Citation Nr: 21008609 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 13-24 843A DATE: February 17, 2021 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1984 to March 1985, from October 2001 to August 2002, October 2003 to November 2004, and June 2005 to December 2006. This case is before the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office. In February 2016, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the electronic claims file. In June 2016 and November 2017, the Board remanded the matter for further development. Now the matter is returned to the Board. The Veteran is seeking for service connection for GERD. Unfortunately, the Board finds that another remand is necessary prior to final adjudication of the matter. The Board notes that a medical opinion and an addendum opinion were obtained in July 2020 and September 2020 in regard to the Veteran’s service connection claim for GERD. In the November 2017 remand order, the examiner was asked to specifically address the January 2004 in-service diagnosis of GERD as well as multiple service treatment reports that demonstrate epigastric complaints. The Board acknowledges that the examiner discussed the January 2004 in-service diagnosis, an epigastric complaint from October 2001, and a December 2006 separation examination. The examiner noted that there was “no mention of heartburn or GERD” in the December 2006 separation examination. However, the Board notes that a medical examiner commented in the Report of Medical Assessment signed by the Veteran on December 21, 2006 that the Veteran 1) experiences sharp chest pain twice a week; 2) was told that it was reflux in 2001; 3) was placed on Zantac, but takes it intermittently; 4) had 20 diarrhea; and 5) there was no acute changes. Also, in a December 2006 Post-Deployment Health Assessment report, the Veteran reported that he had experienced chest pain or pressure, diarrhea, and frequent indigestion during his deployment to Central America from October 2005 to December 2006. The Veteran also reported chest pain as one of the concerns about his health. Further, a medical examiner commented in the Post-Deployment Health Assessment report that the Veteran’s reflux is controlled with prescription. As such, the Board finds that an addendum opinion to fully address the Veteran’s reflux condition noted during the December 2006 Report of Medical Assessment and Post-Deployment Health Assessment report should be obtained in order to make a fully informed decision of the matter. Moreover, the Board notes that the VA examiner provided in the July 2020 medical opinion that “mental health issues” are one of the risk factors for heartburn and reflux symptoms. As the Veteran is currently service-connected for posttraumatic stress disorder (PTSD) at 50 percent disabling, the Board finds that a medical opinion to determine whether the Veteran’s GERD is secondary to his PTSD or whether it was aggravated beyond its natural progression due to PTSD should also be obtained prior to final adjudication of the matter. Accordingly, the matter is REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) must obtain an addendum opinion from the July 2020 VA examiner regarding the Veteran’s service connection claim for GERD. If the July 2020 VA examiner is not available, the requested opinion with rationale should be rendered by another appropriate medical professional. If the examiner determines that a new examination is necessary, the AOJ should schedule one for the Veteran. The examiner should review the Veteran’s claims file and a copy of this REMAND order before rendering the requested addendum opinion. (a.) The examiner must opine whether the Veteran’s current GERD is at least as likely as not (50 percent or greater probability) related to his active duty service or had its onset in active duty service. (b.) The examiner specifically is asked to address the notations by a medical examiner in the December 2006 Report of Medical Assessment that the Veteran 1) experiences sharp chest pain twice a week; 2) was told that it was reflux in 2001; 3) was placed on Zantac, but takes it intermittently; 4) had 20 diarrhea; and 5) there was no acute changes. (c.) Also, the examiner is asked to address the Veteran’s report in the December 2006 Post-Deployment Health Assessment that he was experiencing chest pain or pressure, diarrhea, and frequent indigestion during his deployment to Central America from October 2005 to December 2006, and the chest pain was one of the concerns about his health. Further, the examiner is asked to address the medical examiner’s comment in the Post-Deployment Health Assessment report that the Veteran’s reflux is controlled with prescription. The examiner is advised that the Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, the examiner must provide an explanation for such rejection. (d.) The examiner must also opine whether the Veteran’s current GERD is at least as likely as not (50 percent or greater probability) secondary to his service-connected PTSD, or was aggravated beyond its natural progression due to PTSD. (e.) The examiner must provide a complete written rationale for any opinion offered. 2. After completing the above actions and any other necessary development, the issue on appeal must be readjudicated. If the claims remain denied, a Supplemental Statement of the Case must be provided to the Veteran and his attorney. After the Veteran and his attorney have had an adequate opportunity to respond,   the appeal must be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. E. Kim, 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.