Citation Nr: 21012447 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 15-23 130 DATE: March 4, 2021 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for erectile dysfunction is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1974 January 1984, and from July 1984 to July 1994. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2019, the Veteran testified, sitting in San Diego, California, before the undersigned via a videoconference hearing. A transcript of the hearing has been associated with the virtual file and reviewed. This case was previously before the Board in December 2019, at which time it was remanded for further development, as discussed below. The Board finds that the remand directives were not substantially complied with and thus another remand is warranted. Stegall v. West, 11 Vet. App. 268, 271 (1998).   1. Entitlement to service connection for GERD is remanded. In December 2019, the Board remanded the issue of service connection for GERD and directed the Agency of Original Jurisdiction (AOJ) to obtain any outstanding records of pertinent medical treatment from VA or private health care providers. After the completion of the aforementioned development, the AOJ was directed to schedule the Veteran for a VA examination to determine the nature and etiology of the Veteran’s GERD. During the September 2019 Board hearing, the Veteran testified that he self-treated symptoms of GERD during active service with over-the-counter medication. The examiner was specifically directed to consider the Veteran’s lay statements regarding the onset of symptoms during active service. 12/11/2019, BVA Decision. A February 2020 VA examination noted a diagnosis of GERD. The examiner opined that the Veteran’s GERD is less likely than not related to his period of active service. In the rationale, the examiner remarked on the lack of documented contemporaneous treatment of GERD in the service treatment records. 02/20/2020, C&P Exam; 02/20/2020, C&P Exam (medical opinion). The examination is incomplete because the Board is unable to determine whether the examiner sufficiently considered the Veteran’s lay statements regarding the onset of his GERD symptoms, as the rationale is largely based on the lack of recorded treatment during service. As such, the Board finds that the remand directives were not substantially complied with and, therefore, another remand is warranted. Stegall, 11 Vet. App. at 271. Accordingly, the Board finds the February 2020 VA examination to be incomplete, and that an addendum medical opinion is warranted. 2. Entitlement to service connection for erectile dysfunction is remanded In December 2019, the Board also remanded the issue of service connection for erectile dysfunction and directed the AOJ to obtain any outstanding records of pertinent medical treatment from VA or private health care providers. After the completion of the aforementioned development, the AOJ was directed to schedule the Veteran for a VA examination to determine the nature and etiology of the Veteran’s erectile dysfunction, to include an r as to whether erectile dysfunction was caused or has been aggravated by the Veteran’s service-connected premature ventricular contraction, hypertension, or lumbar spine disabilities. During the September 2019 Board hearing, the Veteran testified that the onset of his erectile dysfunction occurred during active service, and that he did not speak about his erectile dysfunction with others while he was in active service and attempted to sort it out on his own. 12/11/2019, BVA Decision. A February 2020 VA examination noted a diagnosis of erectile dysfunction. The examiner opined that the Veteran’s erectile dysfunction is less likely than not related to his period of active service. In the rationale, the examiner noted the lack of treatment for erectile dysfunction in the service treatment records. 02/20/2020, C&P Exam; 02/20/2020, C&P Exam (medical opinion). The examination is incomplete because the Board is unable to determine whether the examiner sufficiently considered the Veteran’s lay statements regarding the onset of his erectile dysfunction, as well as that the Veteran did not disclose or seek treatment during active service, rather attempting to address the condition on his own. The examiner’s the rationale is based on the lack of recorded treatment during service. As such, the Board finds that the remand directives were not substantially complied with and, therefore, another remand is warranted. Stegall, 11 Vet. App. at 271. Accordingly, the Board finds the February 2020 VA examination to be incomplete, and that an addendum medical opinion is warranted. These matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. Additionally, request the Veteran to submit any relevant private treatment reports or provide VA with authorization to obtain any such records. 2. After completing directive # 1, obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of GERD. An in-person examination is not required unless deemed necessary by the clinician. The clinician is to review the virtual file, including a copy of this Remand. The clinician is to provide an opinion whether any current GERD diagnosis is at least as likely as not related to an in-service injury, event, or disease. Additionally, the clinician is to provide an opinion as to whether any current GERD diagnosis had its onset during the Veteran’s periods of active service (January 1974 to January 1984, and July 1984 to July 1994). **The clinician is to note and consider that at the 2019 hearing the Veteran testified that he has had GERD symptoms continuously since its onset during active service. Additionally, the Veteran testified that he did not seek professional medical treatment for his GERD symptoms during active service, and attempted to treat the condition with over-the-counter medication. See 09/20/2019, Hearing Transcript.** A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. After completing directive # 1, obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of erectile dysfunction. An in-person examination is not required unless deemed necessary by the clinician. The clinician is to review the virtual file, including a copy of this Remand. The clinician is to provide an opinion whether any current erectile dysfunction diagnosis is at least as likely as not related to an in-service injury, event, or disease. Additionally, the clinician is to provide an opinion as to whether any current erectile dysfunction diagnosis had its onset during the Veteran’s periods of active service. Likewise, the clinician must opine as to whether any current erectile dysfunction diagnosis is at least as likely as not: (a.) proximately due to a service-connected disability (such as: premature ventricular contraction and/or hypertension and/or lumbar spine); OR (b.) aggravated beyond its natural progression by a service-connected disability. **The clinician is to note and consider that at the 2019 hearing the Veteran testified that he has had erectile dysfunction symptoms continuously since its onset during active service. Additionally, the Veteran testified that he did not discuss or seek professional medical treatment for his erectile dysfunction during active service, and attempted to sort it out on his own at that time. See 09/20/2019, Hearing Transcript.** A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered.   If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David Han 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.