Citation Nr: 18149978 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-53 152 DATE: November 14, 2018 REMANDED Entitlement to a compensable rating gastroesophageal reflux disease (GERD) with hiatal hernia and eosinophilic esophagitis is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1983 to January 1987 and March 2012 to February 2013. This matter is on appeal from a March 2015 rating decision, which denied a compensable rating for the Veteran’s GERD with hiatal hernia and eosinophilic esophagitis. Entitlement to a compensable rating for GERD with hiatal hernia and eosinophilic esophagitis is remanded. A review of the claims file reveals that a remand is necessary before a decision on the merits of the claim can be reached. A March 2015 rating decision continued a noncompensable disability rating assigned to the Veteran’s GERD with hiatal hernia and eosinophilic esophagitis. A December 2016 rating decision assigned a 10 percent disability rating to the Veteran’s GERD with hiatal hernia and eosinophilic esophagitis, effective December 1, 2016. Although an increased rating has been granted, the issue remains in appellate status, as the maximum schedular rating has not been assigned. AB v. Brown, 6 Vet. App. 35 (1993). During the period on appeal, the Veteran was afforded VA examinations of his esophageal conditions in February 2014 and December 2016. The report for the February 2014 examination reported that the onset of the Veteran’s GERD was in 2009. The Veteran reported being diagnosed with eosinophilic esophagitis in 2009. The examiner reported that the Veteran’s only GERD symptom was dysphagia, for which he was taking Flovent as needed. In December 2016, the Veteran was afforded a VA examination of his esophageal conditions that did not include an in-person examination. The examiner reported the Veteran’s complaints of food getting stuck in his throat and regurgitation. The problem with food getting stuck reportedly is alleviated by Flovent. A January 2013 demobilization examination did not note any GERD complaints. The examiner reported that the Veteran is not using any medications to treat his GERD, though he uses Flovent and fluticasone to treat his allergic rhinitis and respiratory condition. The examiner reported no complains of regurgitation or reflux symptoms in the Veteran’s treatment records. However, the examiner reported that the Veteran’s GERD symptoms as dysphagia and regurgitation. In July 2018, the Veteran submitted a Statement in Support of Claim (VA Form 21-4138) in support an increased rating for his GERD. He expressed that “I wish people would just ask me in plain English” about GERD symptoms and then proceeded to provide detailed descriptions of various GERD symptoms he had been experiencing. First, he reported that epigastric distress is one of his most common symptoms. According to the Veteran, “My chest feels tight and it burns, the food gets clogged in my throat and I can’t breathe and there are times I have to puke or force myself to puke in order to breathe.” He stated that these symptoms have become worse since he deployed to Djibouti, adding that “I had 2 GERD attacks today alone before 1600.” Next, he reported that he has difficulty or discomfort in swallowing every time he has a GERD attack. According to the Veteran, “I can’t swallow and it is very discomforting to say the least when it gets stuck like a ball in my throat, my chest tightens/burns and I can’t breathe.” In describing his heartburn symptoms, he reported that he does not have heartburn when a GERD attack happens unless it happens close to when he is going to bed. He stated that, when GERD attacks happen at night, the heartburn is so bad that he will have to get up to take antacid or lay his side and that he is unable to sleep until the symptoms pass. The next GERD symptoms described by the Veteran were regurgitation symptoms. According to the Veteran, “When I have GERD attacks I either am able to cough up some undigested food, I puke it up or stick my finger down my throat in order to puke so I can breathe.” He also reported that he has substernal pain every time he has a GERD attack. The Veteran stated that he does not remember ever being asked if he had this symptom even though he has described it to the doctors many times. According to the Veteran, “My chest feels like an elephant is sitting on it with a burning sensation even after the food is cleared out of my throat it lingers for 15-30 minutes afterwards.” The Veteran reported that, since his deployment, the frequency and severity of his GERD attacks have increased. He reported having no less than 15 to 20 attacks each month and that it happens so often that it has become a part of his life since 2012. In addition to describing his GERD symptoms, the Veteran’s July 2018 Statement in Support of Claim also requested that medical records from his VA doctor, Dr. D.V.N., at the VA American Lake Hospital in Lakewood, Washington should be evaluated as part of this appeal. According to the Veteran, Dr. D.V.N. has prescribed many medications over the last three years to treat his GERD symptoms, including a generic Flovent, albuterol, and fluticasone. The Veteran was last examined by the VA for GERD in December 2016. Since then, additional treatment records for his service-connected GERD with hiatal hernia and eosinophilic esophagitis have been associated with the claims file, which consist of 2018 private treatment records from A.A.S.S. Additionally, the Veteran had identified the American Lake Division of the VA Puget Sound Health Care System as having relevant records pertaining to the treatment of his GERD symptoms. Moreover, since the Veteran was last examined, he has provided detailed statements describing his GERD symptoms. As additional evidence has been associated with the claims file, a new examination regarding the current severity of the Veteran’s GERD is warranted. On remand, the Agency of Original Jurisdiction (AOJ) should ask the Veteran to identify any additional, pertinent VA or private medical treatment related to his GERD. Any additional records should be associated with the claims file. The AOJ should also ask the Veteran to submit any additional, pertinent lay statements relating to his claims. The matter is REMANDED for the following action: 1. Contact the Veteran and request that he identify all outstanding VA and private treatment records related to his GERD with hiatal hernia and eosinophilic esophagitis. After obtaining the necessary authorization forms from the Veteran, including authorization for records from the VA Puget Sound Health Care System, the AOJ should obtain any pertinent records and associate them with claims file. Any negative response should be in writing and associated with the claims file. 2. Notify the Veteran that he may submit lay statements from himself, as well as from individuals who have first-hand knowledge of the nature, extent and severity of his GERD with hiatal hernia and eosinophilic esophagitis and the impact of the conditions on his ability to work. He should be provided an appropriate amount of time to submit this lay evidence. 3. Upon completion of the foregoing, schedule the Veteran for an appropriate VA examination to determine the current severity of his service-connected GERD with hiatal hernia and eosinophilic esophagitis. The claims folder and a copy of this remand must be provided to and reviewed by the examiner. All pertinent symptomatology and findings must be reported in detail, and any indicated diagnostic tests and studies must be accomplished. 4. Once the above-requested development has been completed, the claim must be readjudicated. If any determination remains unfavorable to the Veteran, he and his representative should be provided with a supplemental statement of the case (SSOC) that addresses all relevant actions taken on the claim for benefits, and be given an opportunity to respond to the SSOC. The case must then be returned to the Board for further consideration, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). (Continued on the next page)   This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Moore, Associate Counsel