Citation Nr: 21000387 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 15-16 249 DATE: January 5, 2021 REMANDED Service connection for sleep apnea is remanded. Service connection for gastroesophageal reflux disease (GERD) is remanded. A disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD) with alcohol use disorder is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Marine Corps from March 1972 to March 1976. These matters come to the Board of Veterans’ Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) made in June 2014 and April 2016. These matters are being adjudicated under the legacy appellate framework. The Veteran testified at a personal hearing before the Board in May 2019, and a transcript of the hearing is of record. These matters were previously before the Board, and, in November 2019, the Board remanded this matter for further development. 1. Service connection for sleep apnea is remanded. At issue is whether the Veteran is entitled to service connection for sleep apnea. In November 2019, the Board remanded this matter in order to obtain additional medical records. Additional medical records were associated with the record in December 2019. Therefore, this matter must be remanded for a new VA examination in order to discuss the medical significance, if any, of the additional medical records in order to ensure that VA’s evaluation of the Veteran’s claim is fully formed. Barr v. Nicholson, 21 Vet. App. 303 (2007). 2. Service connection for GERD is remanded. At issue is whether the Veteran is entitled to service connection for GERD. In November 2019, the Board remanded this matter in order to provide the Veteran with a VA medical opinion in order to determine whether or not the Veteran’s GERD was proximately due to or aggravated by the Veteran’s previously service-connected PTSD with alcohol use disorder. The Veteran was provided a VA addendum opinion in July 2020. The examiner opined that the Veteran’s GERD was less likely due to the Veteran’s previously service-connected PTSD with alcohol use disorder, because the Veteran’s GERD was due to a variety of comorbidity factors including alcohol and obesity. Unfortunately, the rationale – that the Veteran’s GERD could not have been caused by PTSD with alcohol use disorder because the Veteran’s GERD was due to alcohol use – is not sufficiently detailed in order to ensure that VA’s evaluation of the Veteran’s claim is fully formed. See Barr. Additionally, the Board must also consider whether or not obesity served as a linking condition between a previously service-connected disability (such as PTSD with alcohol use disorder) and GERD. VAOPGCPREC 1-2017 (January 6, 2017). Therefore, this matter must be remanded for a new VA examination in order to address these matters. 3. A disability rating in excess of 30 percent for PTSD with alcohol use disorder is remanded. At issue is whether the Veteran is entitled to a disability rating in excess of 30 percent with alcohol use disorder. This matter is inextricably with the above issues, and it must be remanded as well in order to avoid piecemeal appellate litigation. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Arrange to provide the Veteran with a VA examination in order to address the following: (a.) Is it at least as likely as not (50 percent or more) that the Veteran’s GERD is proximately due to or aggravated by a previously service-connected disability to include the Veteran’s previously service-connected PTSD with alcohol use disorder? Why or why not? (b.) Please discuss the what, if any, effect the Veteran’s PTSD with alcohol use (or any other previously service-connected disability for that matter) had on the Veteran’s alcohol use, and what if any effect this had on the Veteran’s GERD. (c.) Is it at least as likely as not (50 percent or more) that any of the Veteran’s previously service-connected disabilities to include the Veteran’s previously service-connected PTSD with alcohol use disorder caused the Veteran to become obese? Why or why not? (d.) Is it at least as likely as not (50 percent or more) that obesity was a substantial factor in the Veteran developing GERD? Why or why not? (e.) Is it at least as likely as not (50 percent or more) that the Veteran would not have developed GERD but for any obesity caused by the Veteran’s previously service-connected disabilities? Why or why not? 2. Arrange to provide the Veteran with a VA examination in order to discuss the following: (a.) Is it at least as likely as not (50 percent or more) that the Veteran’s sleep apnea is proximately due to or aggravated by a previously service-connected disability to include the Veteran’s previously service-connected PTSD with alcohol use disorder? Why or why not? (b.) Please discuss the what, if any, effect the Veteran’s PTSD with alcohol use (or any other previously service-connected disability for that matter) had on the Veteran’s sleep patterns, and what if any effect this had on the Veteran’s sleep apnea. (c.) Is it at least as likely as not (50 percent or more) that any of the Veteran’s previously service-connected disabilities to include the Veteran’s previously service-connected PTSD with alcohol use disorder caused the Veteran to become obese? Why or why not? (d.) Is it at least as likely as not (50 percent or more) that obesity was a substantial factor in the Veteran developing sleep apnea? Why or why not? (e.) Is it at least as likely as not (50 percent or more) that the Veteran would not have developed sleep apnea but for any obesity caused by the Veteran’s previously service-connected disabilities? Why or why not? 3. Arrange to provide the Veteran with a VA examination in order to discuss the current severity of the Veteran’s acquired psychiatric disorder. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Seaton 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.