Citation Nr: 21003246 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 16-59 681 DATE: January 21, 2021 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Marine Corps from June 1988 to April 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge; a transcript is of record. 1. Entitlement to service connection for GERD is remanded. In November 2019, the Board remanded the appeal for further development. The Board remand directed, among other things, that a VA medical nexus opinion be obtained regarding the etiology of her GERD, to address both direct service connection and service connection secondary to her service-connected other specified depressive disorder with anxious distress. The requested VA medical opinion was provided in February 2020. Regarding direct service connection, the VA examiner opined that the Veteran’s GERD was less likely than not incurred in or caused by military service. The examiner indicated in his rationale that he had reviewed the medical records, remand documents, and the Veteran’s lay statements; however, the rationale does not appear to reflect adequate consideration of the Veteran’s lay statements from her September 2019 hearing where she testified that she has experienced symptoms that included sour stomach, upset stomach, diarrhea, cramping, and bloating since approximately 1991 when she returned from Southwest Asia. As to secondary service connection, the examiner provided an opinion as to both causation and aggravation, however, the opinion and rationale do not provide the Board with a sufficient basis upon which to adjudicate this issue. For the causation prong of secondary service connection, the VA examiner opined that the Veteran’s GERD was less likely than not proximately due to or the result of her service-connected conditions. However, the service-connected conditions discussed in the rationale was not the service-connected depressive disorder, but rather orthopedic and peripheral nerve conditions. The Veteran is service-connected for bilateral pes planus, but a peripheral nerve disorder. The rationale does not reflect consideration of the service-connected psychiatric disorder as requested. The matter is REMANDED for the following action: Obtain an addendum VA medical opinion regarding the etiology of the Veteran’s GERD from a qualified medical professional. The need for a physical examination is left to the discretion of the VA examiner. The examiner must review the claims file and a copy of this Remand. a) The examiner must opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s GERD had its onset in, or is otherwise related to, active service. A complete rationale must be provided for the opinions expressed. In providing the requested opinion, consider the Veteran’s description of his/her in-service injury and symptoms as well as his post-service symptoms. These includes the reports of nausea, epigastric pain, and gastritis noted in the STRs, and the Veteran’s September 2019 hearing testimony that she has experienced symptoms that included sour stomach, upset stomach, diarrhea, cramping, bloating since approximately 1991 when she returned from Southwest Asia. If there is any medical reason to accept or reject the proposition that the Veteran’s symptoms in service and thereafter represented the onset of her current disability, this should be noted. Stated another way, do the Veteran’s reports about her symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? b) The examiner also must opine whether it is at least as likely as not that the Veteran’s GERD is proximately due to her service-connected other specified depressive disorder with anxious distress AND whether it is aggravated (worsened beyond its natural progression) by the service-connected other specified depressive disorder with anxious distress. A complete rationale must be provided for the opinions expressed. The rationale must consider the pertinent evidence of record, to include the Veteran’s lay statements and testimony wherein she indicated that when her anxiety symptoms are exacerbated, she also notices stomach problems. If there is any medical reason to accept or reject the proposition that the Veteran’s GERD is neither caused or aggravated by her service-connected psychiatric disorder, this should be noted. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Caban, 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.