Citation Nr: 0306880 Decision Date: 04/09/03 Archive Date: 04/14/03 DOCKET NO. 95-06 320 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania THE ISSUE Entitlement to service connection for gastrointestinal bleeding claimed as secondary to the use of Naprosyn medication for the veteran's service-connected headache disorder. (The claim of service-connection for claimed degenerative joint disease of the cervical spine will be the subject of a later decision.) REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran and his spouse ATTORNEY FOR THE BOARD J. A. Markey, Counsel INTRODUCTION The veteran served on active duty from March 1943 to October 1945. This matter initially came to the Board of Veterans' Appeals (Board) from a September 1994 decision by the RO. A hearing was held at the RO in June 1995. In February 2000, the Board remanded this matter to the RO for further development. FINDING OF FACT The medical evidence demonstrates that the veteran's gastrointestinal bleeding as likely as not was caused by the use of Naprosyn medication for the service-connected headache disorder. CONCLUSION OF LAW By extending the benefit of the doubt to the veteran, his disability manifested by gastrointestinal bleeding is proximately due to or the result of a service-connected headache disorder. 38 U.S.C.A. §§ 1110, 5107, 7104 (West 2002); 38 C.F.R. §§ 3.303 (2002). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran and his representative claim that service connection is warranted for gastrointestinal bleeding as secondary to the use of Naprosyn medication for the veteran's service-connected headache disorder. Initially, the Board notes that the Veterans Claims Assistance Act of 2000 (hereinafter VCAA or the Act), Pub. L. No. 106-475, 114 Stat. 2096 (2000) and implementing regulations (codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a)), enacted during the course of this appeal, essentially eliminate the well-grounded requirement and modify VA's duties to notify and assist claimants; however. 38 U.S.C.A. §§ 5103, 5103A, 5107(a) (West Supp. 2002); 38 C.F.R. § § 3.159(a)-(c) (2002). The relatively new law and regulations also include new notification provisions. Specifically, they require VA to notify the claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to the Secretary, that is necessary to substantiate the claim. As part of the notice, VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, VA will attempt to obtain on behalf of the claimant. 38 U.S.C.A. § 5103 (West Supp. 2002); 38 C.F.R. § 3.159(b) (2002). In this case, the RO has considered the claim on appeal subsequent to the above-noted change in the law and implementing regulations (see the December 2002 supplemental statement of the case). The Board is not precluded from proceeding to an adjudication of these claims as the requirements of such authority have been satisfied. The record reflects during the course of this appeal the veteran was issued a Statement of the Case and (as noted) a Supplemental Statement of the Case. These documents contained the pertinent laws and regulations governing this claim and the reasons for their denials. As well, subsequent to the February 2000 Board remand, the RO, in March 2000, sent the veteran a letter which essentially explained the evidence necessary to substantiate his claim and how to go about assisting the RO in obtaining any such evidence. Hence, the veteran has been provided notice of the information and evidence necessary to substantiate the claims (see Quartuccio v. Principi, 16 Vet. App. 183 (2002), and he has been afforded ample opportunity to submit such information and evidence. In addition, the veteran has also been afforded - pursuant to the Board remand - a relatively recent VA examination, and various VA and private medical records have been associated with the record - through assistance by the RO - throughout the course of this appeal. In view of the above, and given the favorable action hereinbelow, there is no further action to be undertaken to comply with the provisions of the VCAA or implementing regulations, and as such, the appellant will not be prejudiced as a result of the Board deciding this claim. Applicable law provides that service connection will be granted if it is shown that a particular disease or injury resulting in disability was incurred in or aggravated during active duty. See 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2002). Service connection may also be established on a secondary basis for a disability which is shown to be proximately due to or the result of, or has been aggravated by, a service- connected disease or injury. 38 C.F.R. § 3.310(a) (2002); Allen v. Brown, 7 Vet. App. 439, 448 (1995). The veteran's service medical records do not indicate that he suffered from gastrointestinal bleeding during his service, and he and his representative do not contend otherwise. Instead, they contend, in substance, that the veteran suffers from gastrointestinal bleeding (or the residuals thereof) caused by his medication taken for the veteran's service- connected headache disorder. In this regard, it is noted that the veteran's service medical records indeed reflect that service connection was established for posttraumatic headaches by RO decision of August 1999. Additional evidence of record includes records of the veteran's January 1994 admission to Harrisburg Hospital for gastrointestinal bleeding. He was diagnosed with gastrointestinal bleed possibly secondary to Ansaid induced upper gastrointestinal irritation verses lower gastrointestinal pathology. In a January 1995 statement, Frederick J. Seidal, M.D. indicated that the veteran was hospitalized in January 1994 for gastrointestinal bleeding and noted that it was felt, but not proven, that Naprosyn was the cause of the gastritis and gastrointestinal bleed. During the June 1995 RO hearing the veteran testified that both the treating physician at Harrisburg Hospital and Dr. Seidel were of the opinion that his gastrointestinal bleeding was caused by the use of Naprosyn, which he noted he had been taking for four months prior to January 1994. He added that he no longer took this medication. A VA neurologic examination was accomplished in April 1998. In the report of this examination, the neurologist indicated that the veteran's headaches have indirectly caused his gastrointestinal bleed which was due to taking Naprosyn for the headaches. A VA gastrointestinal examination was also accomplished in April 1998. The report of this examination reflects that the veteran had a history of non-steroidal anti-inflammatory agent induced gastrointestinal bleeding. The impression included that of gastrointestinal bleeding secondary to non- steroidal anti-inflammatory agents. Finally, pursuant to the February 2000 Board remand, a VA examination was accomplished in October 2002. The examiner noted that in the early 1990's the veteran was started on Naprosyn for his headaches and that in 1994 was admitted to Harrisburg Hospital with an acute gastrointestinal bleed. As a result of this examination, the veteran was diagnosed with gastrointestinal bleed in 1994 probably secondary to chronic use of non-steroidal anti-inflammatory drugs taken for a service-connected injury to the head causing headaches and a gastrointestinal bleed in 2002 unrelated to a service- connected injury. The Board concedes that the evidence is somewhat unclear regarding the presence of a current gastrointestinal bleed or disability stemming from the 1994 gastrointestinal bleed. However, in view of the applicable law and the evidence discussed hereinabove, and extending the benefit of the doubt to the veteran, the Board concludes that there is sufficient evidence to find that the veteran's gastrointestinal bleeding was secondary to of Naprosyn medication taken for the his service-connected headache disorder. As the evidence in this case is in relative equipoise, service connection for gastrointestinal bleeding as secondary to the use of Naprosyn medication for the veteran's service- connected headache disorder is warranted. ORDER Service connection for gastrointestinal bleeding secondary to the use of Naprosyn medication for the veteran's service- connected headache disorder is granted. ____________________________________________ STEPHEN L. WILKINS Veterans Law Judge, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.