Citation Nr: 21027297 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 10-44 380A DATE: May 5, 2021 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to diabetes mellitus type II, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1966 to October 1969. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in August 2010 by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, the Veteran was denied service connection for a gastrointestinal disability in an August 2010 rating decision, and the Veteran perfected an appeal to the Board in November 2010. In May 2017 the Board reopened the claim for service connection for a gastrointestinal disability, to include GERD, and remanded the merits for further development. The appeal was remanded again in April 2018. A November 2019 Board decision subsequently denied the Veteran's claim for service connection for GERD, and the Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). A January 2021 Order of the Court implemented a Joint Motion for Remand (JMR), vacating and remanding the Board's denial of service connection for GERD. In January 2021 correspondence, the Veteran was notified that his appeal had been returned to the Board. The 90-day window for the submission of additional evidence or argument having closed, the Board will proceed with the adjudication of the claim. Clark v. O'Rourke, 30 Vet. App. 92, 9799 (2018). 1. Entitlement to service connection for GERD. In the January 2021 JMR, it was noted that in denying service connection for GERD the Board relied on July 2017 and August 2019 medical opinions. However, the JMR noted that neither opinion addressed an August 2013 agent orange registry examination note which reflects that the Veteran reported that he ate food or drank water that could have been contaminated with herbicide agents. The JMR stated that this raised the question of whether the Veteran's GERD was causally related to herbicide agent exposure, to include through contaminated food or drink. As such the JMR directed that the appeal should be remanded for an addendum opinion addressing the agent orange registry examination note that the Veteran ate food or drank liquids contaminated with herbicide agents. The Board notes that personnel records establish that the Veteran served in Vietnam during the applicable presumptive period, and therefore is presumed to have been exposure to herbicide agents. 38 C.F.R. § 3.307(a)(6)(iii). As such, a remand is warranted to an addendum opinion addressing whether the Veteran's GERD is casually related to herbicide agent exposure. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the examiner who provided the August 2019 VA opinion, or another appropriate medical professional if the examiner is unavailable. The examiner should answer the following: Is it at least as likely as not (a fifty percent probability or greater) that GERD is causally related to the Veteran's active service, to include herbicide agent exposure? Attention is invited to an August 2013 agent orange registry examination noting the Veteran ate foot or drink that could have been contaminated with herbicide agents (labelled "CAPRI" - pg. 1 - uploaded 9/28/13). In providing the requested opinion the examiner should not solely rely on the fact that GERD is not a disability presumed to be causally related to herbicide agent exposure. A detailed rationale for the opinion must be provided. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Wendell, 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.