Citation Nr: 21001566 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 18-12 097 DATE: January 8, 2021 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1989 to January 1993. This matter returns to the Board of Veterans’ Appeals (Board) on appeal from an October 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This claim was previously before the Board prompting an April 2019 decision wherein the Board denied service connection for GERD. Thereafter, the Veteran appealed the decision to the United States Court of Appeals for Veterans Affairs (CAVC or “the Court”). In July 2020, the Court granted a July 2020 Joint Motion for Partial Remand (JMPR) vacating this part of the Board’s decision and remanding the claim for further development. All remaining issues on appeal were dismissed. Thus, the matters have returned to the Board for further consideration consistent with the July 2020 JMPR. Entitlement to service connection for GERD, to include as secondary to service-connected PTSD, is remanded. As agreed in the July 2020 JMR, the Board did not discuss in the April 2019 denial whether the theory of entitlement to service connection for GERD as secondary to the Veteran’s service-connected PTSD was reasonably raised by the evidence of record. At the time of the April 2019 denial, the Veteran had contended that her GERD was related to an in-service incident where on or around August 1989 the Veteran went to the emergency room (ER) for complaints of vomiting and, was later assessed with viral gastroenteritis. She indicated this treatment was shortly after her 1989 military assault. Arguably, this suggested she was also arguing her bout of vomiting was related to the PTSD, due to the in-service assault. If there was any doubt before, the Board finds that since the July 2020 JMR, the Veteran’s representative has indicated in a November 2020 statement in no uncertain terms that she is claiming GERD as secondary to her service-connected PTSD due to military sexual trauma (MST). The Veteran’s representative also submitted generic medical literature generally establishing a link between PTSD and GERD. The Board does not find the generic medical literature, which is not specific to the Veteran’s medical history or circumstances, sufficient enough to grant the claim outright. See Sacks v. West, 11 Vet.App. 314, 317 (1998) (holding that generic medical treatise evidence cannot, without more, provide the medical nexus necessary to establish entitlement to benefits). The evidence and the statements, however, clearly show the theory has been raised by the record and further development is necessary to resolve the Veteran’s claim. The Veteran was afforded a VA examination in October 2016 where the examiner diagnosed the Veteran with GERD, finding the GERD not likely related to the in-service treatment for viral gastroenteritis or any other in-service symptoms. The focus of the examination, however, was the Veteran’s in-service symptoms or symptoms shortly after service. The examiner did not provide an opinion as to the likelihood that the Veteran’s GERD was caused or aggravated by her service-connected PTSD. The Board finds a new VA medical opinion is warranted to address whether the Veteran’s GERD was caused or aggravated by her service-connected PTSD. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination before an appropriate examiner. The examiner shall be provided the entire claims file including this remand for review prior to the examination. The examiner shall issue an opinion, including rationale, addressing the following: Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s service-connected PTSD caused or aggravated her GERD. The VA examiner is cautioned that the term “aggravated,” as used in 38 C.F.R. § 3.310(b), does not require that there be “permanent worsening” of the nonservice-connected disability. Instead, secondary service connection is warranted for “any incremental increase in disability and any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence.” See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). The examiner is specifically directed to address the Veteran’s statements of GERD symptom worsening and her reports of GERD symptom presentation coinciding with her PTSD as well as the medical literature provided by the Veteran’s representative in November 2020. The examiner must provide a complete rationale for any opinion expressed, based on the examiner’s clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate. If any opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 2. After the above development, and any other development deemed necessary, readjudicate the claims. If the benefits sought on appeal remain denied, the Veteran and her representative should be furnished a supplemental statement of the case and given the opportunity to respond thereto. Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.C. Allen, Association 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.