Citation Nr: 21022802 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 16-05 851 DATE: April 19, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for a gastrointestinal condition, to include as due to an acquired psychiatric disorder, is remanded. Entitlement to service connection for a hiatal hernia, to include as due to an acquired psychiatric disorder, is remanded. Entitlement to service connection for acid reflux, to include as due to an acquired psychiatric disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from April 1966 to April 1968. These matters come before the Board of Veterans Appeals (Board) on appeal from July 2012 and June 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in July 2020 when it was remanded to the Agency of Original Jurisdiction (AOJ) for additional development. 1. Entitlement to service connection for an acquired psychiatric disorder is remanded. Pursuant to the July 2020 Board remand the Veteran received a VA examination in October 2020. The examiner provided a negative opinion. However, the examiner based his opinion in part on the absence of treatment records. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154 (a). The Veteran contends, through his representative, that his psychiatric condition began prior to the 1979 medical record and was simply undiagnosed until 1979. See Third Party Correspondence, received March 2021. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 133637 (Fed. Cir. 2006). Accordingly, the Board finds an addendum opinion must be obtained. 2. Entitlement to service connection for a gastrointestinal condition, to include as due to an acquired psychiatric disorder is remanded. The issue of entitlement to service connection for a gastrointestinal condition must also be remanded as it is inextricably intertwined with the issue of entitlement to service connection for an acquired psychiatric disorder. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when the adjudication of one issue could have “significant impact” on the other issue). Therefore, the Board finds it necessary to remand this issue. 3. Entitlement to service connection for a hiatal hernia, to include as due to an acquired psychiatric disorder is remanded. 4. Entitlement to service connection for acid reflux, to include as due to an acquired psychiatric disorder is remanded. The Board regrets the additional delay but must remand for an addendum opinion. The Veteran contends his hiatal hernia and acid reflux are secondary to his psychiatric condition, to include medications taken for psychiatric treatment. Pursuant to the July 2020 Board remand the Veteran received a VA examination in September 2020. The examiner provided a negative opinion as to secondary service connection but did not address whether the Veteran’s psychiatric medication caused or aggravated his hiatal hernia or acid reflux. Accordingly, remand for an addendum is required. The matters are REMANDED for the following action: 1. Schedule a VA examination to determine the nature and etiology of any current psychiatric disorder that may be present. The examiner must elicit from the Veteran a history of his psychiatric symptoms, to include whether he experienced any symptoms during service. All pertinent evidence of record must be made available to and reviewed by the examiner. Any indicated tests and studies should be performed. The Veteran is competent to attest to observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner must identify all current psychiatric disorders. If any previously diagnosed disorder is no longer present, the examiner must provide an explanation. For each psychiatric disorder identified, the examiner must state whether it is at least as likely as not (a 50 percent or greater probability) that the disorder manifested in or is otherwise related to the Veteran’s military service. A clear rationale for all opinions would be helpful, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 2. Obtain an addendum opinion to determine the nature and etiology of the Veteran’s hiatal hernia and acid reflux. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including a copy of this remand, the Veteran’s service treatment records, post-service medical records, and statements. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. After examining the Veteran—if deemed necessary by the examiner—and considering his pertinent medical history and lay statements regarding his reported symptoms, the examiner should opine as to: (a) Whether it is at least as likely as not (a 50 percent probability or greater) that his hiatal hernia and acid reflux were incurred in, aggravated by, or etiologically related to his military service. (b) Whether it is at least as likely as not (a 50 percent probability or greater) that his hiatal hernia and acid reflux were caused or aggravated by an acquired psychiatric disorder, to include psychiatric medication. Aggravation is defined as any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. The examiner is advised that a finding that a disability was aggravated beyond the normal progression due to a service-connected disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from an already service-connected condition. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. After undertaking any additional development deemed appropriate, and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran’s pending claim in light of any additional evidence added to the record, including the issue of entitlement to service connection for a gastrointestinal condition as secondary to an acquired psychiatric disorder. (Continued on the next page) If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. B. G. LeMoine Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Javed, 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.