Citation Nr: 20034445 Decision Date: 05/18/20 Archive Date: 05/18/20 DOCKET NO. 14-33 848 DATE: May 18, 2020 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1970 to November 1971, from September 1990 to June 1991, from January 2003 to September 2003, from September 2004 to December 2005, and from January 2009 to June 2010. The Veteran testified before the undersigned Veterans Law Judge in May 2017. This case was originally before the Board in March 2018, when the claims listed above were remanded for further development. An additional claim of entitlement to service connection for a left knee disability was additionally remanded for further development at that time. The Board notes that in a subsequent September 2019 Board remand, a service connection claim for headaches was remanded for further development. In March 2020, the Veterans Benefits Administration (VBA) granted service connection for degenerative joint disease of the left knee, scars of the left knee, and tension headaches. Thus, these issues are no longer in appellate status. Additional development was completed with respect to the Veteran’s remaining claims of entitlement to service connection for GERD and hypertension. The RO issued a supplemental statement of the case in March 2020 and the appeal is once again before the Board. Unfortunately, the Board finds that an additional remand is required in this case. 1. Entitlement to service connection for GERD is remanded. The Board notes that the Veteran was afforded a VA medical opinion in November 2019 regarding his GERD. The VA examiner provided a negative etiological opinion at that time, stating that the Veteran’s GERD is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner stated that the Veteran had GERD prior to his last periods of active duty with no evidence that it is etiologically related to service. The VA examiner stated that there is no evidence for permanent aggravation by subsequent periods of active duty. The VA examiner stated that it was also less likely than not that the Veteran’s GERD is a Gulf War illness as the condition has a clear diagnosis and etiology. Rather, she noted that this GERD is due to obesity, poor diet, lifestyle, hiatal hernia or certain medications. Significantly, the VA examiner did not specify which “medications.” The Board notes that the Veteran is service-connected for prostate cancer with voiding dysfunction, sleep apnea, gouty arthritis of the left foot, degenerative joint disease of the left knee, an adjustment disorder with depressed mood, scars of the left knee, erectile dysfunction, and tension headaches. The VA examiner’s opinion is vague and does not specify whether any of the medications taken for the Veteran’s service-connected disabilities contributed to his GERD. An addendum VA medical opinion is thus necessary. 2. Entitlement to service connection for hypertension is remanded. In the March 2018 BVA remand, the Board noted the Veteran had been afforded VA examinations and opinions in May 2014 and August 2014 which were contradictory and had inadequate rationales. The Board remanded for an additional VA medical opinion. In an October 2019 VA medical opinion, the examiner stated that the Veteran’s hypertension was less likely than not incurred in or caused by the claimed in-service in jury, event or illness. The examiner noted that the Veteran’s hypertension was diagnosed during a period between active duty service (after 2005 active duty period and prior to 2009 active duty), and there was no direct service connection to active duty. She then provided negative secondary opinions regarding any relationship between the Veteran’s claimed hypertension and his service-connected acquired psychiatric disability. Unfortunately, the VA examiner incorrectly noted that hypertension was not diagnosed until after the Veteran’s period of active duty service ending in December 2005. The record clearly shows that the Veteran was diagnosed with acute situational disturbance with hypertension as early as May 2004, prior to the Veteran’s period of active service (September 2004 – December 2005). See May 2004 Private Treatment Record. The record shows that the Veteran’s hypertension clearly and unmistakably existed prior to his final two periods of active service. The Board must now consider whether his pre-existing hypertension was aggravated by either his period of service between September 2004 and December 2005, or his period of service between January 2009 and June 2010. The Board notes that a March 2010 treatment record, during his last period of active duty service, notes that the Veteran’s hypertension medication Lisinopril was going to be increased. See March 2010 VA Treatment Record. In this vein, a preexisting injury or disease will be considered to have been aggravated by active service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306(a). Based on the evidence above, the Board finds that an addendum opinion is needed to determine if the Veteran’s hypertension was aggravated by either of his last two periods of his active duty service. The matters are REMANDED for the following actions: 1. Forward the Veteran’s claims folder to the October/November 2019 VA examiner, or to another qualified medical professional, for addendum opinions regarding the claims for service connection for GERD and hypertension. If the examiner is unable to provide the requested supplemental opinions without examining the Veteran, schedule the Veteran for a new VA examination or telehealth interview to obtain the information requested. The examiner is requested to review the claims folder, to include this remand. Following review of the claims file, the examiner must provide opinions on the followings: GERD a. Whether it is at least as likely as not (i.e., there is at least a 50 percent probability) that any GERD is caused by his service-connected disabilities, to include medications taken for any of his service-connected disabilities. b. Whether it is at least as likely as not (a probability of 50 percent or greater) that any GERD is aggravated by his service-connected disabilities, to include medications taken for any of his service-connected disabilities. Hypertension a. Whether there is clear and unmistakable evidence that the Veteran’s pre-existing hypertension disorder did not undergo an increase in the underlying pathology during either period of active service from September 2004-December 2005 or from January 2009-June 2010. In other words, is there clear and unmistakable evidence that the Veteran’s hypertension was not aggravated during service? b. If there was an increase in severity of the Veteran’s hypertension disorder during service, was that increase clearly and unmistakably due only to the natural progress of the disease, or was it above and beyond the natural progression? If the VA examiner does not find that the Veteran’s hypertension was aggravated as a result of either his periods of service from September 2004-December 2005, or January 2009-June 2010, the examiner is then asked to provide an opinion as to whether it is at least as likely as not that any current hypertension is causally related to his earlier periods of active duty service between April 1970-November 1971, September 1990-June 1991, or January 2003-September 2003. Caroline B. Fleming Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. M. Clark, 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.