Citation Nr: 22019705 Decision Date: 04/02/22 Archive Date: 04/02/22 DOCKET NO. 15-31 109A DATE: April 2, 2022 REMANDED Entitlement to service connection for hiatal hernia is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1988 to January 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a November 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Board dismissed the Veteran's service connection claim as moot. He appealed to the Court of Appeals for Veterans Claims. While pending, in November 2021, the Veteran's attorney and VA's Office of General Counsel filed a Joint Motion for Remand (JMR). The parties agreed that remand was necessary because the Board conflated "whether a claimant can receive a compensation for a disability" with "whether the claimant may be granted service connection for a disability. That same month, the Court vacated the Board's decision and remanded the matter for readjudication consistent with the JMR. 1. Entitlement to service connection for hiatal hernia is remanded. In November 2019, the Veteran underwent a trio of VA examinationsstomach and duodenal, intestinal, and esophageal. There, the medical examiner diagnosed the Veteran with hiatal hernia, relying on an April 2014 upper endoscopy. Despite this, the examiner rendered an unfavorable opinion. She explained that a stomach hernia is "a mechanical problem" involving a compromised diaphragm. Usually, it is from "some physical cause," such as heaving lifting or another activity with repetitive increased intra-abdominal pressure. Medically, it is not "physiologically related to or influenced by" intestinal tract inflammation (IBS), the hepatitis B virus, or environmental hazards in the Southwest Asia theater of operations. Here, the Board finds remand needed for a new medical opinion. For starters, the examiner opines that the Veteran's IBS did not aggravate his stomach hernia beyond its natural progression. The problem is the rationale is about an entirely different service-connected disability (hepatitis B). So, although her conclusion is clear (no aggravation), she offers no supporting data or a reasoned explanation for it. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Even then, she provides the same rationale that she did for causation, even though the two are distinct inquiries. Atencio v. O'Rourke, 30 Vet. App. 74, 91 (2018). She does not explain how and why the same rationale can be applied to both. Finally, the examiner opines that it is "very unlikely" that the Veteran's stomach hernia is from military environmental exposure in Southwest Asia. She does not elaborate why, leaving the Board with no way to understand how she arrived at that conclusion. As a result, the Board must remand for a medical opinion that corrects these deficiencies. The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records and associate them with the claims file. 2. Then, arrange for an appropriate healthcare provider to review the Veteran's claims file and provide an opinion on whether the Veteran's hiatal hernia had its clinical onset during service or is due to an event or incident of the Veteran's period of active service, including military environmental exposure in Southwest Asia. In the opinion, the examiner should address the Veteran's contention that his stomach problems are from taking pyridostigmine bromide (PB) bills during service. If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. If not, arrange for an appropriate healthcare provider to review the Veteran's claims file and provide an opinion on whether the Veteran's hiatal hernia was (A) caused or (B) aggravated beyond its normal progression by his service-connected IBS, GERD, or HBV. Aggravation means an increase in disabilityany additional impairment of earning capacityof the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 4. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran's pending claim in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. Mike Sobiecki Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Canedy, 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.