Citation Nr: 18146445 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 15-05 666 DATE: October 31, 2018 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD), on the basis of substitution, is remanded. Entitlement to service connection for hiatal hernia, on the basis of substitution, is remanded. INTRODUCTION The Veteran served on active duty in the Air Force from February 1969 to June 1972, including service in the Republic of Vietnam. He died in January 2012. The appellant is his surviving spouse and has been substituted as the claimant in the appeal. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania, which, inter alia, denied service connection for GERD/hiatal hernia. The Veteran filed a timely Notice of Disagreement (NOD), received in April 2011. The Veteran died in January 2012 and the appellant was then substituted as the claimant. A Statement of the Case (SOC) was issued in December 2014. A timely substantive appeal was received in January 2015. The issue certified to the Board was entitlement to service connection for GERD/hiatal hernia. However, the Board has recharacterized the matter as two separate issues for clarity. In light of the remand below, no prejudice to the appellant has resulted. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). REASONS FOR REMAND The appellant contends that the Veteran’s hiatal hernia and GERD were the result of his service-connected diabetes mellitus and/or his presumed exposure to herbicide agents, including Agent Orange. A VA medical opinion was obtained in June 2014. The claims file was reviewed. The VA physician opined that it was less likely than not that the Veteran’s GERD was due to his service-connected diabetes. He explained that GERD is caused by an incompetent gastroesophageal sphincter from various causes and contributing factors. GERD can be related to diabetes when there is an autonomic neuropathy, but no such condition was seen to have been established, nor was there any manifestation of it such as gastroparesis, which might contribute to GERD, which was seen as having been diagnosed. Unfortunately, this opinion is inadequate. First, it does not address the Veteran’s hiatal hernia. Second, it does not address whether GERD was aggravated by service-connected diabetes mellitus. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Thus, the matter must be remanded in order to obtain an adequate medical opinion. The matter is REMANDED for the following action: Obtain a medical opinion from an appropriate clinician as to the nature and etiology of the Veteran’s (1) GERD, and (2) hiatal hernia. Access to the electronic VA claims file should be made available to the examiner for review. (a) Regarding GERD, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that GERD was incurred during the Veteran’s active service, or was a result of an in-service disease or injury, including presumed exposure to herbicide agents. If not, the examiner must provide an opinion as to whether it is at least as likely as that GERD was proximately due to or the result of the Veteran’s service-connected diabetes mellitus. If neither, the examiner should provide an opinion as to whether it is at least as likely as not that GERD was aggravated (permanently made worse) by the Veteran’s service-connected diabetes mellitus. If aggravation is found, the examiner must attempt to establish a baseline level of severity of GERD prior to aggravation by the service-connected diabetes mellitus. (b) Regarding hiatal hernia, the examiner must provide an opinion as to whether it is at least as likely as not that hiatal hernia was incurred during the Veteran’s active service, or was a result of an in-service disease or injury, including presumed exposure to herbicide agents. If not, the examiner must provide an opinion as to whether it is at least as likely as that hiatal hernia was proximately due to or the result of the Veteran’s service-connected diabetes mellitus. If neither, the examiner should provide an opinion as to whether it is at least as likely as not that hiatal hernia was aggravated (permanently made worse) by the Veteran’s service-connected diabetes mellitus. If aggravation is found, the examiner must attempt to establish a baseline level of severity of hiatal hernia prior to aggravation by the service-connected diabetes mellitus.   The examiner must provide supporting rationale for all opinions. K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Behlen, Associate Counsel