Citation Nr: 21005425 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 11-24 145 DATE: February 1, 2021 REMANDED Entitlement to service connection for a gastrointestinal disability, to include as secondary to medication used to treat service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1969 to February 1972. This matter came before the Board of Veterans Appeals (Board) on appeal from a November 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). May 2016 and June 2018 Board decisions, in pertinent part, remanded the issue on appeal for further development and it was denied in a September 2019 Board decision. The Veteran then appealed the Board’s denial to the United States Court of Appeals for Veterans Claims (Court). The parties submitted a Joint Motion for Remand (JMR) in August 2020, asking that the September 2019 Board decision be vacated and remanded for readjudication. In September 2020, the Court granted the JMR and remanded the issue on appeal for readjudication in accordance with instructions set out in the JMR. Entitlement to service connection for a gastrointestinal disability, to include as secondary to medication used to treat service-connected disabilities is remanded. The Veteran submitted two articles in January 2019 in support of his claim for service connection for a gastrointestinal disability. The Board notes that one article pertained to the relationship between sleep apnea and acid reflux and stated that sleep apnea could be an underlying cause of persistent reflux, and the other addressed the impact of post-traumatic stress disorder (PTSD) and stated that digestive tract disorders such as GERD were more common in those living with PTSD. The Board also notes that when the Veteran filed his claim for service connection, he specifically contended that his gastrointestinal disability was secondary to PTSD as well as to his medication for service connected disabilities. While medical treatises that are not specific to a particular veteran’s disability picture (like those submitted in this case) are generally insufficient, alone, to establish linkage for service-connection purposes, see, e.g., Wallin v. West, 11 Vet. App. 509, 514 (1998); Libertine v. Brown, 9 Vet. App. 521, 523 (1996), such medical treatise evidence may nevertheless provide “‘important support’ for service connection” outside of establishing linkage. McCray v. Wilkie, 31 Vet. App. 243, 255 (2019). Here, the Board finds that the Veteran has submitted evidence indicating that his disabilities may be associated with his service-connected sleep apnea and PTSD and also finds that the current VA examinations of record do not adequately address the question of secondary service connection by either sleep apnea or PTSD. An October 2016 VA examination found that GERD was not due to service as there was no documented onset of symptoms during service. The opinion did not address the question of secondary service connection. A December 2018 VA examination found that the GERD was not due to his service-connected disabilities or the medication for those disabilities. The rationale was that the medications for the Veteran’s disabilities had not been associated with transient relaxation of the lower esophageal sphincter. However, the Board finds that this rationale, while it addressed the effect of the Veteran’s medications, did not address whether the service-connected disabilities themselves either caused or aggravated the Veteran’s GERD. The examination is therefore inadequate as it pertains to the question of secondary service connection and remand for a new examination regarding secondary service connection is required. The examiner should address the Veteran’s treatise evidence regarding a connection between PTSD/sleep apnea and the Veteran’s GERD. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination, from different provider than the one who provided the October 2016 and December 2018 VA examinations, to determine the etiology of his gastrointestinal disability. The examiner should review the file and provide a complete rationale for all opinions expressed. For any current gastrointestinal disability found to be diagnosed, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such disability is related to the Veteran’s service-connected disabilities, including PTSD and sleep apnea, to include the medications taken for those disabilities. The opinion should specifically address the treatise articles submitted by the Veteran in January 2019 regarding the impact of PTSD and the relationship between sleep apnea and GERD. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran’s statements regarding the onset and persistence of his symptoms. 2. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Arnold 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.