Citation Nr: 18152006 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 18-40 671 DATE: November 20, 2018 REMANDED Entitlement to service connection for esophageal cancer is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from December 1971 to October 1975, and in the U.S. Navy from June 1978 to September 1994. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a November 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. Entitlement to service connection for esophageal cancer is remanded. The evidence of record shows that the Veteran was diagnosed with esophageal cancer in 2016. He contends that the condition which led to the onset of this disease were incurred during his period of active service in the Navy. Specifically, he has submitted an April 2018 Disability Benefits Questionnaire (DBQ), completed by a private physician, which indicates that the Veteran had a longstanding history of reflux and gastroesophageal reflux disease (GERD) which eventually resulted in the development of his cancer. (Significantly, no opinion was provided regarding the date of onset of the Veteran’s reflux and GERD). The Veteran’s service treatment records from his period of service in the Navy are missing and unavailable for review. In such cases, VA has a heightened duty to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. See Pruitt v. Derwinski, 2 Vet. App. 83, 85 (1992); O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The Veteran has not been afforded a VA examination in connection his claim. Service treatment records from his period of service in the Air Force reflect that he was treated for symptoms of nausea, sore throat, and chest pain, among other things. In light of VA’s heightened duty to assist in this case, and in order to afford the Veteran every opportunity to substantiate his claim, he should be afforded a VA examination. See 38 C.F.R. § 3.159(c)(4); McClendon v. Nicholson, 20 Vet. App. 79 (2006). This matter is REMANDED for the following action: 1. Arrange to have the Veteran scheduled for a VA examination concerning his esophagus. The examiner should review the record. All indicated tests should be conducted and the results reported. After examining the Veteran and reviewing the record, together with the results of any testing deemed necessary, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran’s esophageal cancer had its onset in, or is otherwise attributable to, his period(s) of active service. In so doing, the examiner should offer an opinion as to whether it is at least as likely as not that GERD began during active service. The examiner should consider the Veteran’s lay statements with regard to the onset of his GERD, and should also review the available service treatment records and determine whether any symptoms noted therein—to include nausea, vomiting, and chest pain—are as likely as not indicative of the presence of GERD. A complete medical rationale for all opinions expressed must be provided. If the examiner cannot provide an opinion without resort to speculation, he or she must provide an explanation as why that is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of the need for additional information, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to a particular question. 2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraph, the Veteran’s claim should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Minot, Associate Counsel