Citation Nr: 21007938 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 14-23 431 DATE: February 11, 2021 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to service-connected diabetes mellitus type II, peripheral neuropathy and an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1964 to July 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board has recharacterized the Veteran’s GERD appeal to accurately reflect all claims reasonably raised by the record, including entitlement to service connection as secondary to an acquired psychiatric disorder, to include PTSD. See May 2011 Statement in Support of Claim, VA form 21-4138. The appeal was previously before the Board in February 2016. The Board remanded the appeal, in pertinent part, to obtain a VA examination if the Veteran’s treatment records showed an acquired psychiatric disability, and if an acquired psychiatric disorder was shown, to address whether the Veteran’s GERD is caused or aggravated by the acquired psychiatric disorder. The appeal was returned to the Board for review. In March 2018, the Board remanded the appeal, in pertinent part, to obtain an examination to determine the nature and etiology of any current acquired psychiatric disability, to include PTSD and to obtain an addendum opinion regarding whether it is as likely as not that the Veteran’s GERD was caused or aggravated by any diagnosed acquired psychiatric disorder. The appeal was returned to the Board for review. In September 2019, the Board remanded the appeal for an addendum opinion regarding whether the Veteran currently has an acquired psychiatric disorder, to include depression and anxiety that is at least as likely as not related to his established stressor, and for an addendum opinion regarding whether the Veteran’s GERD is at least as likely as not proximately due to or and/or aggravated by any service-connected disability, specifically his diabetes mellitus, type II or peripheral neuropathy. In an October 2020 rating decision, the RO granted service connection for an acquired psychiatric disorder of PTSD. As this represents a total grant of the benefit sought on appeal, the issue of entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is no longer before the Board. See Grantham v. Brown, 114 F. 3d 1156, 1159 (Fed. Cir. 1997). A remand is necessary because there has not been substantial compliance with prior Board remand directives as discussed below. See Stegall v. West,11 Vet. App. 268, 271(1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). 1. Entitlement to service connection for GERD, to include as secondary to service-connected diabetes mellitus type II, peripheral neuropathy and an acquired psychiatric disorder, to include PTSD is remanded. The Veteran asserts that his GERD is secondary to his service-connected diabetes mellitus type II disability and PTSD disorder. See Statement in Support of Claim, VA form 21-4138 received June 2011. The appeal must be remanded pursuant to Stegall. In the March 2018 Board decision, the RO was instructed that if the Veteran were diagnosed with an acquired psychiatric disorder, they must obtain an addendum opinion as to whether it is as likely as not that the GERD was caused or aggravated by any diagnosed acquired psychiatric disorder. The Veteran was ultimately diagnosed with PTSD and such an opinion has not been obtained. Thus, the RO did not substantially comply with the Board’s prior remand directives in violation of Stegall. Additionally, the Board notes that VA is obligated to develop and consider all theories of entitlement that are raised by the record or by the claimant. See Robinson v. Mansfield, 21 Vet. App. 545 (2008). The September 2019 Board decision requested additional addendum medical opinions for the GERD appeal, on a secondary basis. The Veteran was provided with an addendum medical opinion for his GERD in September 2020. The examiner opined that the Veteran’s GERD was not at least as likely as not aggravated beyond normal progression by his service-connected diabetes mellitus type II or peripheral neuropathy. The examiner was not asked to provide an opinion as to secondary service connection based on aggravation, as requested by the Board remand. A medical opinion as to secondary service connection should address both causation and aggravation. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Thus, the VA addendum medical opinion does not substantially comply with the September 2019 Board remand directives in violation of Stegall. The appeal must be remanded to comply for development in accordance with the Board’s prior remand directives. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Following that development, obtain an addendum opinion for the Veteran’s GERD as secondary to his service-connected PTSD disorder. The examiner must review the claims file. The examiner is asked to provide responses to the following: (a) Is the Veteran’s GERD at least as likely as not proximately due to his service-connected PTSD disorder? (b) Is the Veteran’s GERD at least as likely as not aggravated, i.e., worsened beyond its natural progression, by his service-connected PTSD disorder? Provide complete rationales to support the opinions. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Susan Leary, 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.