Citation Nr: 18156557 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 16-42 915 DATE: December 11, 2018 ORDER Entitlement to service connection for (gastroesophageal reflux disease) GERD, to include as secondary to the service-connected lumbosacral strain with degenerative disc disease, is granted. REMANDED Entitlement to a compensable rating for the left hip, mild chronic capsulitis, sacroiliitis (limitation of flexion) is remanded. Entitlement to a rating in excess of 10 percent for the left hip, mild chronic capsulitis, sacroiliitis (impairment of abduction, adduction, or rotation) is remanded. Entitlement to a compensable rating for the right hip, mild chronic capsulitis, sacroiliitis (limitation of flexion) is remanded. Entitlement to a rating in excess of 10 percent for the right hip, mild chronic capsulitis, sacroiliitis (impairment of abduction, adduction, or rotation) is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. FINDING OF FACT The Veteran’s GERD is aggravated beyond its natural progress by his service-connected lumbosacral strain with degenerative disc disease. CONCLUSION OF LAW The criteria for entitlement to service connection for GERD, to include as secondary to the service-connected lumbosacral strain with degenerative disc disease, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303(a), 3.304, 3.307(b), 3.309(a) (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS 1. Entitlement to service connection for GERD, to include as secondary to the service-connected lumbosacral strain with degenerative disc disease The Veteran contends that his GERD is caused by side effects related to his treatment of his service-connected lumbosacral strain. The April 2014 VA examination as well as VA and private treatment records show the Veteran has a current diagnosis of GERD. The record contains conflicting medical opinions regarding whether the Veteran’s GERD is at least as likely as not related to the Veteran’s service-connected lumbosacral strain. The April 2014 VA examiner opined that it was not. The rationale was although the Veteran claims that his gastroesophageal symptoms are caused by NSAID’s side effects related to treatment of his lumbar spine condition, the biopsy report indicates that the gastritis is etiologically linked to H. Pylori with secondary GERD. Therefore, the 2014 VA examiner opined that the Veteran’s gastroesophageal condition is less likely than not related to the service connected degenerative disc disease of the lumbar spine or the medications taken for the back condition. Private practitioner N.R. opined that it was. The rationale was that the Veteran’s GERD was aggravated beyond its natural progress by his service-connected lumbosacral strain with degenerative disc disease. Specifically, the examiner noted that the Veteran has been a patient of his for over the past year. He has had ongoing service-connected back pain during that time. The Veteran has been treated with pain medications by the Pain Management Group. The private practitioner opined that, as a result of the treatment with pain medications, the Veteran has developed gastritis and anemia due to the chronic blood loss. The practitioner further reasoned that while the gastroesophageal reflux disease (GERD) is not a direct result of the chronic-back pain, it has been exacerbated by the treatment that he receives for the condition. The Board finds both nexus opinions probative, because they are based on an accurate medical history and provide explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). However, the Board finds the nexus provided by the private practitioner more probative, as the private practitioner has had a history of treating and examining the Veteran over an extended period of time. Therefore, the Board finds a nexus has been established. Resolving all doubt in favor of the Veteran, the Board finds that the Veteran’s GERD is aggravated beyond its natural progress by the Veteran’s service-connected lumbosacral strain with degenerative disc disease. Accordingly, entitlement to service connection for GERD on a secondary basis is warranted. REASONS FOR REMAND 1. Entitlement to a compensable rating for the left hip, mild chronic capsulitis, sacroiliitis (limitation of flexion); entitlement to a rating in excess of 10 percent for the left hip, mild chronic capsulitis, sacroiliitis (impairment of abduction, adduction, or rotation); entitlement to a compensable rating for the right hip, mild chronic capsulitis, sacroiliitis (limitation of flexion); and entitlement to a rating in excess of 10 percent for the right hip, mild chronic capsulitis, sacroiliitis (impairment of abduction, adduction, or rotation) is remanded. The Veteran contends that his hips have gotten worse over the past ten years. VA and private treatment records indicate that the Veteran is receiving ongoing treatment for this hip condition. A VA examination was conducted in May 2015 to determine the severity of the Veteran’s hip. In the May 2015 VA hip examination, all range of motion measurements were normal. The Veteran was examined immediately after repetitive use over time. Flexion was 0 to 125 degrees; extension was 0 to 30 degrees; abduction was 0 to 45 degrees; adduction was 0 to 25 degrees; external rotation was 0 to 60 degrees; and internal rotation was 0 to 40 degrees. Adduction was not limited such that the Veteran cannot cross his legs. No pain was noted during the examination. There was no objective evidence of localized tenderness or pain on palpation of the soft tissue. There was no evidence of crepitus. In addition, the examination indicated that the Veteran was able to perform repetitive-use testing with at least three repetitions, and there was no additional loss function or range of motion after three repetitions. There was no pain, weakness, fatigability or incoordination that significantly limited functional ability with repeated use over a period of time. With respect to flare-ups, the examination was not conducted during a flare-up, and the Veteran did not report any flare-ups in his right hip. In his left hip, the Veteran reported severe flare-ups 2-3 times per week lasting 2-3 hours. The examiner indicated that the examination neither supports nor contradicts the Veteran’s statements describing functional loss during a flare-up. The examiner was unable to say without mere speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability with flare-ups in his left hip as the examiner noted that the Veteran provided a subjective history. The examination indicated that there are no other additional factors that contributed to the Veteran’s hip disabilities. With respect to muscle strength testing, flexion, extension, and abduction were of normal strength (5/5), so there was no reduction in muscle strength. The examination indicated that the Veteran did not have muscle atrophy. There was no evidence of ankylosis. There was no evidence of malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. There was no evidence of scars related to the Veteran’s right hip disabilities. The Veteran is in constant use of a cane and sacroiliac belt due to his hip disabilities. The Board notes that the Court has held that 38 C.F.R. § 4.59 requires that an adequate VA examination of the joints must include joint testing for pain on both active and passive motion, and in weight-bearing and nonweight-bearing. Correia v. McDonald, 28 Vet. App. 158 (2016). Unfortunately, the May 2015 VA examination did not address pain on passive motion and on nonweight-bearing. Therefore, the Veteran must be afforded a new examination that complies with these requirements as well as determine the severity of the Veteran’s current hip condition. 2. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. The Veteran is seeking a claim for TDIU based on his service-connected disabilities, including his hip condition. Because a decision on the above-discussed issues could significantly impact a decision on the Veteran's TDIU claim, the issues are inextricably intertwined. A remand of the claim for TDIU is required. The matters are REMANDED for the following action: 1. Schedule a VA examination to evaluate the current severity of the Veteran’s left and right hip. The examiner should address the following in the Veteran’s left and right hip, mild chronic capsulitis, sacroiliitis: limitation of flexion and impairment of abduction, adduction, or rotation. The electronic claims folder should be made available to the examiner for review in conjunction with the examination and the examiner should acknowledge such review in the examination report. Any indicated studies should be performed. The examination should be conducted in accordance with the current disability benefits questionnaires or examination worksheets applicable to the hip. The examiner should fully describe and distinguish any impairment arising from pain on active motion, passive motion, in weight-bearing, and in nonweight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The rationale for all opinions expressed must be provided. (Continued on the next page)   2. After completion of the above, readjudicate the issues on appeal, including the claim for TDIU. If any benefit requested on appeal is not granted to the Veteran’s satisfaction, the appellant and her representative should be furnished a supplemental statement of the case, which addresses all of the evidence obtained after the issuance of the last supplemental statement of the case, and provided an opportunity to respond. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Christine E. Grossman, Associate Counsel