Citation Nr: 22013259 Decision Date: 03/09/22 Archive Date: 03/09/22 DOCKET NO. 16-22 759 DATE: March 9, 2022 REMANDED The claim for an initial rating in excess of 20 percent for fibromyalgia is remanded. The claim for an initial rating in excess of 10 percent for irritable bowel syndrome (IBS) is remanded. The claim for service connection for hypertension is remanded. The claim for service connection for diverticulitis is remanded. The claim for service connection for gastroesophageal reflux disease (GERD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from June 1987 to July 1995. The matter is on appeal before the Board from July 2014 and November 2014 rating decisions. The Veteran provided testimony at a May 2019 Board hearing before the undersigned Veteran's Law Judge. A transcript of the hearing is of record. In a September 2019 Board decision, the issue of service connection for GERD was remanded for further development. Additionally, the issues pertaining to increased ratings for fibromyalgia and IBS, and the issues for service connection for hypertension and diverticulitis were denied. The Veteran appealed the denied issues to the United States Court of Appeals for Veterans Claims (Court or CAVC), and in July 2021, the Court issued a Memorandum Decision remanding the issues for further development. The Board notes that the Veteran had also appealed the Board's September 2019 denial for a compensable rating for other specified sexual dysfunction to the Court, however, the Board's denial pertaining to that issue was affirmed in the Court's July 2021 Memorandum Decision. This decision is being written in accordance with the findings from the July 2021 Memorandum Decision. 1. Increased Ratings Fibromyalgia and IBS In the July 2021 Memorandum Decision, the Court noted that the Veteran had reported evidence of worsening symptoms of fibromyalgia and IBS during his May 2019 Board hearing. Thus, the Court found that the Board erred in failing to obtain new examinations to evaluate the current severity of the Veteran's disabilities. As such, the Court remanded the issues for the Board to obtain new examinations. 2. Service Connection Hypertension and Diverticulitis Pertaining to service connection for hypertension and diverticulitis, the Court found the VA medical opinions that the Board relied on in denying the Veteran service connection for hypertension and diverticulitis to be inadequate. In the medical opinion pertaining to diverticulitis, the rationale was based solely upon a lack of documentation of diverticulitis in the Veteran's service treatment records (STRs), which the Court found to be inadequate. In the medical opinion pertaining to hypertension, while the examination noted that the Veteran's hypertension did not onset until 10 years after service, the rationale was based upon the Veteran's STRs being silent on the issue. As there was no further rationale provided, the Court found that the opinion ran afoul of 38 C.F.R. § 3.303(d). In addition, the Court indicated that the medical opinion failed to adequately address whether the Veteran's hypertension resulted from exposures in Southwest Asia. As such, the issues of service connection for hypertension and diverticulitis are remanded to obtain adequate medical opinions. 3. Service Connection GERD The Veteran underwent a VA examination pertaining to his GERD in July 2014, and medical opinions pertaining to direct service connection were rendered in July 2014 and October 2014. In the July 2014 medical opinion, the examiner found that the Veteran's GERD was less likely than not (less than 50 percent probability) incurred in or aggravated by his military service, because the Veteran's STRs were silent for GERD. In the October 2014 medical opinion, the examiner opined that the Veteran's GERD was less likely than not (less than 50 percent probability) incurred in or caused by exposure to environmental hazards in Southwest Asia, because the Veteran's STRs were silent for GERD. Both of the VA medical opinions for direct service connection were based upon a lack of documentation in the Veteran's STRs, which is inadequate. As such, remand is warranted to obtain a VA medical opinion that provides a thorough rationale. In addition, the Veteran submitted a private opinion in August 2019, in which his private physician opined that the Veteran's GERD was likely the result of or related to his military service. However, the Veteran's private physician did not provide any rationale in conjunction with the opinion, and therefore the opinion is insufficient to support the grant of service connection. Nevertheless, it does suggest that the Veteran's GERD may be related to his active military service. As the opinion has not been addressed in any VA medical opinions pertaining to direct service connection, a VA medical opinion that addresses the opinion from the Veteran's private physician is warranted. The Board also notes that in the Veteran's May 2016 Form 9 Appeal to the Board, the Veteran contended that his medications for his service-connected fibromyalgia have affected and aggravated his GERD. While a VA medical opinion pertaining to secondary service connection was rendered in January 2020, it was in relation to the Veteran's GERD being secondary to his IBS. No medical opinions have been provided addressing the Veteran's contention that his GERD is secondary to his fibromyalgia, to include his medications. As such, a VA medical opinion pertaining to secondary service connection between the Veteran's GERD and fibromyalgia should also be obtained on remand. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the current severity of his service-connected fibromyalgia. 2. Schedule the Veteran for a VA examination to determine the current severity of his service-connected IBS. 3. Obtain a VA addendum medical opinion pertaining to the etiology of the Veteran's hypertension. If a physical examination is necessary to answer the Board's questions, one should be scheduled. The examiner should answer the following question: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's hypertension was incurred in or otherwise related to his active military service, to include exposure to environmental hazards while serving in Southwest Asia (the Veteran has reported being exposed to burning tanks, and wearing a gas mask several times in response to chemical and biological weapons alerts)? Why or why not? The examiner should review the July 2021 CAVC Memorandum Decision to understand why previous opinions were inadequate. The examiner should also review the private opinion from August 2019 (Medical Treatment Record - Non-Government Facility received 08/01/2019). 4. Obtain a VA addendum medical opinion pertaining to the etiology of the Veteran's diverticulitis. If a physical examination is necessary to answer the Board's questions, one should be scheduled. The examiner should answer the following question: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's diverticulitis was incurred in or otherwise related to his active military service? Why or why not? The examiner should review the July 2021 CAVC Memorandum Decision to understand why previous opinions were inadequate. 5. Obtain a VA addendum medical opinion pertaining to the etiology of the Veteran's GERD. If a physical examination is necessary to answer the Board's questions, one should be scheduled. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's GERD was incurred in or otherwise related to his active military service, to include exposure to environmental hazards while serving in Southwest Asia (the Veteran has reported being exposed to burning tanks, and wearing a gas mask several times in response to chemical and biological weapons alerts)? Why or why not? The examiner should specifically review the opinion from the Veteran's physician submitted in August 2019 (Medical Treatment Record - Non-Government Facility received 08/01/2019). (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's GERD was caused by his service-connected fibromyalgia, to include as a result of his fibromyalgia medications? Why or why not? (c.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's GERD was aggravated (made worse) by his service-connected fibromyalgia, to include the medication prescribed to treat his fibromyalgia? Why or why not? If aggravation is found, the examiner should identify the baseline level of severity of the Veteran's GERD created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the Veteran's GERD. If such cannot be done, then it should be explained why. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Lutgens-Staley, 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.