Citation Nr: 23019596 Decision Date: 03/29/23 Archive Date: 03/29/23 DOCKET NO. 19-12 319A DATE: March 29, 2023 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for a gastroesophageal disorder, variously diagnosed as gastroesophageal reflux disorder (GERD), hiatal hernia, and gastritis is remanded. REASONS FOR REMAND The Veteran serve on active duty from February 1999 to October 2004. This matter comes to the Board of Veterans' Appeals (Board) from a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for an acquired psychiatric disorder The Veteran contends that service connection is warranted for an acquired psychiatric disorder. Specifically, the Veteran contends that her acquired psychiatric disorder onset during active duty and has continued to the present. See May 2019 VA Form 9. In January 2005, the Veteran underwent a Mental Disorders (Except PTSD and Eating Disorders) Examination, at which time an examiner noted, in relevant part, a diagnosis of anxiety. The examiner concluded that the Veteran's primary source of her psychological distress was her relationship with her husband. The examiner stated that there was no direct relationship between the cause of her depressive and anxiety symptoms and her service. Additionally, the examiner concluded that there was no evidence that the Veteran's military service contributed to or exacerbated her depressive and anxiety symptoms. In August 2018, the Veteran underwent a Mental Disorders (Other than PTSD and Eating Disorders) Disability Benefits Questionnaire (DBQ), at which time an examiner noted that the Veteran had a diagnosis of unspecified depressive disorder. The examiner opined that it was less likely than not that the Veteran's acquired psychiatric disorder was caused by or a result of service. The examiner reasoned that the primary source of the Veteran's psychological distress is her relationship with her husband, consistent with the opinion rendered in January 2005. The examiner also reasoned that there was no direct relationship between the cause of her depressive and anxiety symptoms and her military service. The examiner further noted that according to peer-reviewed medical literature, risk factors for the Veteran's mood disorders (depression) include childhood trauma-witnessing domestic violence, stressful circumstances during childhood, parent's divorce and withholding of financial support by her father, stressful life events, infidelity by her spouse, lack of support by her spouse, continued marital problems and lack of social supports. The examiner further reported that there was no military stressor or military risk factors identified. The Board finds that the opinions of record are inadequate as they did not fully consider the Veteran's lay statements of record regarding the onset and continuity of the Veteran's symptoms. In this regard, the Veteran has identified that she experienced a stressful incident in service, to specifically include that she was assigned to checking IDs at Barksdale Air Force Base and did not believe that she was adequately protected during a presidential visit. The Veteran also acknowledged that while she had marital issues, this was not the only reason for her diagnosis. Remand is necessary. 2. Entitlement to service connection for a gastroesophageal disorder, to include gastroesophageal reflux disorder (GERD), hiatal hernia The Veteran contends that service connection is warranted for a gastroesophageal disorder. Specifically, the Veteran contends that her digestive issues onset during service and have continued to the present. See May 2019 VA Form 9. In September 2018, the Veteran underwent an Esophageal Conditions DBQ, at which time a VA examiner noted a diagnosis of GERD. At the time of the examination, the Veteran stated that during service, in 2004, she started complaining about vomiting and that she was told that it was likely related to her pregnancy. The examiner opined that it was less likely than not that the Veteran's esophageal condition was caused by or related to active service. The examiner reasoned that the Veteran's service treatment records did not include any complaints, diagnosis, or treatment for an esophageal condition. The examiner also stated that the Veteran's separation examination, dated March 2014, was also silent for the condition. Additionally, the examiner stated that the Veteran was officially diagnosed with the condition ten years after she was released from service after an esophagogastroduodenoscopy (EGD) was performed in March 2014. The Board finds that the opinion of record is inadequate as it did not fully consider the Veteran's lay statements of record regarding the onset and continuity of the Veteran's symptoms. Furthermore, the Board notes that the examiner heavily relied on the absence of the contemporaneous medical evidence establishing a chronic diagnosis to support negative nexus opinions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008); Buchanan v. Nicholson, 451 F. 3d 1331, 1336-37 (Fed. Cir. 2006); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2010); Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007). Accordingly, the Board finds the claim must be remanded so that the RO can obtain a new medical opinion that addresses whether the Veteran's claimed disability is directly related to service. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records dated September 2018 to Present. 2. Contact the Veteran and request that he identify and/or submit outstanding medical records pertaining to treatment for any of the disabilities on appeal. If indicated, the Veteran should be asked to provide the necessary authorization so VA can attempt to obtain these records. The Veteran should be notified of all efforts to obtain such records. 3. Schedule the Veteran for an examination to determine the nature and etiology of any current acquired psychiatric disorder/s, to include major depressive disorder. The claims file must be made available to the examiner, and the examiner must specify in the examination report that these records have been reviewed. The examiner must then respond to the following: (a) Clarify any current diagnosis related to the Veteran's mental health. (b) Opine as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any of the Veteran's acquired psychiatric disorder(s) were incurred in or are otherwise related to his service. The examiner must provide a rationale for any opinion expressed, based on the examiner's clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate. If any opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. . 4. Schedule the Veteran for an examination to determine the nature and etiology of any current esophageal condition, to include GERD and hiatal hernia. The examiner is asked to review the claims file and respond to the following: (a) Clarify any current diagnosis related to the Veteran's esophageal system, to include GERD, hiatal hernia, and gastritis. (b) Opine as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any of the Veteran's esophageal disorder(s) were incurred in or are otherwise related to his service. In doing so, the examiner must consider the Veteran's lay statements of record. The examiner must provide a rationale for any opinion expressed, based on the examiner's clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate. If any opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 5. Readjudicate the matter. TIFFANY HANSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T.H. 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.