Citation Nr: 22014553 Decision Date: 03/14/22 Archive Date: 03/14/22 DOCKET NO. 18-19 101 DATE: March 14, 2022 REMANDED Entitlement to service connection for a stomach disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from April 1965 to October 1968. In June 2019, the Board remanded the above issue for additional development. The claim was again remanded in September 2021 to obtain an adequate VA medical opinion. The claim now returns to the Board. Entitlement to service connection for a stomach disorder is remanded. The Veteran contends that his stomach disorder is related to service. Although the Board regrets the additional delay, the Veteran's claim must be remanded before the Board is able to make a determination on the merits. As an initial matter, the Veteran has been diagnosed with hiatal hernia, gastroesophageal reflux disease (GERD), Barrett's esophagus, and antral gastritis. See December 2021 VA addendum. The Veteran was provided a VA examination and medical opinion in October 2021. The examiner, a nurse practitioner, opined that a nexus had not been established. The examiner noted that during service, gastroenteritis and right lower quadrant abdominal pain was acute only, and there was no evidence of chronicity of care and the symptoms were subjective only. The examiner also provided an opinion that the Veteran's hiatal hernia, GERD, and Barrett's esophagus was related to Agent Orange exposure. The examiner noted the Veteran had no issues related to the claimed stomach conditions to include GERD, hiatal hernia, or Barrett's esophagus prior to military service and there was evidence of chronicity and therefore a nexus had been established. The Board finds that each of the medical opinions are inadequate. The October 2021 opinions are contradictory as the examiner found no evidence to support chronicity of symptoms in the opinion for direct service connection but, within the opinion for secondary service connection, found evidence of chronicity of symptoms. Thus, the opinions are inadequate. An addendum was provided in December 2021. The examiner, a physician's assistant, indicated that the opinions rendered in October 2021 should be disregarded. She stated that review of the service treatment records showed the Veteran had an acute viral gastroenteritis in January 1966. It was noted that gastroenteritis is an intestinal condition, not a stomach condition, and there was no further medical evidence to suggest stomach issues during service. The examiner opined that none of the conditions diagnosed, including hiatal hernia, GERD, Barrett's esophagus, and antral gastritis, were related to service and therefore it was less likely as not that any diagnosed stomach disorder had its onset in, or is otherwise related to, the Veteran's service. The examiner also opined that none of the conditions were due to Agent Orange exposure. The examiner found that a thorough review of the medical literature failed to demonstrate a causal relationship between Agent Orange exposure and hiatal hernia, GERD, and Barrett's esophagus. Therefore, the Veteran's conditions were less likely as not due to Agent Orange exposure. The Board finds that the December 2021 opinion is inadequate because it gives conclusory opinions without providing sufficient rationales and explanations for their opinions. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Additionally, the examiner did not address service treatment records documenting abdominal pain right lower quadrant in January and March 1967 and diagnosis for gastroenteritis in January 1966 as specifically requested in the September 2021 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Also, the examiner did not address the Veteran's lay statements and other evidence regarding the onset and continuity of his symptoms. Accordingly, a remand is necessary. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The matter is REMANDED for the following action: 1. Ensure all outstanding VA treatment records are associated with the claims file. 2. Provide the Veteran with a VA opinion by an appropriate examiner to determine the nature and etiology of any currently diagnosed stomach disorders, to include GERD, hiatal hernia, and Barrett's esophagus. The claims file, and a copy of this Remand, must be made available to and be reviewed by the examiner. After a thorough review of the record, the examiner is asked to respond to the following: (a) Identify all currently diagnosed stomach disorders, to include GERD, hiatal hernia, Barrett's esophagus, and antral gastritis. (a) Provide an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that any diagnosed stomach disorder, to include GERD, hiatal hernia, Barrett's esophagus, and antral gastritis had its onset in, or is otherwise related to, the Veteran's active service. In rendering the opinion, the examiner must specifically consider and discuss the Veteran's service treatment records documenting abdominal pain right lower quadrant in January and March 1967 and diagnosis for gastroenteritis in January 1966. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. (Continued on the next page) 3. Thereafter, readjudicate the claim on appeal. Richard Kettler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Moldawer, 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.