Citation Nr: 23065835 Decision Date: 12/13/23 Archive Date: 12/13/23 DOCKET NO. 20-21 767 DATE: December 13, 2023 ORDER Entitlement to service connection for gastroesophageal reflux disease (GERD) as secondary to posttraumatic stress disorder (PTSD) is granted. Entitlement to service connection for irritable bowel syndrome (IBS) as secondary to PTSD is granted. Entitlement to service connection for hypertension as secondary to PTSD is granted. REMANDED Entitlement to a rating of total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. Affording the Veteran the benefit of the doubt, his diagnosed GERD is related to his service-connected PTSD. 2. Affording the Veteran the benefit of the doubt, his diagnosed IBS is related to his service-connected PTSD. 3. Affording the Veteran the benefit of the doubt, his diagnosed hypertension is related to his service-connected PTSD. CONCLUSIONS OF LAW 1. The criteria for service connection for GERD as secondary to service-connected PTSD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for IBS as secondary to service-connected PTSD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for hypertension as secondary to service-connected PTSD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Army, on active duty from July 1967 to July 1969. This claim comes before the Board of Veterans' Appeals (Board) on appeal from a March 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2021, the Veteran testified before the undersigned Veterans Law Judge. A transcript of that hearing is of record. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). A disability may also be found service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310. 1. Entitlement to service connection for gastroesophageal reflux disease (GERD) as secondary to posttraumatic stress disorder (PTSD) 2. Entitlement to service connection for irritable bowel syndrome (IBS) as secondary to PTSD 3. Entitlement to service connection for hypertension as secondary to PTSD The Veteran seeks service connection for his GERD, IBS and hypertension, which he contends has been caused or aggravated by his service-connected PTSD. Affording the Veteran the benefit of the doubt, the Board finds that these conditions were caused by his PTSD. As an initial matter, the Board finds that the Veteran has current diagnoses of GERD, IBS and hypertension, as noted in the March 2020 VA examination reports. Moreover, a review of the record indicates that he is service connected for PTSD. Thus, the question before the Board is whether his currently diagnosed conditions are related to his service connected PTSD. In support of his appeal, the Veteran submitted significant evidence, to include private opinions from his treating clinicians. In a private examination, dated March 2017, Dr. J.U. wrote that his predecessor had been treating the Veteran for hypertension during the previous 30 years, and that he had referred him to a psychiatrist, Dr. W.V., for his PTSD symptoms. In reviewing the file, Dr. J.U. wrote that he agreed with Dr. W.V., that his PTSD caused his hypertension. The Veteran also submitted another private opinion dated May 2017, from his treating psychiatrist. Here, Dr. W.V. opined that the Veteran's IBS, hypertension and GERD were all secondary to his diagnosed PTSD. In a separate private opinion dated that month, Dr. E.W. opined that his GERD and IBS were related to his PTSD. Specifically, they wrote that they "agree with the diagnosis of his psychiatrist, [Dr. V.] who has documented that his IBS is secondary to his service-related PTSD." Turning to the negative medical evidence of record, it includes reports from VA examiners dated March 2020. While all three VA opinions confirm the Veteran's diagnoses, each opinion is inadequate for the same reason. Specifically, the VA examiner opined against service connection, noting that his service treatment records are "silent" for the conditions, although his primary claimed disability is service connected. Moreover, each opinion notes only "2 instances found" for IBS, GERD or hypertension in the medical record, and that the VA examiner "instructed [the Veteran] to contact his attorney to ensure that all of his medical records have been submitted to the VA." Due in part to the lack of private medical treatment in the record, the VA examiner opined against service connection. The Board finds these opinions to be of little probative value, as the VA examiner did not acknowledge or discuss the Veteran's private opinions, DBQs and treatment records that are of record. Ultimately, affording the complete benefit of the doubt, the Board finds that the private opinions are more persuasive than the VA opinions of record. In this regard, the private examiners were the Veteran's treating clinicians, and discussed his long-term care over several decades. Further, the VA examiner's opinions were provided without addressing his private opinions, especially that of Dr. W.V. As such, the Board finds that the evidence to be at least in relative equipoise. When the evidence is in equipoise, the Veteran should prevail. As such, the Board finds that the claims should be granted. 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. REASONS FOR REMAND Entitlement to a rating of total disability rating based on individual unemployability (TDIU) With respect to the Veteran's claim for TDIU, because the Board has granted service connection for GERD, IBS and hypertension, the Veteran's disability picture has now changed. Indeed, once the RO effectuates the above order, the Veteran may meet the schedular criteria for TDIU. Therefore, it would be prejudicial to evaluate the Veteran's TDIU claim in the first instance given these changes, and the RO should reevaluate this issue prior to Board consideration. The matters are REMANDED for the following action: The RO should undertake any additional action it deems necessary in order to properly adjudicate the Veteran's claim of entitlement to TDIU, including any additional VA examinations. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. McDonald