Citation Nr: 21067361 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 17-37 044 DATE: November 4, 2021 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to service connected right knee arthritis and right hip arthritis, is remanded. Entitlement to service connection for degenerative joint disease of the left hip, to include as secondary to service connected right knee arthritis and right hip arthritis, is remanded. Entitlement to service connection for left knee medial meniscus tear, to include as secondary to service connected right knee arthritis and right hip arthritis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from September 1980 to February 1982. This matter is before the Board of Veterans' Appeal (Board) on appeal from an October 2014 rating decision of the agency of original jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA). These issues have previously been before the Board. In April 2020, the Board remanded the issues for VA examinations on the nature and etiology of the Veteran's GERD, degenerative joint disease, and left knee medial meniscus tear. The matter is now before the Board again for further appellate review. The Board finds that additional development is needed to adjudicate these claims. Remand of the issues is warranted as the May 2020 opinions are inadequate for adjudication purposes because the examiner does not adequately address whether the Veteran's disabilities are aggravated by his service-connected right knee arthritis and because the opinion did not comply with the Board's prior remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). In its April 2020 remand, the Board noted "The Veteran and his representative contend that the American College of Sports Medicine, opines that, 'poor biomechanics and arthritis can affect the rest of the body. Arthritis is often originally caused by poor walking biomechanics. Any pain in the affected knee can cause an individual to favor the less painful side....' See January 2020 Brief. As such, additional medical guidance is needed to address the findings submitted by the Veteran." In May 2020, the Veteran was afforded additional VA examinations for GERD, his left hip condition, and his left knee condition. Regarding the Veteran's GERD, the examiner opined that "anti-inflammatories and other meds" do not cause GERD and do not aggravate GERD. The examiner stated, "this is well accepted" but did not explain further or cite any medical literature. Regarding the Veteran's degenerative joint disease of the left hip and his left knee medial meniscus tear, the examiner stated, "one joint condition does not cause a condition of the contralateral joint" and stated, "this is accepted medical knowledge and practice, supported by standard texts, such as Wheeless." The examiner attributed the worsening of the Veteran's left hip condition and left knee condition to the process of aging. The examiner did not directly address the medical literature that the Veteran and his representative submitted to support their contentions that the injury to one joint caused accelerated degeneration to the opposite joint, to include as due to altered gait patterns. In August 2021, the Veteran and his representative submitted medical literature to support their contentions that the Veteran's medications caused or aggravated his GERD. There is no medical opinion in the record concerning the medical literature submitted to support Veteran's contention that his medications caused or aggravated his GERD. As such, additional medical guidance is needed to address the GERD findings submitted by the Veteran. The Board finds the May 2020 examinations for left hip condition and left knee conditions are inadequate for adjudication purposes because the examiner did not sufficiently address whether the Veteran's left hip condition and left knee condition were aggravated by poor biomechanics caused by his arthritis of the right knee and hip. The Veteran and his representative also submitted additional medical literature to support their contentions that the injury to one joint cause accelerated degeneration to the opposite joint. Medical guidance is needed to address the medical literature submitted by the Veteran. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the VA examiner who conducted the May 2020 VA examination, or a suitable substitute, regarding the etiology of the Veteran's GERD disability. A new examination is only required if deemed necessary by the examiner. The claims file must be reviewed in conjunction with the examination. The examiner must opine as to whether it is at least as likely as not currently diagnosed GERD is caused or aggravated service or service-connected disabilities, to include by medications taken for service-connected disabilities (NSAIDS). The opinion must address the medical literature submitted by the Veteran in August 2021 concerning medications that cause or aggravate GERD. Any updates to such literature should also be raised and discussed. A full and complete rationale for all opinions expressed must be provided. 2. Obtain an addendum opinion from the VA examiner who conducted the May 2020 VA examination, or a suitable substitute, regarding the etiology of the Veteran's left knee and left hip disabilities. A new examination is only required if deemed necessary by the examiner. The claims file must be reviewed in conjunction with the examination. The examiner must opine as to whether it is at least as likely as not any currently diagnosed disability of the left knee or hip is caused or aggravated by service or a service-connected disability. The opinion must address the medical literature submitted by the Veteran in August 2021 concerning the impact of poor biomechanics due to arthritis of the service-connected right hip and knee. Any updates to such literature should also be raised and discussed. A full and complete rationale for any opinion expressed is required. 3. Then, readjudicate the remanded issue. If any benefit sought remains denied, issue a supplemental statement of the case. The case should then be returned to the Board for appellate review if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lauren Barletta 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.