Citation Nr: 21062391 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 17-34 913 DATE: October 7, 2021 REMANDED Entitlement to service connection for service connection for gastroesophageal reflux disease (GERD) claimed as secondary to service-connected posttraumatic stress disorder (PTSD) with major depressive disorder (MDD) is remanded. REASONS FOR REMAND Entitlement to service connection for service connection for gastroesophageal reflux disease (GERD) claimed as secondary to service-connected posttraumatic stress disorder (PTSD) with major depressive disorder (MDD) is remanded. The Veteran had active service from June 1999 to May 2005. This matter comes before the Board of Veterans' Appeals (Board) from a July 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) rating decision that denied service connection for GERD claimed as secondary to service-connected PTSD with MDD. These matters were previously before the Board in May 2020, when it was determined that the VA examinations and opinions then currently of record were inadequate and remanded for a new VA examination and medical opinion as to the nature and etiology of the Veteran's GERD. Specifically, the Board noted that the Veteran is also service-connected for esophageal diverticulum, and that the Veteran's contentions include that his GERD has been caused or aggravated by his service-connected PTSD with MDD, to include the effect of medications taken to treat his PTSD with MDD. The Board noted that previous opinions, obtained in May 2016 and June 2017 had not been offered by physicians. In light of the medical questions concerning the possible intertwined disabilities and/or overlapping symptoms of GERD and the esophageal diverticulum, the Board directed that the new VA examination and opinion be obtained by a physician (i.e. a medical doctor). The Board also directed that the examiner address whether the Veteran's claimed GERD is related to exposure to airborne pollutants during the Veteran's naval service in the Persian Gulf in 2002 and 2004. A new VA examination and opinion addressing the purported relationship between the Veteran's esophageal disabilities and/or PTSD with MDD was obtained in June 2020. The June 2020 examination and opinion were obtained from a medical professional who was not a physician (i.e. not a medical doctor). Similarly, a medical opinion addressing the airborne pollutant theory was obtained in December 2020. The December 2020 opinion was obtained from a medical professional who was not a physician (i.e. not a medical doctor). A remand by the Board confers on the Veteran, as a matter of law, the right to substantial compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). In May 2020 the Board directed that a new VA examination and opinion be obtained by a physician (i.e. a medical doctor). The June 2020 examination and opinion and December 2020 opinion were obtained from medical professionals who were not physicians (i.e. not medical doctors). Accordingly, the Board finds that there has not been substantial compliance with its May 2020 remand directives, and additional remand is required. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate physician (i.e. a medical doctor) to determine the nature and etiology of his GERD. The examiner must opine whether it is at least as likely as not that his GERD is related to an in-service injury, event, or disease, including the symptoms of gastroenteritis treated in-service, or alternately, including rom exposure to airborne pollutants during his Naval Service in the Persian Gulf for periods in 2002 and 2004. If service connection is not shown to be warranted on a direct basis, the examiner should address whether it is at least as likely as not that his GERD (1) is proximately due to service-connected disability to include his service connected diverticulum of esophagus and/or his service connected psychiatric disorder presently diagnosed as PTSD and MDD, or (2) aggravated beyond its natural progression by service-connected disability from his diverticulum of esophagus and/or his service connected psychiatric disorder presently diagnosed as PTSD and MDD. In addressing the questions of whether GERD is caused or aggravated by his service-connected psychiatric disorder presently diagnosed as PTSD and MDD, the examiner should address whether medication shown to have been used to treat his psychiatric disorder caused or aggravated his GERD. Additionally, if aggravation is found, the examiner should attempt to identify the baseline level of disability prior to such aggravation. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. C. Sametshaw 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.