Citation Nr: 18142394 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 14-26 206 DATE: October 15, 2018 REMANDED Entitlement to service connection for a digestive disorder (claimed as Barrett’s Esophagus and gastroesophageal reflux disease (GERD)), to include as secondary to service-connected posttraumatic stress disorder (PTSD) and depressive disorder with panic disorder with agoraphobia is remanded. Entitlement to a rating in excess of 30 percent for PTSD and depressive disorder with panic disorder with agoraphobia is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1969 to September 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Augusta, Maine. The Board notes that jurisdiction now rests with Detroit, Michigan. 1. Entitlement to service connection for a digestive disorder (claimed as Barrett’s Esophagus and gastroesophageal reflux disease (GERD)), to include as secondary to service-connected posttraumatic stress disorder (PTSD) and depressive disorder with panic disorder with agoraphobia is remanded. In an April 2016 VA examination, the examiner opined that the Veteran’s GERD/Barrett’s esophagitis was less likely as not aggravated beyond the natural progression of the disease by the service-connected psychiatric conditions. The examiner reasoned that medical records did not evidence any symptoms or complaints associated with GERD/Barrett’s esophagitis. The examiner further stated that the Veteran was on no medication for these diagnoses, and the Veteran himself stated that he had no symptoms at that time related to GERD/Barrett’s esophagitis. The Board finds this opinion inadequate. Initially, the Board notes that in an April 2016 statement, the Veteran asserted that he took pantoprazole for his GERD but could not remember this during the April 2016 VA examination. The Board notes that VA treatment records show that the Veteran is prescribed pantoprazole for acid reflux. Additionally, the Veteran stated in an August 2016 VA Form 646 that his Barrett’s Esophagus disease was secondary to his mental health condition due to side effects of the prescribed medications he was taking for his mental health condition. Thus, on remand a new VA opinion, and VA examination if necessary, is needed to address the conflicting evidence of record that shows the Veteran is prescribed medication for his digestive disorder. The examiner should address whether the Veteran has a current digestive disorder, to include Barrett’s Esophagus disease and GERD. Additionally, the examiner is also asked to address whether the Veteran’s medication prescribed for his PTSD and depressive disorder with panic disorder with agoraphobia has caused or aggravated his Barrett’s Esophagus and GERD. 2. Entitlement to a rating in excess of 30 percent for PTSD and depressive disorder with panic disorder with agoraphobia is remanded. In a September 2018 Appellate Brief, the Veteran contended that the severity of his PTSD and depressive disorder with panic disorder with agoraphobia was more severe and warranted a higher evaluation. The Veteran requested that he be provided a new VA examination to determine the current severity of his psychiatric condition. The Veteran was last afforded a VA examination in April 2016. This examination is over 2 years old. Accordingly, a remand for an appropriate VA examination to assess the current severity of his service-connected PTSD and depressive disorder with panic disorder with agoraphobia is needed. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994); VAOPGCPREC 11-95 (1995). The matters are REMANDED for the following actions: 1. Obtain any outstanding private or VA treatment records. Request that the Veteran assist with locating these records, if possible. Associate these records with the claims file. 2. Then, forward the claims file and a copy of this remand to the April 2016 VA examiner, if available, or an appropriate substitute to determine the etiology of the Veteran’s digestive disorder, claimed as Barrett’s Esophagus and GERD. A VA examination should be scheduled if deemed necessary. After a review of the evidence, the examiner is asked to first determine whether the Veteran has a current diagnosis of a digestive disorder, to include Barrett’s Esophagus and GERD. If so, the examiner is asked to consider whether it is at least as likely as not (50 percent or greater probability), that the Veteran’s digestive disorder, to include Barrett’s Esophagus and GERD, are caused or aggravated by the medication taken for the Veteran’s psychiatric disorder. The examiner must provide a clear rationale for all opinions expressed. The examiner must consider the evidence showing that the Veteran takes medication for acid reflux, as well as the lay statements of record. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 3. Also, schedule the Veteran for a VA examination with an appropriate examiner to determine the current severity of the Veteran’s PTSD and depressive disorder with panic disorder with agoraphobia. The claims file and a copy of this remand should be provided to the examiner. A review of the evidence must be made by the examiner. The examiner should identify all current manifestations of the service-connected PTSD and depressive disorder with panic disorder with agoraphobia. The examiner should also provide an opinion concerning the current degree of social and occupational impairment resulting from the service-connected PTSD and depressive disorder with panic disorder with agoraphobia. A clear rationale must be provided for all opinions expressed. The examiner must consider the lay statements of record. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 4. Thereafter, readjudicate the claim on appeal. If the benefit sought remains denied, issue the Veteran and his representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning this matter to the Board for further appellate review. J. CONNOLLY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Saudiee Brown, Associate Counsel