Citation Nr: 21071075 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 17-40 110A DATE: November 29, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent for service-connected gastroesophageal reflux disease (GERD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from September 2009 to April 2011. This appeal comes to the Board of Veterans' Appeals (Board) from an October 2015 rating decision in which the RO granted service connection for GERD and assigned an initial 10 percent disability rating. In April 2016, the Veteran filed a notice of disagreement (NOD) as to the initial rating assigned. A statement of the case (SOC) was issued in June 2017 and, in August 2017, the Veteran timely filed a substantive appeal to the Board (via VA Form 9). The Veteran was issued supplemental SOCs (SSOC) in May 2019 and February 2020. Entitlement to an initial rating in excess of 10 percent for service-connected gastroesophageal reflux disease (GERD) is remanded. The Veteran's GERD is rated under 38 C.F.R. § 4.114, Diagnostic Codes (DCs) 7399-7346. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. GERD is not specifically listed in the Rating Schedule, and the hyphenated diagnostic code including the "99" series indicates that the most analogous diagnostic code for the Veteran's GERD is DC 7346, which applies to hiatal hernia. 38 C.F.R. § 4.20 (providing for rating by analogy). 38 C.F.R. § 4.114 provides that ratings under DCs 7301 through 7329, 7331, 7342, and 7345 to 7348, inclusive, will not be combined with each other. Rather, a single rating will be assigned under the diagnostic code that reflects the predominant disability picture, with elevation to the next higher rating where the severity of the overall disability warrants such elevation. Under DC 7346, a 10 percent rating is warranted where there are two or more of the symptoms listed in the criteria for the 30 percent rating of less severity. A 30 percent rating is warranted where there is persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain productive of considerable impairment of health. A 60 percent rating is warranted where there are symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia, or other symptoms combinations productive of severe impairment of health. For the following reasons, the Board finds that a remand is necessary for further development before the claim on appeal can be decided. A June 2015 primary care evaluation note reported significant reflux and regurgitation with occasional vomiting. The Veteran's October 2015 VA examination showed persistently recurrent epigastric distress, pyrosis, reflux, and sleep disturbance, more than four times per year. Subsequent medical records in April and May of 2016, prepared in connection with treatment for disorders other than GERD such as mental health disorders, show right shoulder pain, chest pain, and chest pain radiating to right shoulder pain. A June 2016 VA treatment note indicates chronic nausea due to hiatal hernia. While these symptoms are relevant to a determination as to whether the Veteran meets all of the required criteria for a higher rating, it is notable that the Veteran is also in receipt of service connection for panic disorder, migraine headaches, and chronic right shoulder strain with possible impingement syndrome. It is also notable that reports of chest and shoulder pain were predominantly associated with psychiatric consults and emergency room visits associated with the Veteran's panic disorder. It is unclear if the Veteran's chest and right shoulder pain are caused by her service-connected panic disorder and/or right shoulder strain, or her GERD. Moreover, the Veteran's last VA esophageal conditions examination was in 2015 and there is no medical opinion or evidence addressing whether the above symptoms are due to the GERD or the other service-connected disabilities. Cf. Mittleider v. West, 11 Vet. App. 181, 182 (1998) (when effects of service-connected and non-service-connected disabilities cannot be separated, reasonable doubt requires that the signs and symptoms should be attributed to the service-connected disabilities). Where the record does not adequately reveal the current state of the claimant's disability, the fulfillment of the statutory duty to assist requires a thorough and contemporaneous medical examination. Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Thus, a remand is warranted for such an examination and an opinion addressing which disability or disabilities are causing these symptoms. Accordingly, the claim is REMANDED for the following action: Schedule the Veteran for a VA examination to evaluate the severity of her current service-connected GERD. The claims file must be made available to, and be reviewed by, the examiner, and the examination report should note that review. Any indicated evaluations, studies and test should be conducted. The examination should be conducted in accordance with the current disability benefits questionnaire. The examiner should indicate whether the Veteran's chest pain and right shoulder pain are symptoms of her service-connected GERD, due to other disorders, or whether the effects of the various disorders cannot be separated. The examiner should more generally indicate all symptoms that are due to the Veteran's GERD. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board JR Cummings, 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.