Citation Nr: 21021182 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 16-19 240 DATE: April 12, 2021 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD) to include as secondary to posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for gastritis to include as secondary to PTSD is remanded. REASONS FOR REMAND The Veteran had active service from August 1988 to August 1992 that included service in Southwest Asia. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a November 2017 rating decision of the Department of Veterans Affairs (VA). The Board notes that in June 2019 the Veteran’s claims for entitlement to service connection for gastritis and GERD were remanded by the Board for further development. A review of the record since the June 2019 remand does not reflect that the developmental actions were consistent with all of the directives of that remand, particularly with respect to specific inquires that the examiner was requested to provide a response to. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary, and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. Accordingly, remand is required to obtain an adequate medical opinion that complies with the Board remand directives. 1. Entitlement to service connection for gastroesophageal reflux disease (GERD). 2. Entitlement to service connection for gastritis. The Veteran assets that his GERD and gastritis disabilities are related to active duty service. Additionally, the Veteran asserts that he developed gastritis and GERD when he was overseas as a Marine and was exposed to burning oil wells as it left him with permanent GERD and Gastritis. He re-iterated that his gastrointestinal issues are all directly related to his time in service. See Form 9 Received February 2018. The Veteran has also asserted that his gastrointestinal disabilities are related to his service connected posttraumatic stress disorder (PTSD). As stated above, in June 2019 these matters were remanded for a medical opinion to specifically address whether it is at least as likely as not (a 50 percent probability or higher) that the Veteran’s currently diagnosed GERD and/or gastritis was caused or aggravated by his service-connected PTSD. The Board’s June 2019 remand instructed the examiner to consider and comment upon the December 2016 private disability benefits questionnaire (DBQ) which indicated a correlation between the Veteran’s stress level and his abdominal symptoms. The subsequent December 2019 and November 2020 medical opinions regarding these disabilities failed to specifically indicate that the December 2016 DBQ was reviewed and failed to specifically comment on any possible relationship regarding the Veteran’s stress level and his abdominal symptoms. Therefore, the Board finds that the December 2019 and November 2020 medical opinions did not substantially comply with the June 2019 remand directives and are inadequate to decide the claims. Remand is required for an addendum opinion, or a new VA examination if necessary. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). As the December 2019 and November 2020 medical opinions fail to address the specific remand directive regarding the December 2016 private disability benefits questionnaire which indicated a correlation between the Veteran’s stress level and his abdominal symptoms, remand is required. These matters are REMANDED for the following action: Obtain a VA addendum medical opinion that addresses whether the Veteran’s GERD and gastritis is related to service, or alternatively, caused or aggravated by service-connected PTSD. Schedule the Veteran for an examination at the discretion of the clinician selected to offer the opinion. Following a review of the electronic file, the examiner is asked to address the following with respect to both GERD and gastritis. (1) Is it at least as likely as not (a 50 percent probability or higher) that the Veteran’s currently diagnosed GERD and gastritis was caused by his service-connected PTSD? (2) Is it at least as likely as not (a 50 percent probability or higher) that the Veteran’s currently diagnosed GERD and gastritis was aggravated by his service-connected PTSD? The examiner must consider and comment upon the December 2016 private disability benefits questionnaire which indicated a correlation between the Veteran’s stress level and his abdominal symptoms. The rationale provided must address both causation and aggravation separately. A complete rationale must be provided. The examiner must consider the Veteran’s lay statements. If the examiner is unable to provide a medical opinion, then he/she should must explain in detail why that is the case and provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. Tiffany Dawson Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Dorsey-Kwansa, 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.