Citation Nr: 21065467
Decision Date: 10/26/21	Archive Date: 10/26/21

DOCKET NO. 16-39 266
DATE: October 26, 2021

REMANDED

Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to the service-connected sleep apnea is remanded.

REASONS FOR REMAND

The Veteran served on active duty from August 1968 to July 1988. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). 

This matter was previously remanded by the Board in November 2018 and May 2021.

1. Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to the service-connected sleep apnea is remanded.

Pursuant to the May 2021 Board remand, the Board directed that an addendum medical opinion be obtained to determine whether the Veteran's GERD was caused or aggravated by his service-connected sleep apnea.  The opinion was obtained in July 2021.  At that time, the examiner opined that the Veteran's GERD was less than likely caused by his service-connected sleep apnea and the examiner provided supporting rationale.  In concluding the rationale, the examiner stated that based on available medical evidence, the Veteran's GERD, diagnosed in 2009, was less likely than not caused or aggravated beyond its natural progression as a result of his service-connected sleep apnea, diagnosed in August 2013.  While the examiner provided a negative nexus as it pertains to the question of aggravation, he did not provide a rationale.  Consequently, remand is required to fully comply with the Board's prior remand directives.  Stegall v. West, 11 Vet. App. 268 (1998).

Updated treatment records should also be obtained upon remand.

The matters are REMANDED for the following actions:

1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disability.  After securing any necessary releases, the AOJ should request any relevant records identified.  In addition, obtain updated VA treatment records.  If any requested records are unavailable, the Veteran and his representative should be notified of such.

2. After records development is completed, the Veteran should be afforded a VA esophageal conditions examination to determine the nature of his GERD and to obtain an opinion as to whether such is possibly related to his service-connected sleep apnea.  The claims file should be reviewed by the examiner in conjunction with the examination.  All necessary tests should be conducted, and the results reported.

Following review of the claims file and examination of the Veteran, the examiner 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 worsened beyond natural progression (aggravated) by his service-connected sleep apnea?  Please explain why or why not, to include addressing the August 2016 private medical opinion noting that "obstructive sleep apnea can cause airway pressure changes that may cause or aggravated existing GERD."  See August 2016 private medical opinion.

 

 

A. S. CARACCIOLO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	S. Medina

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.