Citation Nr: 21004228 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 14-38 649 DATE: January 26, 2021 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from December 2009 to December 2013. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a January, March, and September 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2018 and June 2020, the Board remanded the Veteran’s claim for additional development. In the latter, the Board added the issue of entitlement to a TDIU to the appeal pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The case is once again before the Board. 1. Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to the Veteran’s service-connected mental disorder, is remanded. In June 2020, the Board remanded the Veteran’s GERD claim for an appropriate clinician to consider a medical article on the relationship between GERD and mental disorders. However, the examiner never got that far because he concluded that the Veteran did not have GERD. In arriving at his conclusion, the examiner considers the brief GERD discussion in the January 2016 VA joints examination. But he did not address the December 2019 VA esophageal examination. There, the Veteran was diagnosed with GERD manifested by infrequent episodes of epigastric distress, pyrosis, reflux, and sleep disturbance caused by esophageal reflux. This directly conflicts with the examiner’s statement that the Veteran had never been diagnosed with GERD at any previous examination. As such, remand is warranted for an addendum medical opinion. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). 2. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities before May 21, 2019 is remanded. Because a decision on the the Veteran’s GERD claim could significantly impact a decision on his TDIU claim, the issues are inextricably intertwined. As such, a remand of both is required. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Finally, as the case is being remanded for additional development, any outstanding VA treatment records should be associated with the claims file. See Bell v. Derwinski, 2 Vet. App. 611, 613 (1992) (per curiam). The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records and associate them with the claims file. 2. Then, arrange for an appropriate healthcare provider to review the Veteran’s claims file and provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s GERD had its clinical onset during service or is due to an event or incident of the Veteran’s period of active service. (a.) If GERD is not diagnosed, the examiner should comment on the January 2016 and December 2019 VA examinations, where the Veteran appears to have been diagnosed with GERD. (b.) If GERD (or some other identifiable disease) is not diagnosed, the examiner is asked to describe the Veteran’s symptoms and provide an opinion as to whether those symptoms cause functional impairment of his earning capacity. (c.) If GERD is diagnosed, or if the Veteran’s symptoms result in a functional impairment of earning capacity, the healthcare provider should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s GERD was (A) caused or (B) aggravated beyond its normal progression by his service-connected mental disorder, including any medication taken to treat such disorder. In rendering an opinion, the examiner must address the May 2015 article submitted by the Veteran—“Gastro-oesophageal Reflux Disease and Psychological Comorbidity.” Aggravation means an increase in disability—any additional impairment of earning capacity—of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. If the reviewing healthcare provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran’s pending claim in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his attorney should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Canedy, 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.