Citation Nr: 18148675 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 16-41 574 DATE: November 8, 2018 REMANDED Entitlement to service connection for a gastrointestinal disorder, gastroesophageal reflux disease (GERD), is remanded. REASONS FOR REMAND The appellant served on active duty in the United States Army from June 1969 to December 1970, with service in the Republic of Vietnam from February 1970 to December 1970. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). On appeal, the Veteran has contended that his GERD was incurred during his active service, and that he has had persistent symptoms of GERD since his deployment to Vietnam. The Veteran has submitted a September 2016 Disability Benefits Questionnaire (DBQ) from his VA treating physician, Dr. R.P., at which time he indicated that the Veteran was diagnosed with GERD and noted the Veteran’s reported history of “acid reflux almost daily” since returning from Vietnam. The examiner also took note of the appellant’s diagnosis of PTSD. Considering this evidence, the examiner determined that the appellant’s GERD was at least as likely as not aggravated by his service-connected PTSD. As a rationale for this opinion, the examiner cited to a medical journal article that cites a correlation between symptoms of GERD and mental health disorders among World Trade Center workers who were present on September 11th, 2001. As this rationale does not address the Veteran’s circumstances, including his symptoms of GERD and his symptoms of PTSD, and only cites to a general study of a population the Veteran is not a part of, the Board finds it inadequate for purposes of granting entitlement to service connection for GERD, as aggravated by his PTSD. However, as no VA examination has been afforded to the Veteran and no examiner has addressed whether the Veteran’s GERD is directly related to service or secondarily related to his service-connected PTSD, the Board finds that the low threshold for obtaining a VA examination has been met in this case and a remand is necessary in order for such to be accomplished. See 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). On remand, the Board also finds that any outstanding VA treatment records should also be obtained. See 38 U.S.C. § 5103A(b), (c); 38 C.F.R. § 3.159(b); see also Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016) (where the Veteran “sufficiently identifies” other VA medical records that he or she desires to be obtained, VA must also seek those records even if they do not appear potentially relevant based upon the available information); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matter is REMANDED for the following action: 1. Obtain any and all VA treatment records not already associated with the claims file from the Muskogee and Tulsa VA Medical Centers, or any other VA medical facility that may have treated the Veteran and associate those documents with the claims file. 2. Ensure that the Veteran is scheduled for a VA examination with an appropriate examiner in order to determine whether he has any current gastrointestinal disorder that are related to his service or a service-connected disability. The claims folder must be made available to and be reviewed by the examiner. All tests deemed necessary should be conducted and the results reported in detail. Following examination of the Veteran and review of the claims file, the examiner should state any and all gastrointestinal disorders found, to include GERD. Then, for any gastrointestinal disorders found, including GERD, the examiner should opine whether such at least as likely as not (50 percent or greater probability) began in service or is otherwise the result of military service, to include his presumed exposure to herbicide agents as a result of his service in the Republic of Vietnam. The examiner should take as conclusive fact that the Veteran is presumed exposed to herbicides due to his service in the Republic of Vietnam. Next, for any gastrointestinal disorders, including GERD, not directly found to be related to service, the examiner should also opine whether any such disorders at least as likely as not were (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected PTSD. The examiner should specifically address the September 2016 DBQ from Dr. R.P., his findings and conclusions, as well as the cited article therein. The examiner is reminded that he or she must address both prongs (a) and (b) above. In addressing the above, the examiner should consider the Veteran’s lay statements regarding onset of symptomatology and any continuity of symptomatology since onset and/or since discharge from service. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Kleponis, Associate Counsel