Citation Nr: 20023073 Decision Date: 04/02/20 Archive Date: 04/02/20 DOCKET NO. 13-24 471 DATE: April 2, 2020 REMANDED Entitlement to service connection for a hiatal hernia is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1968 to March 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in March 2013 by the Department of Veterans Affairs (VA) Regional Office (RO). A Notice of Disagreement was received in June 2013. In August 2013, a Statement of the Case was issued. In August 2013, the Veteran filed his substantive appeal via a VA Form 9. In March 2017, the Veteran testified before the undersigned in a videoconference hearing. A transcript of the hearing has been associated with the claims file. In June 2017 and in January 2019, the Board remanded the claim for further development. In a January 2020 rating decision, the RO granted service connection for right knee arthritis. This represents a full grant of the benefits sought. See AB v. Brown, 6 Vet. App. 35 (1993). Entitlement to service connection for a hiatal hernia is remanded. The Veteran contends that service connection is warranted for a hiatal hernia. Specifically, the Veteran testified that he had symptoms of a hiatal hernia since service, to include choking that his hiatal hernia was caused by his active service. See March 2017 Hearing Transcript. The Veteran’s service treatment records show that he was seen for chest and throat tightness and that he was diagnosed with a head cold. During a January 2013 VA examination, the Veteran reported that he was diagnosed with a hiatal hernia in the 1980s when he choked and had to have an emergency EGD. The Veteran was afforded an Esophageal Conditions Disability Benefits Questionnaire in January 2013, at which time the examiner noted a diagnosis of hiatal hernia. At the time of the examination, the Veteran reported that his condition was related to heavy lifting required when rearming and repairing M48 and M60 tanks. The Veteran also reported that he was diagnosed with an esophageal stricture and hiatal hernia in the mid-1980s. The examiner opined that it was less likely than not that the Veteran’s hiatal hernia was incurred in or caused by the claimed in-service injury, event, or illness. The examiner rationed that a January 2008 VA treatment record showed that the Veteran did not have a hiatal hernia apparent, but that there was documentation in October 2011, from the Veteran’s private physician, which showed that the Veteran had a foreign body in his esophagus, stricture and ulceration of distal esophagus, and a small hiatal hernia. The examiner noted that a review of medical literature indicates that the cause of a hiatal hernia can be after an injury, coughing, straining during bowel movements, substantial weight gain, that some people are born with a predisposition to the condition, or that the cause can be unknown. The examiner then noted that it was less likely than not that the Veteran’s current small hiatal hernia was the result of lifting required when rearming and repairing M48 and M60 tanks in the military service. In a January 2020 Medical Opinion Disability Benefits Questionnaire, a VA examiner opined that it was less likely than not that the Veteran’s hiatal hernia was incurred in or caused by his in-service symptoms of hiatal hernia, to include choking. The examiner rationed that a review of the Veteran’s separation Report of Medical History showed that the Veteran denied a contributory history of illness pertaining to a condition involving the gastrointestinal tract. The examiner also cited that the Veteran’s Report of Medical Examination, conducted at separation, showed no objective findings of abnormalities pertaining to the abdomen and viscera. The examiner also noted that the Veteran’s in-service records showed no evidence of a consult or treatment for heartburn. The examiner acknowledged the Veteran’s testimony that he had symptoms of hiatal hernia since service to include choking and that his condition was caused by his active service, but the examiner found that there was no associated evidence of a consult or treatment, during service, for choking, heartburn, regurgitation, difficulty swallowing, shortness of breath, vomiting of blood, melena and other medically-known symptoms associated with hiatal hernia documented. The examiner also noted that while the Veteran presented with in-service complaints of chest and throat tightness, he was diagnosed with a head cold. The examiner also referred to the January 2013 VA examination which noted that the Veteran’s records were silent for consultations and treatments for known symptoms associated with hiatal hernia. The examiner further reported that an August 2004 examination showed that the Veteran had a past medical history of hiatal hernia, but that there were no diagnostic examinations conducted and that, in January 2008, the Veteran had impressions of a normal upper gastrointestinal examination and a normal esophagram. The examiner additionally reported that the Veteran’s records show a definitive diagnosis of hiatal hernia in October 2011, clearly and unmistakably following service. Here, it is still unclear to the Board whether the Veteran’s condition is related to active service, to include his reports of rearming and repairing M48 and M60 tanks in the military service. The Board finds that an addendum opinion as to this issue, particularly in light of the January 2013 VA examiner’s opinion noting that the cause of a hiatal hernia can be attributed to an injury, amongst several other etiologies. Therefore, on remand, another addendum opinion should be obtained. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician (who has never treated the Veteran) regarding whether the Veteran’s hiatal hernia is at least as likely as not (a probability of 50 percent or greater) related to service, to include the Veteran’s contention that his hernia was caused by rearming and repairing M48 and M60 tanks during service. If the clinician determines that another examination is required, one should be scheduled. If it is determined that the Veteran’s hiatal hernia did not have an onset during his military service or was otherwise not causally or etiologically related to service, the examiner must provide an opinion as to the more likely etiology. A complete rationale must be provided. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.