion whether it is at least as likely as not that the disability is etiologically related to medications taken by the veteran in response to her service-connected right knee disability. It is imperative that a copy of this remand be provided to the examiner, and the claims folder must be made available to the examiner for review prior to the examination. The rationale for all opinions expressed should be fully explained. 3. Then, after undertaking any development deemed necessary in addition to that specified above, the RO should readjudicate the issue on appeal. 4. If the benefit sought on appeal is not granted to the veteran's satisfaction, the veteran and her representative should be provided a Supplemental Statement of the Case. The veteran should be provided appropriate notice of the requirements to perfect an appeal with respect to any issue addressed therein which does not appear on the title page of this decision. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. In taking this action, the Board implies no conclusion, either legal or factual, as to the ultimate outcome warranted. No action is required of the veteran until she is otherwise notified. SHANE A. DURKIN Member, Board of Veterans' Appeals (CONTINUED ON NEXT PAGE) 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).