Citation Nr: 20055681 Decision Date: 08/24/20 Archive Date: 08/24/20 DOCKET NO. 15-18 517A DATE: August 24, 2020 ORDER Entitlement to service connection for gastroesophageal reflux disease (GERD), secondary to service-connected asthma, is granted. FINDING OF FACT Inhaled and oral treatment for the Veteran’s service-connected asthma caused GERD. CONCLUSION OF LAW The criteria for service connection for GERD as secondary to service-connected asthma are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 1995 to September 1999. The Veteran’s appeal from a December 2011 rating decision returns to the Board of Veterans’ Appeals (the Board). In July 2018, the Board, among other things, remanded the Veteran’s claim for service connection for GERD to afford her an addendum opinion to address whether treatment for her service-connected asthma caused or aggravated GERD. The requested addendum opinion was proffered in October 2019. For the reasons discussed below, the Board finds that the opinion is inadequate and afforded no probative weight. However, a remand is not needed because the Board is granting the benefit sought on appeal and thereby rendering moot any issues regarding compliance with the Board’s July 2018 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); Mlechick v. Mansfield, 503 F.3d 1340 (Fed. Cir. 2007). The Board also notes the August 2020 request under the Freedom of Information Act (FOIA) from the Veteran’s attorney seeking the October 2019 VA examination. The Department of Veterans Affairs (VA) has acknowledged receipt of the request but has not yet provided the requested materials to the Veteran’s attorney. Because the Board is granting the Veteran’s claim, however, there is no need to delay adjudication pending fulfillment of the FOIA request. Entitlement to Service Connection for GERD The Veteran contends that she is entitled to service connection on direct and secondary bases. In a statement accompanying the December 2012 notice of disagreement, her attorney contends that GERD onset during active service. Alternately, in a March 2017 correspondence, the attorney contends GERD is due treatment for the Veteran’s service-connected asthma. The Board concludes that secondary service connection is warranted here. To establish service connection on a secondary basis, there must be (1) medical evidence of a current disability; (2) a service-connected disability; and (3) medical evidence of a nexus between the current and service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). The first two requirements of secondary service connection are met. The record shows the onset of symptoms related to GERD in 2004 and a diagnosis of GERD in October 2006. The Veteran’s VA treatment records similarly document diagnosis of GERD. The Veteran is service connected for asthma, and the record shows that relies on inhaled and oral therapies to manage it. There is conflicting evidence regarding the third element requiring a nexus between GERD and the Veteran’s service-connected asthma. The record includes a March 2017 opinion from A.C., a registered nurse. After reviewing the Veteran’s private and VA treatment records, she opined that the Veteran’s GERD was more likely than not due to treatment related to her service-connected asthma. A.C. reasoned that medical literature shows that asthma treatments, particularly inhaled albuterol and oral prednisone, reduce lower esophageal sphincter tone and thereby increase acid reflux. She reasoned further that asthma patients are shown to take longer to clear acid after eating and to have a longer period of acid exposure. As a result, people with asthma are at an increased risk of developing GERD. A.C. cited medical associations as estimating that 70 percent of patients with asthma also have GERD. A.C. also cited medical studies showing airflow obstruction associated with asthma, rhinitis, and sleep apnea, increases the number of lower esophageal relaxations and the number of reflux episodes. The A.C.’s opinion is highly probative. While she did not physically examine the Veteran, she completed a thorough review of the Veteran’s claims file and proffered an opinion that is well-supported with rationales grounded in medical literature. The opinion from A.C. is also more probative than a February 2011 VA examination and an October 2019 addendum opinion. First, the evidence does not show that the VA examiner responsible for the examination and addendum opinion reviewed the Veteran’s private treatment records. As a result, he mistakenly placed the diagnosis of GERD in 2009 rather than 2006. The opinions are thereby predicated on a false factual premise and are not therefore entitled to any probative weight. The October 2019 addendum opinion also fails to address the relationship between the Veteran’s asthma treatment and GERD but instead focuses on the impact the Veteran’s September 2011 lap band surgery may have had on GERD. The Board specifically requested an opinion on the impact of the Veteran’s medications for asthma on GERD, and the October 2019 addendum opinion is therefore not compliant with the Board’s remand directive. See Stegall, 11 Vet. App. at 271. Notwithstanding the Veteran’s September 2011 surgical procedure, the record shows a diagnosis and treatment for GERD during the period on appeal. As a result of these deficiencies, the Board affords the February 2011 VA examination and October 2019 VA addendum opinion no probative weight. In light of the foregoing, the third element of secondary service connection is met, and entitlement to service connection for GERD, secondary to service-connected asthma, is granted. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Douglas M. Humphrey, Associate 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.