Citation Nr: 21042157 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 15-06 694A DATE: July 12, 2021 REMANDED Entitlement to an initial increased rating in excess of 10 percent for gastroesophageal reflux disorder (GERD) with fatty liver hepatomegaly is remanded. Entitlement to a total disability based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from June 1981 to March 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2010 rating decision letter issued by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to an initial increased rating in excess of 10 percent for GERD with fatty liver hepatomegaly is remanded. The issue last appeared before the Board in December 2020, at which time the issues were remanded to assess the severity level and manifestations of the Veteran's service connected GERD, including asking the examiner to determine whether the Veteran experiences severe frequent gall bladder attacks and t consideration the VA treatment records that show that the Veteran experiences nausea and dizziness related to his service-connected GERD. The examiner was also asked to differentiate between gastric or esophageal symptoms attributable to the service-connected GERD and those symptoms attributable to the nonservice-connected disabilities. The Veteran underwent such examination in January 2021 at which time the examiner confirmed a diagnosis of GERD with fatty liver/hepatomegaly. The examiner indicated that the Veteran has acid in his stomach, has regurgitation with pain in the chest, has to watch what and when he eats, and sleeps with his head raised and that his treatment plan includes taking continuous medication. The examiner further indicated that the Veteran has symptoms of reflux, regurgitation, sleep disturbances caused by esophageal reflux four or more times per year for an average duration of less than one day. However, the examiner failed to notate any further symptoms, including nausea or dizziness and in so doing failed to discuss such symptoms as noted in the Veteran's medical records. Hence, the Board finds the examination is inadequate as the examiner failed to address the Veteran's symptoms as noted in the treatment records and as directed to discuss in the December 2020 Board remand, which fails to describes the disability in sufficient detail. An opinion is adequate where it is based upon consideration of the Veteran's prior medical history and examinations and also describes the disability in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one. D'Aries v. Peake, 22 Vet. App. 97, 104 (2008). Finally, a June 2021 opinion reflecting that the examiner provided a negative opinion of the condition's relationship to the Veteran's military service and noted no evidence of GERD symptoms has been associated with the claims file that has not first been reviewed by the RO. Additionally, the Board notes that the Veteran is already service connected for the condition and such opinion is not on point with the current evidence of record nor stage in the appeal. Hence, remand is appropriate to obtain an adequate examination. 2. Entitlement to a TDIU due to service-connected disabilities is remanded. The Board finds that the issue of entitlement to TDIU remains inextricably intertwined with the increased evaluation claim for GERD. The matters are REMANDED for the following action: 1. Obtain any updated treatment records and associate those records with the claims file. 2. Forward the claims file to the examiner that performed the January 2021 VA examination, or appropriate clinician, including a copy of this REMAND. If upon review of the claims file, the examiner determines that an in-person examination is necessary, the Veteran should be afforded a VA examination to ascertain the current severity and manifestations of his service-connected GERD. 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. The examiner should report all signs and symptoms necessary for rating the disability. In particular, he or she should address whether there is persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. The examiner should also indicate whether the Veteran experiences severe frequent gall bladder attacks. It should be considered that VA treatment records show the Veteran experiences nausea and dizziness related to his service-connected GERD. See November 2016 and March 2020 VA treatment records. To the extent possible, the examiner should differentiate between gastric or esophageal symptoms attributable to the service-connected GERD and those symptoms attributable to the Veteran's nonservice-connected disabilities. A complete rationale for all opinions is required. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Alli, 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.