Citation Nr: 21012959 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 15-45 562 DATE: March 8, 2021 REMANDED Entitlement to service connection for a hernia condition, to include as secondary to service-connected gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for an ulcer disease, to include as secondary to service-connected GERD is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1967 to April 1971. 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). The Board remanded the claim for further development in June 2019. In a July 2020 rating decision, the RO granted service connection for Barrett's esophagus, also claimed as internal scarring of esophagus, at 30 percent disabling. The RO determined entitlement i combined with the evaluation of GERD (claimed as GERD/stomach condition) with Barrett's esophagus, also claimed as internal scarring of esophagus, at 30 percent disabling. As this constitutes a grant of full benefits sought with respect to this issue of service connection, this claim is no longer in appellate status for the Board's consideration. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997) (holding that where an appealed claim of service connection is granted during the pendency of the appeal, a second notice of disagreement must thereafter be timely filed to initiate appellate review of the claim concerning "downstream" issues, such as the compensation level assigned for the disability and the effective date). 1. Entitlement to service connection for a hernia condition, to include as secondary to service-connected GERD is remanded. 2. Entitlement to service connection for an ulcer disease, to include as secondary to service-connected GERD is remanded. The Veteran seeks entitlement to service connection for ulcer and hernia conditions. Regarding hernia conditions, in a July 2020 VA opinion, the examiner stated the “etiology of hiatal hernias includes age related weakening of stomach muscles, trauma/injury near diaphragm, and straining/heavy lifting.” The website the examiner provided in support of the rationale states possible causes are injury to the area, for example, after trauma or certain types of surgery. The examiner does not address if any of the Veteran’s surgeries could have contributed to the hernias. Also, the examiner does not address a December 1993 private treatment record noting partial gastrectomy for ulcer disease, repair of a hernia on the left; known hiatal hernia; or a March 2004 private treatment record noting bilateral inguinal hernias and epigastric incisional hernia. Regarding ulcer conditions, in the July 2020 VA opinion, the examiner did not address the December 1993 private treatment record; an April 2004 record noting “reported multiple gastric ulcers requiring a 2/3 gastrectomy in the 1980s; a June 2014 VA examination report noting “gastric ulcer date of diagnosis 1980; subtotal gastrectomy 1980 secondary to gastric ulcers”; or a June 2014 VA opinion noting Veteran had symptoms (SX) consistent with peptic ulcer disease (PUD) on active duty (AD). Veteran has had documented gastric ulcer and surgery for same.” Finally, the examiner did not address the November 2019 private treatment record noting “the hiatal hernia, esophagitis, PUD, continued reflux, and Barrett' esophagus are all part of a continuum related to the Veteran’s original GERD.” Accordingly, a remand for addendum opinions is warranted. Barr v. Nicholson, 21 Vet. App. 303 (2007). The records for the hernia repairs and gastric ulcers are not associated with the claims file. On remand, the RO should attempt to obtain these records. The matters are REMANDED for the following action: 1. Request that the Veteran complete authorizations for VA to obtain and associate all private treatment records for the ulcer and hernia conditions, since discharge from active duty in April 1971. If any requested records cannot be obtained, inform the Veteran the results of the requests for records and a negative response must be associated with the claims file. 2. Once the development above is completed, provide the electronic file, to include this Board remand, and a copy of the July 2020 VA opinion to a gastrointestinal specialist who is a Doctor of Medicine (M.D.). The physician is asked whether he or she concurs with the findings and conclusions provided by the family nurse practitioner regarding the issue of the Veteran’s hernia and ulcer conditions. Please explain why or why not. The physician should offer comments and an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability): * that the Veteran's current hernia condition occurred in or is caused by his military service, to include: (1) December 1993 private treatment record noting repair of a hernia on the left; known hiatal hernia; (2) March 2004 private treatment record noting bilateral inguinal hernias and epigastric incisional hernia; (3) Whether any of the Veteran’s surgeries contributed to the hernia condition. * that the Veteran's current hernia condition is proximately due to or AGGRAVATED (beyond a natural progression) by his service-connected GERD, to include: November 2019 private treatment record noting “the hiatal hernia, esophagitis, peptic ulcer disease, continued reflux, and Barrett' esophagus are all part of a continuum related to the Veteran’s original GERD.” * that the Veteran's current ulcer condition occurred in or is caused by his military service, to include: (1) December 1993 private treatment record noting partial gastrectomy for ulcer disease; (2) April 2004 record noting “reported multiple gastric ulcers requiring a 2/3 gastrectomy in the 1980s”; (3) June 2014 VA examination report noting “gastric ulcer date of diagnosis 1980; subtotal gastrectomy 1980 secondary to gastric ulcers”; (4) June 2014 VA opinion noting “Veteran had SX consistent with PUD on AD. Veteran has had documented gastric ulcer and surgery for same”; * that the Veteran's current ulcer condition is proximately due to or AGGRAVATED (beyond a natural progression) by his service-connected GERD, to include: November 2019 private treatment record noting “the hiatal hernia, esophagitis, peptic ulcer disease, continued reflux, and Barrett' esophagus are all part of a continuum related to the Veteran’s original GERD.” All opinions should be supported by a clear rationale, and a discussion of the facts and medical principles involved would be of considerable assistance. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Edwin B. Esmenda, 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.