Citation Nr: 19106910 Decision Date: 01/29/19 Archive Date: 01/29/19 DOCKET NO. 10-46 902 DATE: January 29, 2019 REMANDED Entitlement to service connection for hiatal hernia, as secondary to service-connected duodenal ulcer is remanded. REASONS FOR REMAND The Veteran served in the United States Army from October 1968 to October 1970. In April 2014, the Board issued a decision that denied service connection for hiatal hernia, to include as secondary to service-connected duodenal ulcer. The Veteran appealed that decision to the U.S. Court of Appeals for Veterans Claims (Court). In November 2014, the Court issued an order that vacated the Board’s April 2014 decision and remanded the matter on appeal for adjudication consistent with the instructions outlined in the Joint Motion for Remand (JMR) by the parties. In January 2016, the Board issued a decision that, in pertinent part, denied service connection for hiatal hernia, to include as secondary to service-connected duodenal ulcer. The Veteran appealed that decision to the Court. In July 2016, the Court issued an order that partially vacated the Board’s January 2016 decision and remanded the matter on appeal for adjudication consistent with the instructions outlined in the Joint Motion for Partial Remand (JMPR) by the parties. In March 2017, the Board issued a decision that, in pertinent part, denied service connection for hiatal hernia, to include as secondary to service-connected disability. The Veteran appealed that decision to the Court. In a May 2018 Memorandum Decision, the Court dismissed the matter of service connection for hiatal hernia on a direct basis, vacated the portion of the Board’s May 2017 decision that denied service connection for hiatal hernia on a secondary basis, and remanded the matter on appeal for adjudication consistent with the instructions outlined in the Memorandum Decision. This matter is back before the Board. Entitlement to service connection for hiatal hernia, as secondary to service-connected duodenal ulcer is remanded. The Court found the Board’s May 2017 conclusion that the November 2016 VA examination opinion adequately addressed the matter of aggravation was clearly erroneous. See May 2018 Memorandum Decision. Therefore, the Court instructed remand was warranted for the Board to obtain a medical opinion with the requisite detail or to provide an adequate statement of reasons or bases, explaining why such action is not necessary. Id. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician, to exclude the clinician who provided the September 2015 and November 2016 medical opinions, regarding the nature and etiology of the Veteran’s hiatal hernia. An in-person examination is not required unless deemed necessary by the clinician. The examiner must opine: (a.) Whether the Veteran’s hiatal hernia is at least as likely as not (50 percent or greater probability) proximately due to his service-connected duodenal ulcer? (b.) Whether the Veteran’s hiatal hernia is at least as likely as not aggravated beyond its natural progression by his service-connected duodenal ulcer? The examiner must discuss the Veteran’s contention that his treatment for ulcers, to include his medication use, caused or aggravated his hernia. See statement in support of claim and attached medical articles received by VA on January 30, 2017. The examiner must discuss the contention that the Veteran’s hiatal hernia symptoms, including pain, discomfort and reflux, were aggravated by his service-connected ulcer. See January 2019 representative brief. The examiner must provide a detailed rationale for any opinion expressed. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Winkler, Associate Counsel