Citation Nr: 21025698 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 15-10 115 DATE: April 28, 2021 REMANDED Service connection for hiatal hernia and gastroesophageal reflux disability, to include as due to an undiagnosed illness, is remanded. Service connection for a migraine and tension headache disability, to include as due to an undiagnosed illness, is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Navy from September 1982 to August 1986 and in the United States Army from November 1990 to June 1991. These matters come to the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter is being adjudicated under the legacy appellate framework. The Veteran testified at a personal hearing before the Board in June 2018, and a transcript of hearing is of record. The Board disposed of these matters in August 2018. In April 2020, the Court of Appeals for Veterans Claims (Court) vacated the Board’s disposition and remanded the matter back to the Board for further consideration. In November 2020, the Board remanded these matters for further development. Unfortunately, further development must be conducted prior to disposition of these claims. 1. Service connection for hiatal hernia and gastroesophageal reflux disability, to include as due to an undiagnosed illness, is remanded. 2. Service connection for a migraine and tension headache disability, to include as due to an undiagnosed illness, is remanded. At issue is whether the Veteran is entitled to service connection for hiatal hernia and gastroesophageal reflux disability as well as migraine and tension headache disability. Unfortunately, these matters must be remanded again for further development. In November 2020, the Board remanded these matters for new examinations. The Veteran was provided new esophageal and migraine examination in January 2020. Both examinations indicated that the Veteran’s claimed conditions were more likely due to the Veteran’s history of tobacco use rather than an in-service incurrence. The Veteran may not be granted service connection on a direct basis for diseases or disabilities caused tobacco use. 38 C.F.R. § 3.300. Service connection may be granted on a secondary basis, however, is tobacco use served as a linking condition between a previously service-connected acquired psychiatric disorder and a claimed disability. VAOPGCPREC 6-2003 (October 28, 2003). The Veteran has been granted service connection for a number of disabilities including for posttraumatic stress disorder (PTSD). See January 2016 Rating Decision Code Sheet. Once VA undertakes the effort to provide the Veteran with an examination, it must provide the Veteran with an adequate one, and an adequate examination is sufficiently detailed in order to ensure that VA’s evaluation of the Veteran’s claim is fully formed. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, these matters must be remanded in order to provide a VA examination addressing these concerns.   The matters are REMANDED for the following action: Arrange to provide the Veteran with a VA examination in order to discuss the following: (a.) Is it at least as likely as not (50 percent or more) that the Veteran’s hiatal hernia and gastroesophageal reflux disability is proximately due to or aggravated by a previously service-connected disability? Why or why not? (b.) If the Veteran’s hiatal hernia and gastroesophageal reflux disability was aggravated by a previously service-connected disability, then please estimate the baseline severity of the Veteran’s hiatal hernia and gastroesophageal reflux disability but for the aggravating effects. Please offer a rationale for the estimate. (c.) Is it at least as likely as not (50 percent or more) that the Veteran’s migraine and tension headache disability is proximately due to or aggravated by a previously service-connected disability? Why or why not? (d.) If the Veteran’s migraine and tension headache disability was aggravated by a previously service-connected disability, then please estimate the baseline severity of the Veteran’s migraine and tension headache disability but for the aggravating effects. Please offer a rationale for the estimate. (e.) Is it at least as likely as not (50 percent or more) that any of the Veteran’s service-connected disabilities caused the veteran to use tobacco products after service? Why or why not? (f.) What is the medical significance, if any, of pertinent medical literature suggesting a connection between PTSD and smoking to include: Brett Froeliger, Jean Crowell Beckham, Michelle Feldman Dennis, Rachel Victoria Kozink, and Francis Joseph McClernon, Effects of Nicotine on Emotional Reactivity in PTSD and Non-PTSD Smokers: Results of Pilot fMRI study, Advances in Pharmacological and Pharmaceutical Sciences (June 3, 2012)? Why? (g.) Is it at least as likely as not (50 percent or more) that the use of tobacco products a substantial factor in causing the Veteran’s hiatal hernia and gastroesophageal reflux disability? Why or why not? (h.) Is it at least as likely as not (50 percent or more) that the use of tobacco products a substantial factor in causing the Veteran’s migraine and tension headache disability? Why or why not? (i.) Is it at least as likely as not (50 percent or more) that, but for, the use of tobacco products the Veteran’s hiatal hernia and gastroesophageal reflux disability would not have occurred? Why or why not? (j.) Is it at least as likely as not (50 percent or more) that, but for, the use of tobacco products the Veteran’s migraine and tension headache disability would not have occurred? Why or why not? (k.) Please provide a baseline estimate of the severity of the Veteran’s hiatal hernia and gastroesophageal reflux disability absent any aggravating effects of tobacco use? Why? (l.) Please provide a baseline estimate of the severity of the Veteran’s migraine and tension headache disability absent any aggravating effects of tobacco use? Why? DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Seaton 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.