Citation Nr: 21070284 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 14-10 538 DATE: November 23, 2021 REMANDED Entitlement to service connection for heartburn or gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for a right shoulder disability is remanded. REASONS FOR REMAND The Veteran had active-duty military service from October 2004 to October 2008, to include service in Iraq. This matter was previously before the Board in April 2018, when the claim of service connection for right shoulder disability was reopened. At that time, the claim for right shoulder disability and heartburn or GERD were remanded to the Agency of Original Jurisdiction (AOJ). The remand instructions included specific considerations to be addressed in VA examinations. The VA examinations in December 2018 failed to address the considerations specified in the remand instructions. As such, they were inadequate, and this matter must again be remanded for new VA examinations. 1. Entitlement to service connection for heartburn or GERD The Veteran seeks service connection for heartburn, which was diagnosed by the December 2018 VA examiner as GERD. The Veteran testified at the Board hearing in August 2017 that he experienced symptoms of heartburn in service, specifically while serving in Iraq, but was unable to take the time to seek treatment for the issue. (See Hearing Transcript, 08/02/2017.) He further testified that his symptoms of heartburn and gastrointestinal upset tended to flare-up when he was experiencing stress. The Board remand in April 2018 directed that any VA examination and opinion consider the Veteran's testimony regarding symptoms in service and flare-ups related to his mental health disability. The December 2018 VA examination and opinion was conclusory at best, offering the opinion that GERD is a common condition and unlikely to be specifically related to military service or any other medical condition. The examiner did not address the question of whether the symptoms reported in service were consistent with his current diagnosis, signifying onset of the disability in service, nor did he address the specifics of the Veteran's testimony of symptom flare-ups as instructed. This examination is inadequate, and a new examination and opinion must be obtained on remand. 2. Entitlement to service connection for a right shoulder disability The Veteran seeks service connection for a right shoulder disability, which was diagnosed by the December 2018 examination as right shoulder strain. The records show that he was treated in service for a shoulder injury, although the primary record is confusing as to whether the shoulder at issue was the right shoulder or the left shoulder. The Veteran testified at the Board hearing in April 2018 that it was his right shoulder that was injured, and other medical records support this testimony. Indeed, the December 2018 VA examination noted that the Veteran has limitation of range of motion in his right shoulder but not in his left shoulder. The December 2018 VA examination and opinion found no basis for relating the Veteran's current right shoulder disability to his injury in service, which the examiner described as affecting the left shoulder. While not perhaps fully clear, the intent of the prior remand was for the VA examiner to consider the record as referring to the right shoulder. As such, the examination with respect to the right shoulder is likewise inadequate and a new examination and opinion must be obtained on remand. The matters are REMANDED for the following action: 1. Provide the Veteran with an appropriate VA examination with respect to his claim of service connection for heartburn or GERD, to be conducted by a provider other than the one who performed the December 2018 examination. The examiner should consider the Veteran's testimony at the April 2018 Board hearing, the history of symptoms and treatment as related by the Veteran, and the issue of flare-ups during times of stress or increased mental health symptoms. The examiner should accept all of these as credible and competent unless a specific reason for discounting these statements can be given. The examiner should offer an opinion as to whether it is at least as likely as not (probability 50 percent or greater) that the Veteran's heartburn and/or GERD had its onset in service or is otherwise related to his service. The examiner should specifically address the symptoms which the Veteran experienced in service in rendering this opinion. The examiner is instructed that the absence of medical records related to complaints or treatment for heartburn or GERD in service may not, by itself, constitute a basis for finding that onset in service is not shown. If the examiner concludes that the Veteran's heartburn or GERD did not have onset in service or is otherwise related to service, the examiner should consider the statements and testimony regarding the Veteran's experience of flare-ups of symptoms during times of increased stress and mental health symptomatology. The examiner should then offer an opinion as to whether it is as least as likely as not that the Veteran's heartburn or GERD have been aggravated by his mental health disability and, if so, should provide a baseline for the heartburn disability prior to such aggravation. The examiner should provide a statement of rationale or reasons for the opinions provided. The examiner should cite to any specific medical evidence of record or any specific medical treatise or research which informed the opinion. 2. Provide the Veteran with an appropriate VA examination with respect to his claim of service connection for right shoulder disability, to be conducted by a provider other than the one who performed the December 2018 examination. The examiner is instructed that the Board is satisfied that the treatment record from April 2005 should be read as referring to a right shoulder injury rather than a left shoulder injury. The examiner is asked to provide an opinion as to whether it is at least as likely as not (probability 50 percent or greater) that the Veteran's current right shoulder disability is the result of the injury in service or is otherwise related to service. The examiner should consider the Veteran's lay history, testimony at the April 2018 Board hearing, and additional medical records in rendering this opinion. The examiner should provide a statement of rationale or reasons for the opinions provided. The examiner should cite to any specific medical evidence of record or any specific medical treatise or research which informed the opinion. 3. After the examinations and opinions have been obtained, the AOJ should review them for compliance with the Board's remand instructions before further adjudicating the claim. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cheryl E. Handy 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.