Citation Nr: 18152812 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 16-49 940 DATE: November 27, 2018 REMANDED Entitlement to service connection for gastroesophageal reflex (GERD) to include Barrett's esophagus, to include as secondary to service-connected irritable bowel syndrome (IBS), is remanded. REASONS FOR REMAND The Veteran had active military service from November 2001 to May 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Board’s review of the claims file reveals that further action on the claim of entitlement to service connection for GERD to include Barrett’s esophagus is needed. Specifically, the Board finds that the December 2013 VA medical opinion is incomplete, and as such further development is needed before the Veteran’s claim can be decided. At the outset, the Board notes that the Veteran has a diagnosis of GERD and Barrett’s esophagus. See December 2013 CAPRI and February 2015 Medical Treatment Record – Non-Government Facility. A review of the service treatment records shows that in the April 2001 operational screening examination and November 2001 entrance examination the Veteran had no complaints of indigestion, heartburn, or intestinal or stomach trouble. See August 2013 STR – Medical. In July 2003, the Veteran had a ruptured acute necrotizing appendicitis with associated focal peritonitis, right colon, and distal ileum and appendix. See August 2013 STR – Medical. A month after the appendicitis, the Veteran continued to complain of abdominal pain and bloating. Id. In the March 2003 medical board examination, the Veteran endorsed stomach, liver or intestinal trouble but no frequent indigestion or heartburn. Id. In August 2004, the Veteran complained of nausea and diarrhea. See October 2004 Medical Treatment Record – Government Facility. In 2005, the Veteran was noted to have gastrointestinal bleeding. See September 2016 CAPRI. In 2007, the Veteran was diagnosed with GERD. See September 2016 CAPRI. The December 2013 VA examiner opined that the Veteran’s esophageal condition is less likely than not proximately due to or the result of the Veteran’s service-connected IBS. The examiner stated that Barrett’s esophagus has nothing to do with IBS, Barrett’s is a complication of GERD. The Board finds this opinion incomplete as the examiner did not address the relationship of GERD to IBS. As such, the Board finds that a remand is necessary. The matter is REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records identified by the Veteran. 2. Thereafter, obtain an addendum to the December 2013 VA examination from an appropriate medical professional. The claims file, including a copy of this remand, must be made available to be reviewed by the examiner. A record of the review of the claims file should be documented in the examination report. All indicated diagnostic tests should also be completed. a. The examiner must determine if it is at least as likely as not (50 percent probability or more) that the Veteran’s Barrett’s esophagus and/or GERD had its onset in service or is otherwise etiologically related to service. b. The examiner must determine if it is at least as likely as not (50 percent probability or more) that the Veteran’s service-connected IBS caused his Barrett’s esophagus and/or GERD. c. The examiner must determine if it is at least as likely as not (50 percent probability or more) that the Veteran’s service-connected IBS aggravated his Barrett’s esophagus and/or GERD. (Continued on the next page)   The examiner must discuss the reasons for why or why not in answer to each question. The examiner must address both GERD and Barrett’s esophagus when providing opinions. A detailed rationale for all opinions must be provided. If the examiner is unable to offer the requested opinion, it is essential that he or she offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Noh, Associate Counsel