Citation Nr: A21020152 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 200527-88848 DATE: December 16, 2021 REMANDED Entitlement to service connection for an esophageal disorder, to include as secondary to a service-connected disability is remanded. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from June 1993 to July 1995. In April 2020, the agency of original jurisdiction (AOJ) issued a supplemental claim decision, which found that new and relevant evidence had been received to readjudicate the matter. The Board is bound by this favorable finding. In April 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the April 2020 supplemental claim rating decision. In May 2020, the AOJ issued the HLR decision on appeal. In the May 2020 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. REASONS FOR REMAND Entitlement to service connection for an esophageal condition, to include as secondary to service-connected disability, is remanded. The Board finds that Remand is required to correct the following pre-decisional duty to assist errors. The Veteran offers alternative theories of service connection: (1) his esophageal conditions are due to his service connected acquired psychiatric disorder, low back disability, bilateral lower extremity radiculopathy and leukopenia, to include medications for such disabilities and (2) causation or aggravation of digestive system disorders based on obesity as an intermediate step between such service-connected disabilities and digestive system disorder(s). The March 2020 VA examiner did not address whether the Veteran's current esophageal system disorders are secondary to his service connected acquired psychiatric disorder, low back disability, bilateral lower extremity radiculopathy and leukopenia with obesity as an intermediate step, thus this is a pre-decisional duty to assist error and the appeal must be remanded to correct the error. Further, an opinion should have been obtained regarding service connection as secondary to service-connected leukopenia, to include medications prescribed for such, as the issue was reasonably raised by the record as it pertains to the drug taken for the condition. The examiner who conducted the March 2020 ACE examination identified GERD as a present esophageal disorder, however, the Veteran also has hiatal hernia and Barrett's esophagus diagnoses, and the examiner did not address the disorders. The matter is REMANDED for the following action: Obtain an addendum opinion from a qualified examiner. The examiner must review the entire claims file and note that it was reviewed. a) The examiner must identify all of the Veteran's esophageal conditions, including but not limited to, GERD, hiatal hernia and Barrett's esophagus during or proximate to the claim. b) Is it as likely as not (50 percent probability or greater) that any esophageal condition is proximately due to or aggravated by service-connected acquired psychiatric disorder, low back disability, bilateral lower extremity radiculopathy and/or leukopenia and/or aggravated beyond its natural progression by such service-connected disabilities, to include all medications taken for such service-connected disabilities during the appeal period? The examiner must address both causation and aggravation. c) Is at least as likely as not (50 percent probability or greater) that any of the above service-connected disabilities caused him to become obese or gain weight; or aggravated his obesity. If so, the examiner should provide an opinion as to whether the obesity was a substantial factor in causing the Veteran's esophageal disability. He or she should also provide an opinion as to whether the Veteran's an esophageal disability would not have occurred or worsened but for the weight gain caused or aggravated by his service-connected disability. (Continued on the next page) A complete rationale must be provided for all opinions offered. If any opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what, if any, additional evidence would potentially allow for a more definitive opinion. If an in-person examination is required for the examiner to sufficiently address the above questions, then an in-person examination should be afforded. Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Susan Leary 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.