Citation Nr: 18153211
Decision Date: 11/27/18	Archive Date: 11/27/18

DOCKET NO. 10-10 308
DATE:	November 27, 2018
REMANDED
Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.
REASONS FOR REMAND
The Veteran served on active duty from September 1986 to September 1989, January 2001 to May 2001, and June 2004 to December 2005.
The Board previously denied this matter in a September 2017 decision.  The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims, resulting in a May 2018 Joint Motion for Partial Remand (JMPR).
1. Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.
Pursuant to the May 2018 JMPR, the Board has determined that remand for a new medical opinion is necessary.  Specifically, the new medical opinion must address whether the Veteran’s GERD preexisted any of his three periods of service, and if so, whether it was aggravated during such service.  In doing so, the opinion should focus on a July 2003 treatment note (in between periods of service) documenting the loss of dental enamel suggesting possible reflux issues.  
The matter is REMANDED for the following action:
1. Return the claims file to an examiner of appropriate expertise to determine the etiology of the Veteran’s GERD.  It is up to the discretion of the examiner if a new examination is necessary, or in the alternative, an addendum opinion is sufficient. 
Based on a review of the record, the examiner should:
(a) Provide an opinion as to whether the Veteran’s GERD clearly and unmistakably (obviously or manifestly) existed prior to any period of active service.  Specific focus should be given to the third period of service (June 2004 to December 2005) and a July 2003 treatment note documenting loss of tooth enamel.   
If GERD clearly and unmistakably existed prior to a period of active service, provide an opinion as to whether such disorder clearly and unmistakably (obviously or manifestly) was not aggravated (increased in severity beyond the natural progression of the disability) during the Veteran’s period of active service.
(b) If GERD did not preexist any period of service, provide an opinion as to whether it is at least as likely as not (i.e. probability of 50 percent or greater) that GERD is causally or etiologically related to any period of active service.
In making these determinations, the examiner is asked to address the aforementioned July 2003 treatment note documenting loss of tooth enamel and other relevant medical records. 
A complete rationale for any opinion expressed should be provided in a report.  The Veteran is competent to report symptoms and treatment, and his reports must be taken into account, along with the other evidence of record.
2. Readjudicate the Veteran’s claims.  If the benefits sought on appeal are not granted, the Veteran should be provided a Supplemental Statement of the Case and afforded the requisite opportunity to respond before the case is returned to the Board.

 
H. N. SCHWARTZ
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	W. R. Stephens, Counsel