Citation Nr: 21022385 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 14-38 649 DATE: April 15, 2021 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from December 2009 to December 2013. The Board remanded this appeal in June 2018, June 2020, and January 2021. Following issuance of a supplemental statement of the case in February 2021, the Agency of Original Jurisdiction returned this appeal to the Board in March 2021. In April 2021, the Veteran’s representative submitted document entitled “Cancellation of Limited Power of Attorney” in which he stated that he was revoking power of attorney for the Veteran. Under 38 C.F.R. § 20.6, a representative may withdraw services as representative in an appeal that has been certified to the Board only if good cause is shown on motion. In this case, the representative’s April 2021 attempt to withdraw does not include any statement showing good cause for withdrawing. Therefore, the representative has not met the requirements for withdrawal of services, and continues to be recognized as the Veteran’s representative of record. 1. Entitlement to service connection for GERD is remanded. In its January 2021 remand, the Board noted that a November 2019 VA esophageal examiner diagnosed the Veteran with GERD manifested by infrequent episodes of epigastric distress, pyrosis, reflux, and sleep disturbance caused by esophageal reflux. The Board determined that those findings contradicted an August 2020 VA examiner’s finding that the Veteran does not have a diagnosis of GERD. The Board therefore remanded the issue so that an addendum opinion may be obtained in consideration of the November 2019 VA examination. In February 2021, a VA examiner concluded that the Veteran does not have a diagnosis of GERD because “He mentions no ongoing or chronic symptoms consistent with a diagnosis of GERD. He mentioned rare ‘indigestion’, but this would not be consistent in labeling him with a true diagnosis of GERD.” He characterized the November 2019 VA examiner’s findings as “vague entries” and stated that the Veterans Health Administration cannot comment on, support, or explain comments from the November 2019 VA examiner because that examiner was a contractor and not a VA employee. He concluded that “none of [the Veteran’s] cumulative CPRS clinical entries make mention of GERD, nor symptoms consistent with that.” The February 2021 VA examiner appears to have based his conclusions on a telephone interview conducted with the Veteran in February 2021. Although the examiner discussed the November 2019 VA examination generally, the only upper gastrointestinal symptom he mentions is the rare indigestion the Veteran reported in the telephone interview. He does not discuss the infrequent episodes of epigastric distress, pyrosis, reflux, and sleep disturbance the Veteran reported at the November 2019 VA examination or explain why such symptoms are not diagnostic of GERD. Therefore, the February 2021 VA examiner’s opinion is not adequate, and the issue must again be remanded so that a further addendum opinion may be obtained. 2. Entitlement to a TDIU is remanded. Finally, because a decision on the remanded issue of entitlement to service connection for GERD could significantly impact a decision on the issue of entitlement to a TDIU, the issues are inextricably intertwined. A remand of the claim for entitlement to a TDIU is required. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran currently has a diagnosis of GERD or other upper gastrointestinal disability, or had such a disability at any time since his separation from active service in December 2013. In discussing whether there is such a current disability, the clinician must discuss the findings of the November 2019 VA examiner, who diagnosed the Veteran with GERD manifested by infrequent episodes of epigastric distress, pyrosis, reflux, and sleep disturbance caused by esophageal reflux. The clinician must also discuss the Veteran’s report at the November 2019 VA examination that he began experiencing acid in the throat with burping in 2009, that he had such episodes once or twice per week, and that he would wake up once per month due to such episodes. If the clinician determines that such symptoms do not warrant a diagnosis of GERD or other upper gastrointestinal disability, he or she should explain why. If the clinician determines that the Veteran currently has a diagnosis of GERD or other upper gastrointestinal disability, or had such a disability at any time since his separation from active service in December 2013, then he or she must also provide opinions as to direct and secondary service connection. Specifically, the clinician must respond to the following: a) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s diagnosed upper gastrointestinal disability had its clinical onset during his active service or is due to an in-service event, injury, or disease? b) If not, is it at least as likely as not that the diagnosed upper gastrointestinal disability is proximately due to the Veteran’s service-connected psychiatric disability, including any medications he takes to treat that disability? c) If not, is it at least as likely as not that the diagnosed upper gastrointestinal disability has been aggravated beyond its natural progression by the Veteran’s service-connected psychiatric disability, including any medications he takes to treat that disability? In rendering any opinion, the clinician must address the articles the Veteran submitted along with notice of disagreement in May 2015, including the article entitled “Gastro-oesophageal Reflux Disease and Psychological Comorbidity.” A clear rationale must be provided for all opinions given. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. J. Anthony, 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.