Citation Nr: 21023001 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 15-28 094 DATE: April 19, 2021 REMANDED Entitlement to service connection for acid reflux, to include as secondary to treatment for service-connected disabilities is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from May 1974 to May 1977. The matter is before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision. In December 2018, a videoconference hearing was held before the undersigned; a transcript is in the record. In November 2019 and November 2020, the case was remanded to the agency of original jurisdiction (AOJ) for further development. Entitlement to service connection for acid reflux, to include as secondary to treatment for service-connected disabilities. The Veteran’s primary theory of entitlement to service connection for acid reflux is one of secondary service connection (either as due to medication taken in treatment for service-connected disabilities, or as due to obesity as an intermediate step between the service-connected disabilities and acid reflux.) Unfortunately, there has not been substantial compliance with the Board’s previous remand directives, and another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The November 2020 Board remand requested a medical opinion (with rationale) addressing whether the Veteran’s acid reflux disease was caused or aggravated by his service-connected disabilities (to include as due to prescribed medication taken for any of the disabilities, and also due to obesity as an intermediate step between the acid reflux and the service-connected disabilities). The November 2020 remand directed the examiner to opine whether the Veteran’s acid reflux was caused or aggravated by his newly service-connected disabilities (sleep apnea, left shoulder, and left and right knee (right with shin splints) disabilities), effective from 2011. In a December 2020 Disability Benefits Questionnaire (DBQ), the provider opined that the Veteran’s acid reflux disease is unrelated to his service. Citing to medical literature, he stated that sertraline (a medication for depression) is not a risk factor for gastroesophageal reflux disease (GERD) and was not known to cause relaxation of the lower esophageal sphincter (LES). He also opined that the Veteran’s obesity did not cause his GERD symptoms. While he indicated that ingestion of food triggers as a nonservice-related etiology for GERD, he did not discuss whether the acid reflux was caused or aggravated by his service-connected disabilities (specifically those for which service connection was granted, effective from 2011). Therefore, a remand for an addendum opinion is necessary. The matter is REMANDED for the following: 1. Arrange for the Veteran’s record to be forwarded to the December 2020 consulting provider for re-review and an addendum medical opinion regarding the etiology of his acid reflux and specifically whether it is secondary to (was caused or aggravated [the opinion must address aggravation] by) his service-connected disabilities (including those for which service-connection was granted, effective from 2011), to include as due to medication taken for treatment of those additional service-connected disabilities. The opinion should include responses to the following: (a.) Identify the likely etiology for the Veteran’s acid reflux (or GERD). Specifically, is it at least as likely as not (a 50% or better probability) that it was caused or aggravated by any of his (now) service-connected disabilities (to include as due to prescribed medication taken for any of the disabilities)? (b.) If the acid reflux is found to not have been caused or aggravated by the service-connected disabilities, identify the etiology (if any exists other than ingestion of food triggers) for the acid reflux that is considered to be more likely, and explain why that is so. All opinions must include rationale that cites to supporting factual data and medical principles. If an opinion sought cannot be provided with resort to mere speculation, there must be explanation why resort to speculation is necessary. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Chu, 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.