Citation Nr: 20026034 Decision Date: 04/15/20 Archive Date: 04/15/20 DOCKET NO. 19-12 212 DATE: April 15, 2020 ORDER The application to reopen a claim for service connection for chronic dysphagia and residuals of an esophageal motility disorder is granted. The application to reopen a claim for service connection for an intestinal motility disorder is granted. Service connection for a psychiatric disorder, diagnosed as a major depressive disorder and an anxiety disorder, is granted. Service connection for a gastrointestinal disorder, diagnosed as gastroesophageal reflux disease (GERD), Barrett’s esophagus, a hiatal hernia, an esophageal stricture, and an esophageal spasm, is granted. REMANDED Entitlement to service connection for chronic dysphagia and residuals of an esophageal motility disorder is remanded. Entitlement to service connection for an intestinal motility disorder is remanded. Entitlement to service connection for residuals of heat stroke is remanded. Entitlement to service connection for seizures is remanded. FINDINGS OF FACT 1. The Veteran’s psychiatric disorder, diagnosed as a major depressive disorder and an anxiety disorder, had its onset in service. 2. The Veteran’s gastrointestinal disorder, diagnosed as GERD, Barrett’s esophagus, a hiatal hernia, an esophageal stricture, and an esophageal spasm, had its onset in service. CONCLUSIONS OF LAW 1. The criteria for service connection for a psychiatric disorder, diagnosed as a major depressive disorder and an anxiety disorder, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1154(a), 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2018). 2. The criteria for service connection for a gastrointestinal disorder, diagnosed GERD, Barrett’s esophagus, a hiatal hernia, an esophageal stricture, and an esophageal spasm, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1154(a), 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Marine Corps from February 2002 to June 2002. This matter is before the Board of Veterans’ Appeals (Board) on appeal of an April 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, that reopened and denied the Veteran’s claim for entitlement to service connection for chronic dysphagia and an esophageal motility disorder on a de novo basis, and reopened and denied his claim for entitlement to service connection for an intestinal motility disorder on a de novo basis. By this decision, the RO also denied service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD) (listed as a major depressive disorder, claimed as PTSD, anxiety, depression, and a mood disorder). As there are multiple other psychiatric diagnoses of record, the Board finds that it is more appropriate to characterize the claim broadly as one of entitlement to service connection for a psychiatric disorder, to include PTSD. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The RO further denied service connection for gastrointestinal disorder, to include GERD (listed as chronic dysphasia and residuals of an esophageal motility disorder, also claimed as GERD). As there are multiple other gastrointestinal disorders of record, the Board finds that it is more appropriate to characterize the claim broadly as one of entitlement to service connection for a gastrointestinal disorder, to include GERD. See Clemons, 23 Vet. App. at 1. The RO denied service connection for residuals of heat stroke, and for seizures, as well. The Board observes that the April 2016 RO decision reopened and denied the ervice connection for chronic dysphagia and an esophageal motility disorder on a de novo basis, and reopened and denied his claim for entitlement to service connection for an intestinal motility disorder on a de novo basis. The Board notes, however, that service connection for chronic dysphagia and an esophageal motility disorder, and service connection for an intestinal motility disorder, were previously denied, respectively, in a final March 2013 RO decision. Thus, the Board must address whether new and material evidence has been received to reopen the Veteran’s claims for entitlement to service connection for chronic dysphagia and an esophageal motility disorder, and for an intestinal motility disorder. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). The Board finds, however, that new and material evidence has been received to reopen those claims pursuant to 38 C.F.R. § 3.156 (a). Therefore, this decision will address the merits of the underlying service connection claims for chronic dysphasia and an esophageal motility disorder, and for an intestinal motility disorder. 1. Psychiatric Disorder, to include PTSD Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA’s policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by an established service-connected disability. 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f). Further, 38 C.F.R. § 3.304(f) provides that if a stressor claimed by a Veteran is related to the Veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of [PTSD] and that the Veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board”). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran’s demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). The Veteran contends that he has a psychiatric disorder, to include PTSD, that is related to service. He specifically maintains that he has a psychiatric disorder, to include PTSD, as a result of trauma that happened to him in the Marine Corps. He reports that during basic training, at a rifle range at Parris Island in South Carolina, he suffered from heat stroke and was taken to a medical clinic. He states that he was out of it mentally at that time. The Veteran states that he has had numerous hospitalizations for psychiatric issues. He indicates that a private psychological evaluation report provides a nexus between his depressive disorder and anxiety disorder and his period of service. He essentially contends that his psychiatric problems began during his period of service. The Veteran served on active duty in the Marine Corps from February 2002 to June 2002. His DD Form 214 indicates that his discharge was uncharacterized and that he had an entry level separation. The narrative reason for separation was entry level performance and conduct. The Veteran’s available service personnel records do not show that he was awarded decorations evidencing combat, and he has not claimed that he served in combat. A June 2002 Recommendation for Discharge report notes that the Veteran was discharged for entry level performance and conduct because of incapability-dysphagia and rule out an esophageal motility disorder. The Veteran’s service treatment records do not specifically show treatment for psychiatric problems. Post-service private and VA treatment records, including a VA examination report, show treatment for variously diagnosed psychiatric problems, including bipolar, manic depression; a major depressive disorder; a generalized anxiety disorder; an anxiety disorder; and PTSD. A July 2004 treatment report from R. Arumugam, M.D., from the Highlands Regional Occupational Medicine and Rehabilitation Center, approximately two years after the Veteran’s separation from service, notes that his chief complaints were dizzy spells, sweating from the chest up, blurred vision, and passing out. The Veteran reported that he had heat stroke in the Marines in 2002 and that he had suffered from problems ever since that time. He stated that he had hot sweats from the chest up even in the winter months. He indicated that he had his gallbladder was removed in February 2003 and that when he felt hot, he would have sweats, which caused blurred vision, and he would have to cool off to keep from passing out. The diagnoses were thermoregulation, heat; status post cholecystectomy; difficulty swallowing with dry foot, and bipolar, manic depression. A July 2015 private psychiatric examination report, from J. Bolarous, M.D., indicates that no medical evidence was reviewed. Dr. Bolarous reported that the Veteran had multiple bowel surgeries and severe health problems. It was noted that the Veteran had a colostomy and reversible surgery, as well as achalasia of the esophagus. Dr. Bolarous reported that the Veteran had lots of hospitalizations for mental health issues. The diagnoses were PTSD; a major depressive disorder; and a generalized anxiety disorder. A March 2016 VA psychiatric examination report includes a notation that the Veteran’s claims file was reviewed. The examiner stated that the record indicates that he had a history of depression, as well as a bipolar disorder. The examiner indicated that the Veteran reported that he had been “Baker Acted” numerous times due to suicidal ideation. It was noted that the Veteran maintained that he had symptoms of poor sleep; agitation; irritability with violence; a poor appetite; and death thoughts, as well as confusion and a poor memory. The diagnosis was a major depressive disorder. The examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) incurred in, or cause by, the claimed in-service injury, event, or illness. The examiner maintained that there was no treatment on active duty, no relationship between heat strokes and a major depressive disorder, and there was no stressor reported at the examination which met the criteria for PTSD. A January 2020 report from C. L. Koah, LPC., from Progressive Rehabilitation Systems, indicates that he reviewed pertinent VA treatment records, which included information on the Veteran’s active service and medical history. The professional counselor reported that a recent VA examination report indicates that the Veteran did indeed have major depression. The professional counselor stated that based on the report that the Veteran had anxiety and major depression, and that those symptoms started while in the military, it was more likely than not that those disorders started in the military. The professional counselor indicated that it was his professional opinion that the Veteran did not have PTSD, but that, instead, he had an acquired psychiatric disorder, to include a major depressive disorder and an anxiety disorder, and that those disorders had their origins in, and were related to, his active military service. The probative value of medical opinion evidence “is based on the medical expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches.... As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the adjudicators...” Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). The determination of credibility is the province of the Board. It is not error for the Board to favor the opinion of one competent medical expert over that of another when the Board gives an adequate statement of reasons or bases. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). The Board observes that there are opinions of record, pursuant to a March 2016 VA psychiatric examination report, and a January 2020 statement from a professional counselor, that address the etiology of the Veteran’s claimed psychiatric disorder, to include PTSD. The Board notes that the March 2016 VA psychiatric examination report relates a diagnosis of a major depressive disorder. The examiner, following a review of the claims file, indicated that the claimed condition was less likely than not incurred in, or cause by, the claimed in-service injury, event, or illness. The examiner maintained that there was no treatment on active duty, no relationship between heat strokes and a major depressive disorder, and there was no stressor reported at the examination which met the criteria for PTSD. The Board observes that the examiner solely diagnosed the Veteran with a major depressive disorder. The Board notes, however, that the Veteran has been diagnosed with numerous other psychiatric problems, including bipolar, manic depression; a major depressive disorder; a generalized anxiety disorder; an anxiety disorder; and PTSD. Further, the Board notes that the examiner did not address any reports by the Veteran of psychiatric problems during service and since that time. The Board observes that the Veteran is competent to report that he had psychiatric problems during his period of service and since that time. See Davidson, 581 F.3d at 1313. Therefore, the Board finds that the opinion by the examiner, pursuant to the March 2016 VA psychiatric examination report, has little probative value in this matter. The Board observes that in his January 2020 statement, C. L. Koah, LPC., from Progressive Rehabilitation Systems, indicated that he reviewed pertinent VA treatment records, which included information on the Veteran’s active service and medical history. The professional counselor also referred to the March 2016 VA examination report. The professional counselor stated that based on the report that the Veteran had anxiety and major depression, and that those symptoms started while in the military, it was more likely than not that those disorders started in the military. The professional counselor also indicated that the Veteran did not have PTSD, but that, instead, he had an acquired psychiatric disorder, to include a major depressive disorder and an anxiety disorder, and that those disorders had their origins in, and were related to, his active military service. The Board observes that although professional counselor reviewed some of the Veteran’s VA treatment records, including information on his active service and military history, he apparently did not review the Veteran’s entire claims file. Although claims file review is not necessary, the probative value of a medical opinion is based on its reasoning and its predicate in the record so that the opinion is fully informed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board observes, however, that the professional counselor did discuss the Veteran’s medical history in some detail, and his diagnoses and opinions are more consistent with the evidence of record. Therefore, the Board finds that professional counselor’s opinions, pursuant to the January 2020 statement, are very probative in this matter. See Wensch v. Principi, 15 Vet. App. 362 (2001). The Board observes that the service treatment records do not specifically show treatment for any psychiatric problems. The Board notes, however, that a July 2004 treatment report from R. Arumugam, M.D., approximately two years after the Veteran’s separation from service, relates diagnoses including bipolar, manic depression. The Board notes that post-service treatment records show treatment for variously diagnosed psychiatric problems, including a major depressive disorder and an anxiety disorder. The Board observes that the medical evidence indicates that the Veteran currently has a psychiatric disorder, diagnosed as a major depressive disorder and an anxiety disorder. Further, the Board notes that a professional counselor, in a probative opinion, specifically found that the Veteran had a psychiatric disorder, to include a major depressive disorder and an anxiety disorder, that was related to service. Resolving any doubt in the Veteran’s favor, the Board finds that the evidence is at least in equipoise regarding whether the current psychiatric disorder, diagnosed as a major depressive disorder and an anxiety disorder, commenced during his period of service. In light of the evidence of record, to include the January 2020 opinions from the professional counselor, as well as the deficiencies in the opinion provided by the VA examiner, pursuant to the March 2016 VA psychiatric examination report, the Board cannot conclude that the preponderance of the evidence is against granting service connection for a psychiatric disorder, diagnosed as a major depressive disorder and an anxiety disorder. The Board notes that there is no probative evidence of record relating any other psychiatric disorders of record, to include PTSD, to the Veteran’s period of service. Accordingly, service connection for a psychiatric disorder, diagnosed as a major depressive disorder and an anxiety disorder, is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; See also Clemons, 23 Vet. App. at 1. 2. Gastrointestinal Disorder, to include GERD The Veteran contends that he has a gastrointestinal disorder, to include GERD, that is related to service. He specifically maintains that he has a gastrointestinal disorder, to include GERD, that began during his period of service. The Veteran reports that during basic training, at a rifle range at Parris Island in South Carolina, he suffered from heat stroke and was taken to a medical clinic. He states that from that point on, he started having problems with his esophagus, and that he was never allowed to fully recover and return to duty. The Veteran essentially contends that he suffered from gastrointestinal problems during service and since that time. The Veteran served on active duty in the Marine Corps from February 2002 to June 2002. His DD Form 214 indicates that his discharge was uncharacterized and that he had an entry level separation. The narrative reason for separation was entry level performance and conduct. A June 2002 Recommendation for Discharge report notes that the Veteran was discharged for entry level performance and conduct because of incapability-dysphagia and rule out an esophageal motility disorder. The Veteran’s service treatment records show that he was treated for gastrointestinal problems on numerous occasions during service. On a medical history form at the time of a February 2002 enlistment examination, the Veteran checked that he did not have stomach, liver, or intestinal trouble, or an ulcer. He also checked that he did not have frequent indigestion or heartburn. The reviewing examiner did not refer to any disabilities. The February 2002 objective enlistment examination report includes a notation that the Veteran’s abdomen and viscera were normal. An April 2002 treatment entry notes that the Veteran complained of vomiting and body aches since the previous night. He indicated that he currently had not vomited, but that he felt nauseous. The assessment was viral gastroenteritis. An additional April 2002 treatment entry, the next day, notes that the Veteran was seen for follow-up of his viral gastroenteritis. He reported that he was better and that he was no longer nauseous or vomiting. The assessment was resolved viral gastroenteritis. A May 2002 treatment report indicates that the Veteran complained of excessive sweating, nausea, abdominal cramps, and lower back pain for six days. He stated that he passed out six days ago, and that he constantly felt weak and lethargic. The assessment was a normal examination, with an unknown etiology for the syncope. An additional May 2002 treatment entry notes that the Veteran complained of difficulty swallowing and constipation for two weeks. He stated that when he ate or drank, it felt like what he ate or drank would get stuck in his chest. The assessment was constipation. A subsequent May 2002 entry is somewhat illegible. The assessment was rule out GERD. A further May 2002 entry, the next day, is also somewhat illegible. The assessment was suspect an esophageal stricture. A May 2002 radiologic examination report notes that the Veteran had a history of possible gastroenteritis and GERD. The impression included consistent narrowing of the distal fourth of the esophagus at the esophagogastric junction; a relatively large amount of residual barium in the column proximal to that point; and relatively normal motility. The examiner indicated that he believed that the findings represented a stricture of the distal most esophagus just proximal to the esophagogastric junction. It was noted that no ulceration was seen and that the problem did not appear to be one of reflux. A May 2002 consultation report indicates a provisional diagnosis of an esophageal stricture. A May 2002 hospital report, apparently on that same day, relates a diagnosis of dysphagia. A later May 2002 entry notes that the Veteran had solid food dysphagia. The impression was a stricture versus achalasia. A further May 2002 treatment entry indicates that the Veteran was seen for solid food dysphagia. The examiner stated that there was a need to rule out a motility disorder. A May 31, 2002 emergency care and treatment report notes that the Veteran presented for an evaluation of esophageal tightness. The assessment was an esophageal spasm, rule out a stricture. A May 31, 2002, hospital history and physical report indicates that the Veteran reported that he had a fifteen-pound weight loss, with solid food dysphagia. It was noted that a barium swallow shows a regular, narrowed, smooth, concentrical tapering of the distal esophagus. The examiner reported that there was no masses or lesions, and that the Veteran reported no reflux symptoms. The examiner reported that the Veteran did have symptoms prior to enlistment, which were characterized as solid food dysphagia of an intermittent nature, associated with chest pain. It was noted that the Veteran never had a lye ingestion or a chest injury. The impression was solid food dysphagia; an abnormal barium swallow, suggesting a LES dysfunction stricture versus a neoplasm versus achalasia cardia. A June 2002 entry notes that the Veteran was seen for epigastric pain and dysphagia. The examiner stated that the Veteran had a history of dysphagia that existed prior to service. A June 2002 surgery clinic note, on that same day, reflects that the Veteran underwent an esophagogastroduodenoscopy. The examiner reported that the findings were a normal esophagogastroduodenoscopy. A June 2002 medical clinic report indicates that the Veteran was given light duty pending his separation. The examiner reported that the medical reason for separation was chronic dysphagia and rule out an esophageal motility disorder. It was noted that the type of separation recommended was that the Veteran was medically incapable. Post-service private and VA treatment records, including a VA examination report, show treatment for variously diagnosed gastrointestinal problems, including moderate gastritis in the body and the antrum of the stomach; ulcers, multiple in the antrum; duodenitis in the bulb of the duodenum; duodenitis in the second portion of the duodenum; GERD; GERD, with chest discomfort secondary to acid exposure to the esophagus; GERD/reflux; constipation; rule out Barrett’s esophagus; Barrett’s esophagus; a hernia; a hiatal hernia; an esophageal stricture; and an esophageal spasm, etc. A February 2013 VA esophageal conditions examination report includes a notation that the Veteran’s claims file was reviewed. The Veteran reported that he had chronic dysphagia and residuals of esophageal motility that were incurred during service. He stated that he had swallowing and acid reflux during service. The examiner discussed the Veteran’s medical history in some detail. The diagnoses were GERD and Barrett’s esophagus. The examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner reported that the Veteran’s service treatment records show that he had a history of symptoms prior to enlistment that were characterized as solid food dysphagia of an intermittent nature. The examiner stated that the Veteran was not diagnosed with GERD during service. It was noted that a September 2002 note shows that the Veteran underwent an upper endoscopy and that he did not have any significant gastrointestinal problems. The examiner maintained that the Veteran’s medical records in 2004 are silent for GERD, and that he was first diagnosed with GERD in 2007. The examiner maintained that the Veteran’s claimed chronic dysphagia and residuals of esophageal motility were less likely as not (less than 50 percent probability) incurred in, or caused by, or aggravated by, swallowing and acid reflux that occurred in February 2002. A January 2016 private esophageal conditions examination report, by P. Patel, M.D., does not specifically include a notation that the Veteran’s claims file was reviewed. Dr. Patel indicated, as to the Veteran’s history, that he had chronic acid reflux and regurgitation. The diagnoses were GERD; a hiatal hernia; an esophageal stricture; and an esophageal spasm. The Board observes that the Veteran’s service treatment records indicate that he was treated for gastrointestinal problems on numerous occasions, and that diagnoses included a history of possible gastroenteritis and GERD; rule out GERD; dysphagia; an esophageal spasm and rule out stricture; rule out a motility disorder; and chronic dysphagia, and rule out an esophageal motility disorder. The Board notes that post-service treatment records show treatment for variously diagnosed gastrointestinal problems, including moderate gastritis in the body and the antrum of the stomach; ulcers, multiple in the antrum; duodenitis in the bulb of the duodenum; duodenitis in the second portion of the duodenum; GERD; GERD, with chest discomfort secondary to acid exposure to the esophagus; GERD/reflux; constipation; rule out Barrett’s esophagus; Barrett’s esophagus; a hernia; a hiatal hernia; an esophageal stricture; and an esophageal spasm, etc. Additionally, the Board observes that a February 2013 VA esophageal conditions examination report relates diagnoses of GERD and Barrett’s esophagus. The Board further notes that a January 2016 private esophageal conditions examination report indicates diagnoses of GERD; a hiatal hernia; an esophageal stricture; and an esophageal spasm. The Board observes that the examiner, pursuant to the February 2013 VA esophageal conditions examination report, following a review of the claims file, maintained that the Veteran’s claimed chronic dysphagia and residuals of esophageal motility were less likely as not incurred in, or caused by, or aggravated by, swallowing and acid reflux that occurred in February 2002. The Board observes that the examiner specifically stated that the Veteran’s service treatment records show that he had a history of symptoms prior to enlistment that were characterized as solid food dysphagia of an intermittent nature. The Board notes that although a treatment report did refer to such a history, the Veteran’s enlistment examination shows that he his abdomen and viscera were normal. The examiner also did not specifically address other gastrointestinal diagnoses of record. Further, the examiner did not address any reports by the Veteran of gastrointestinal problems during service and since that time. See Davidson, 581 F.3d at 1313. Therefore, the Board finds that the examiner’s opinions are not very probative in this matter. Additionally, although the examiner provided negative opinions, she did indicate that the Veteran had swallowing and acid reflux that occurred in February 2002, which was during service. So, clearly, the examiner stated that the Veteran had acid reflux during service. The Board notes that the Veteran is diagnosed, pursuant to a February 2013 VA esophageal examination report, and a January 2016 private esophageal examination report, with a gastrointestinal disorder, diagnosed as GERD, Barrett’s esophagus, a hiatal hernia, an esophageal stricture, and an esophageal spasm. The Board finds the Veteran’s reports of gastrointestinal problems during service and since service to be credible. See Jandreau, 492 F.3d at 1372 (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). Resolving any doubt in the Veteran’s favor, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s gastrointestinal disorder, diagnosed as GERD, Barrett’s esophagus, a hiatal hernia, an esophageal stricture, and an esophageal spasm, commenced during his period of service. In light of the evidence, including the deficiencies in the February 2013 VA examiner’s opinions of record, the Board cannot conclude that the preponderance of the evidence is against granting service connection for a gastrointestinal disorder, diagnosed as GERD, Barrett’s esophagus, a hiatal hernia, an esophageal stricture, and an esophageal spasm. Therefore, service connection for a gastrointestinal disorder, diagnosed as GERD, Barrett’s esophagus, a hiatal hernia, an esophageal stricture, and an esophageal spasm, is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As the Board has granted direct service connection in this matter, it need not address other theories of service connection. REASONS FOR REMAND The remaining issues on appeal are entitlement to service connection for chronic dysphagia and an esophageal motility disorder; an intestinal motility disorder; residuals of heat stroke; and for seizures. As discussed in the decision above, the Board has granted service connection for a psychiatric disorder, diagnosed as a major depressive disorder and an anxiety disorder, and for a gastrointestinal disorder, diagnosed as GERD, Barrett’s esophagus, a hiatal hernia, an esophageal stricture, and an esophageal spasm. To accord the Veteran due process, the RO should adjudicate the issues of entitlement to service connection for chronic dysphagia and an esophageal motility disorder; an intestinal motility disorder; residuals of heat stroke; and for seizures. The Veteran contends that he has chronic dysphagia and an esophageal motility disorder; an intestinal motility disorder; residuals of heat stroke; and seizures, that are all related to service. He specifically maintains that during basic training, at a rifle range at Parris Island in South Carolina, he suffered from heat stroke and was taken to a medical clinic. He states that from that point on, he started having seizures and problems with his esophagus, and that he was never allowed to fully recover and return to duty. The service treatment records show treatment for chronic dysphagia and the need to rule out an esophageal motility disorder. Such records do not specifically show treatment for intestinal motility disorder; residuals of heat stroke, or for seizures. His service treatment records also indicate that he was treated for numerous gastrointestinal problems and that he was also treated for syncope of an unknown etiology. Post-service private and VA treatment records, including a VA examination report, show treatment for numerous gastrointestinal problems and for seizures. Such records do not specifically show treatment for residuals of heat stroke, but they do note that the Veteran referred to heat stroke during service. The Veteran has not been afforded a VA examination, as to his claims for service connection for residuals of heat stroke and for seizures. The Veteran was afforded a February 2013 VA esophageal conditions examination report, as to his claimed chronic dysphagia and an esophageal motility disorder, and an intestinal motility disorder, but as discussed in the decision above, the Board has found that the examiner’s opinions are not very probative in this matter. In light of the above, the Board finds that the Veteran has not been afforded VA examinations, with the opportunity to obtain responsive etiological opinions, following a thorough review of the entire claims file, as to his claims for service connection for chronic dysphagia and an esophageal motility disorder; an intestinal motility disorder; residuals of heat stroke; and for seizures. Such examinations must be accomplished on remand. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all medical providers who have treated him for chronic dysphagia and an esophageal motility disorder; an intestinal motility disorder; residuals of heat stroke; and for seizures, since March 2016. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptoms regarding his chronic dysphagia and an esophageal motility disorder; intestinal motility disorder; residuals of heat stroke; and seizures. He should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the onset and/or etiology of his claimed chronic dysphagia and an esophageal motility disorder, and an intestinal motility disorder. The examiner should determine whether a physical examination is necessary. The claims file must be reviewed by the examiner. The examiner must specifically indicate if the Veteran has currently diagnosed chronic dysphagia, an esophageal motility disorder, and an intestinal motility disorder. The examiner must provide a medical opinion, as to whether it is at least as likely as not that any currently diagnosed chronic dysphagia, an esophageal motility disorder, and an intestinal motility disorder, are related to and/or had their onset during the Veteran’s period of service. The examiner must specifically acknowledge and discuss the Veteran’s treatment for dysphagia and the need to rule out an esophageal motility disorder during service, as well as any reports by the Veteran of gastrointestinal problems during service and since service. The examiner must state whether it is at least as likely as not that any diagnosed chronic dysphagia, an esophageal motility disorder, and an intestinal motility disorder, are caused or aggravated by Veteran’s service-connected psychiatric disorder, diagnosed as a major depressive disorder and an anxiety disorder, and gastrointestinal disorder, diagnosed as GERD, Barrett’s esophagus, a hiatal hernia, an esophageal stricture, and an esophageal spasm. 4. Schedule the Veteran for an appropriate VA examination(s) (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the onset and/or etiology of his claimed residuals of heat stroke and seizures. The examiner(s) should determine whether a physical examination is necessary. The claims file must be reviewed by the examiner. The examiner(s) must diagnose all current residuals of heat stroke and seizure disorders. The examiner(s) must provide a medical opinion(s), as to whether it is at least as likely as not that any currently diagnosed residuals of heat stroke and seizure disorders are related to and/or had their onset during the Veteran’s period of service. (Continued on the next page)   The examiner(s) must specifically acknowledge and discuss the Veteran’s treatment for syncope during service, and any reports by the Veteran of residuals of heat stroke and seizures during service and since service. The examiner(s) must state whether it is at least as likely as not that any diagnosed residuals of heat stroke and seizure disorders, are caused or aggravated by Veteran’s service-connected psychiatric disorder, diagnosed as a major depressive disorder and an anxiety disorder, and gastrointestinal disorder, diagnosed as GERD, Barrett’s esophagus, a hiatal hernia, an esophageal stricture, and an esophageal spasm. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. D. Regan, Counsel 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.