Citation Nr: 21075269 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 17-06 336 DATE: December 20, 2021 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1995 to August 2000. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2019 and July 2021, the Board remanded the Veteran's appeal to the RO for further evidentiary development. The July 2021 decision remanded the claim for service connection for GERD and also the claim for entitlement to an effective date prior to November 30, 2012, for the grant of service connection for tinnitus. The Board directed the RO to issue a Statement of the Case for the claim for entitlement to an earlier effective date for tinnitus. See Manlincon v. West, 12 Vet. App. 238 (1999). Subsequently, the RO issued a Statement of the Case for the claim for entitlement to an earlier effective date for tinnitus. As the Veteran has not filed a VA Form 9 Substantive Appeal in response to the Statement of the Case, the issue of entitlement to an earlier effective date for the grant of service connection for tinnitus is not before the Board. A Supplemental Statement of the Case was issued in September 2021, continuing the denial of entitlement to service connection for GERD. Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. In response to the Board's July 2021 remand directive, the RO obtained a medical opinion in August 2021. The Board's remand had directed the RO to obtain an addendum medical opinion which was to include the Veteran's account of the onset and continuity of symptoms (which may be obtained by the ACE telephone process), and which considered the Veteran's lay statement that he experienced symptoms a year and a half after service and his belief that the condition was caused by eating greasy food while in service. The August 2021 opinion stated that the examiner had attempted to contact the Veteran by phone in order to inquire about the onset and continuity of symptoms but the Veteran did not answer. The opinion concluded that the Veteran's GERD was less likely than not caused by or onset during service because it was "not seen in service so less likely than not." The examiner acknowledged reports of vomiting in January 1996 and September 1999 and acknowledged the Veteran's May 2013 statement that his symptoms manifested one and a half years after separation. Still, the examiner stated that the determination was "multifactorial and records do not have enough evidence to establish cause" and "it has to be done per records and available data while taking into account veteran claims." The August 2021 opinion relies on the absence of service treatment records and omitted a report of vomiting during service in March 2000 and failed to discuss or address the Veteran's statement that his symptoms onset within eighteen months of separation from service and were caused by eating greasy food in service. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (examination inadequate where examiner did not comment on report of in-service injury and relied on lack of evidence in STRs to provide a negative opinion.) Further, the rationale that the records do not have enough evidence to establish cause is not adequate for VA purposes. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (medical opinion must provide the degree of certainty require to show a medical nexus, speculative language is not enough). As the medical opinion for the Veteran's GERD did not provide an adequate explanation for its conclusion, it is inadequate for VA purposes and remand is necessary for a new opinion. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As the RO must obtain a new medical opinion, the examiner should make another attempt to contact the Veteran to inquire about the onset and continuity of his GERD symptoms. The matter is REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the Veteran's GERD. A new examination is not required unless the clinician providing the opinion finds one is. The clinician must obtain from the Veteran and record in the opinion a complete description of the onset and continuity of symptoms, which may be obtained via the ACE telephone process. Following a review of the evidence of record and with consideration of the Veteran's statements, determine the following: Is it at least as likely as not (50 percent probability or higher) that the Veteran's GERD began during or is etiologically related to the Veteran's active-duty service? Why or why not? The clinician should consider and address the Veteran's lay statements that he experienced symptoms a year and a half after service and his belief that this condition was caused by eating greasy food while in service. The examiner's attention is directed to the in-service reports of nausea in January 1996, vomiting and diarrhea in September 1999, and vomiting in March 2000. A rationale for any opinions expressed is required. If the clinician is unable to provide any opinion without resorting to speculation, he or she must explain why this is so. Jane Nichols Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Dean, Associate 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.