Citation Nr: 21015820 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 10-26 216 DATE: March 18, 2021 REMANDED Entitlement to service connection for a gastrointestinal disorder, to include GERD, including as secondary to a service-connected back disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1966 to February 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2010 rating decision by the St. Petersburg, Florida, Regional Office (RO) of the Department of Veterans Affairs (VA). This matter was previously before the Board in November 2014, June 2016, May 2017, and February 2018. Each time, the claim was remanded for additional development. In November 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The record was held open for 90 days to allow the Veteran to submit an opinion; however, the virtual claims file does not reflect that any additional evidence has been received. The representative included in the informal hearing presentation (IHP) the issues of entitlement to service connection for left ear hearing loss and entitlement to initial evaluation in excess of 10 percent for the service-connected back disorder as issues on appeal. However, neither the left ear hearing loss nor the increased rating for the low spine issue is currently within the Board’s jurisdiction as a June 2016 Board decision denied service connection for left ear sensorineural hearing loss and a rating in excess of 20 percent for the low back. Entitlement to service connection for a gastrointestinal disorder, to include GERD, including as secondary to a service-connected back disability The February 2018 Board remand directed that the VA examiner should opine regarding the etiology of the previously diagnosed GERD even if the examiner found no current disability related to the bowels. The medical records show the Veteran was noted to have GERD on proton pump inhibitors (PPI). However, the December 2018 VA examiner’s rationale stated that the medical records are silent for any gastrointestinal complaints. Therefore, there has not been substantial compliance with the Board’s previous remand directives. Another remand is required to obtain a supplemental medical opinion. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Please secure for the record copies of complete updated clinical records (any not already of record) of all VA and non-VA treatment the Veteran has received for the disorders on appeal. Please ask the Veteran to provide the releases necessary for VA to secure any adequately identified private treatment records. 2. After the action requested in paragraph 1 is complete, please refer the claim to an appropriate clinician for a medical opinion as to the nature and etiology of the Veteran’s gastrointestinal disorder, to include GERD. The clinician should review the Veteran’s claims-file. The clinician is explicitly advised that the Veteran has previously been diagnosed with GERD during the period on appeal. The clinician should provide an opinion that responds to the following: (a.) Whether it is at least at likely as not (a 50% or greater probability) that the Veteran’s gastrointestinal disorder, to include GERD is related to his military service? The clinician is explicitly advised that the Veteran has been diagnosed with GERD during the period on appeal. Therefore, even if the examiner finds no current gastrointestinal disability, the clinician should opine regarding the etiology of the previously diagnosed GERD. (b.) Whether it is at least at likely as not (a 50% or greater probability) that the Veteran’s gastrointestinal disorder, to include GERD is caused by his service-connected low back or psychiatric disability or any medication for his service-connected low back or psychiatric disability? The clinician is explicitly advised that the Veteran has been diagnosed with GERD during the period on appeal. Therefore, even if the examiner finds no current gastrointestinal disability, the clinician should opine regarding the etiology of the previously diagnosed GERD. Please explain and address the December 2018 VA opinion provider’s statement that “medications . . . might contribute to constipation.” (c.) Whether it is at least at likely as not (a 50% or greater probability) that the Veteran’s gastrointestinal disorder, to include GERD is aggravated (any increase in disability) by a service-connected disability or any treatment/ medication for a service-connected disability? The clinician is explicitly advised that the Veteran has previously been diagnosed with GERD during the period on appeal. Therefore, even if the examiner finds no current gastrointestinal disability, the clinician should opine regarding the etiology of the previously diagnosed GERD. Please explain and address the December 2018 VA opinion provider’s statement that “medications... might contribute to constipation.” The clinician must consider and address as appropriate evidence including: The June 2016 treatment note showing the Veteran’s medication was adjusted and he was instructed on the need to adhere to GERD diet. The medical records noting the Veteran has GERD on proton pump inhibitors (PPI). The Veteran’s report to the December 2018 VA examiner that he had problems with heartburn when he was working and eating a lot of fast food and processed foods. The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. The clinician should take into consideration that the Veteran is competent to report in-service and post-service symptom experiences; other witnesses are competent to report observable symptoms. If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an   explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Sowden, 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.