Citation Nr: 22016404 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 09-30 642 DATE: March 22, 2022 REMANDED Service connection for a gall bladder disorder, to include as due to stress and radiation exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from July 1957 to July 1960. The matter is on appeal before the Board from a February 2010 rating decision. The Veteran provided testimony at a hearing before a Veterans Law Judge in December 2011. A transcript of the hearing is of record. In August 2014, the Veteran was notified that the Veterans Law Judge who presided over his December 2011 Board hearing was no longer employed at the Board. The Veteran was provided the option to have an additional hearing before another Veterans Law Judge. In August 2014, the Veteran replied to the notification stating that he did not wish to participate in a second hearing before another Veterans Law Judge. The Veteran's appeal was denied by the Board in August 2013. The Veteran appealed the August 2013 Board decision to the United States Court of Appeals for Veterans Claims (Court), and in July 2014 a Joint Motion for Remand (JMR) was rendered. In accordance with the findings from the July 2014 JMR, the Board has remanded the appeal for further development in September 2014, December 2016, and February 2020. The Board notes that a claim for service connection for Barrett's esophagus was initially a part of the appeal. However, service connection for Barrett's esophagus was granted in a November 2021 rating decision, which is a full grant of the benefit sought on appeal. As such, the issue of service connection for Barrett's esophagus is no longer before the Board for consideration. 1. Service Connection Gall Bladder Disorder In the February 2020 Board remand, the Board noted that the claim had been remanded to obtain VA examinations and opinions on several occasions between 2012 and 2016. Unfortunately, these examinations and opinions were previously found to be inadequate. Thus, pursuant to VHA Directive 1602 (Feb. 19, 2016), the Board referred these claims in May 2018 for an expert medical opinion on the etiology of the Veteran's gallbladder disorder. An opinion from a gastroenterologist was rendered in December 2019, however, it too was found to be inadequate. The Board explained in the February 2020 remand, that while the medical expert offered opinions on some of the questions the Board posed in its December 2019 Request for Specialist's Opinion, the specialist had based one of his opinions on an inaccurate factual premise and refrained from answering another on the basis that he could not find the evidence to which the Board referred. Thus, the Board remanded the issue to obtain an addendum medical opinion from the same specialist that provided the December 2019 opinion. However, while on remand an opinion was not obtained from the specialist that provided the December 2019 opinion, nor was an addendum opinion obtained from a different specialist with a similar background in gastroenterology. Rather, a medical opinion was obtained from a general practice nurse practitioner, which is not in accordance with either the Board's February 2020 remand directives or the July 2014 JMR. As such, an additional remand is required to obtain an addendum medical opinion from a specialist in gastroenterology that is in accordance with the February 2020 remand directives, the Request for Specialists Opinion, and the July 2014 JMR. The matters are REMANDED for the following action: 1. Pursuant to VHA Directive 1602 (Feb. 19, 2016), return this case to the specialist who provided a written opinion in December 2019 (Dr. A. B, physician, gastroenterology and hepatology, Louis Stokes Cleveland VAMC). If Dr. A.B. is unable to provide an addendum medical opinion, then an addendum medical opinion should be obtained from another specialist in gastroenterology. The specialist should answer the following questions: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's gallbladder disease first manifested during, or is otherwise related to, his active military service, including the Veteran's claimed radiation exposure and stress? Why or why not? The specialist should review the July 2014 JMR, the September 2014 and December 2016 Board remands, and the Request for Specialists Opinion from December 2, 2019, which is listed as BVA letter. Then the specialist should revise the prior December 2, 2019 medical opinion (also listed as BVA letter) in light of the following evidence, and specifically indicate whether the following facts change the prior opinion. (1) The Veteran was slim, not obese, when he was diagnosed with gallbladder disease; and (Continued on the next page) (2) The Veteran was seen for chest pain in 1969 and 1970 and a sore throat in 1972; and (3) Beginning in 1977, the Veteran was seen for chest pain, a heavy feeling in his chest, a hurting chest, a sore tongue, an upset stomach, and diarrhea. 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.