Citation Nr: 18153088 Decision Date: 11/28/18 Archive Date: 11/27/18 DOCKET NO. 16-48 392 DATE: November 28, 2018 REMANDED Entitlement to service connection for gastritis to include GERD is remanded. Entitlement to service connection for neurogenic bladder, to include urinary incontinence is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1977 to October 1978, from October 2001 to April 2002, from February 2004 to February 2005 and from January 2008 to December 2008. This matter comes before the Board from a July 2011 rating decision. 1. Entitlement to service connection for a gastrointestinal disorder to include gastritis and gastroesophageal reflux disease (GERD) is remanded. The Veteran contends that her gastrointestinal disorder is secondarily related to the treatments for her service connected cervical and lumbar disabilities. The Veteran was afforded a VA examination in January 2010. An addendum opinion was obtained in May 2011. The examiner noted that the Veteran had a history of gastritis and presently diagnosed GERD. The examiner opined that the gastritis in 2008 was most likely caused by the Veteran’s use of NSAIDs to treat her pain from her service connected cervical and lumbar spine disabilities, but the condition had resolved when the Veteran reduced her use of NSAIDs. The examiner also opined that the Veteran’s diagnosed GERD was a long-standing condition that pre-dated service and was less likely than not related to treatments for her service connected cervical and lumbar spine disabilities. The Veteran contends that her gastrointestinal conditions were worsened by her August 2009 surgery on her spine to treat her service connected injury. She states that the gastrointestinal conditions are complications from the surgery. She also suggests that there is a correlation between the gastritis that she had in service and her GERD. As the Veteran has raised an additional contention that her gastrointestinal conditions were aggravated by her surgery and this contention has not been addressed by a VA examiner, another VA examination is necessary to determine the nature and etiology of the Veteran’s gastrointestinal disorders. 2. Entitlement to service connection for neurogenic bladder, to include urinary incontinence is remanded. The Veteran contends that her urinary incontinence is related to her service connected lumbar spine disability. The Veteran was afforded a VA examination in January 2010 and there was an addendum opinion in November 2010. The examiner opined that the Veteran’s urinary incontinence was less likely than not caused or worsened by her lumbar spine disability. The Veteran has submitted records from physical therapy suggesting a link between her urinary incontinence and weakness in the Veteran’s left side hip, back, and leg. However, the statement from the physical therapist is too speculative to support the award of service connection. These records were not available to previous VA examiners. Another VA examination is necessary to determine the etiology of the Veteran’s urinary incontinence. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of her gastrointestinal conditions. All pertinent symptomatology and findings must be reported in detail. All studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner should: (a.) Identify/diagnose any disability of the gastrointestinal tract that presently exists or that has existed during the appeal period. (b.) For any diagnosed gastrointestinal disorder, opine as to whether it is at least as likely as not that it was caused by her service connected cervical and lumbar spine disabilities, to include medications used to treat these disabilities and the 2009 spine surgery. The examiner should address the question as to whether the Veteran’s in-service gastritis was a pre-cursor to any current gastrointestinal disorder. (c.) For any diagnosed gastrointestinal disorder, opine as whether it is at least as likely as not that the Veteran’s GERD was aggravated (i.e., made chronically worse) by the Veteran’s service-connected cervical and lumbar spine disabilities to include the medications used to treat these conditions and the 2009 spine surgery. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of her urinary incontinence. All pertinent symptomatology and findings must be reported in detail. All studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner should opine: (a.) Whether it is at least as likely as not that the Veteran’s diagnosed urinary incontinence had its onset in service or within a year of service discharge or otherwise should be related to her active service. (b.) Whether it is at least as likely as not that the Veteran’s urinary incontinence was caused by her service connected lumbar spine disabilities, to include the left side weakness described by the Veteran’s physical therapist. (c.) Whether it is at least as likely as not that the Veteran’s urinary incontinence was aggravated (i.e., made chronically worse) by the Veteran’s service-connected lumbar spine disabilities, to include the left side weakness described by the Veteran’s physical therapist. Rationale should be provided for all opinions. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Rekowski, Associate Counsel