Citation Nr: A25035480 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 240130-412529 DATE: April 17, 2025 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from March 1991 to December 1999 and from March 2005 to August 2005. This case comes before the Board of Veterans' Appeals (Board) from a January 2024 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that on his January 2024 Notice of Disagreement (VA Form 10182) the Veteran listed issues other than entitlement to service connection for GERD and hypertension. However, those issues were adjudicated by the Board in two decisions issued in January 2025 and are not currently before the Board. ? 1. Entitlement to service connection for GERD is remanded. The Veteran asserted on his August 2022 claim form that he is entitled to service connection for GERD as secondary to his service-connected post-traumatic stress disorder (PTSD). A VA physician reviewed the Veteran's records in September 2022. The VA examiner opined that the Veteran's GERD is less likely than not proximately due to or the result of his service-connected PTSD. However, the VA clinician did not address the question of aggravation and therefore the Board finds that the VA opinion is insufficient. Accordingly, the Veteran's claim must be remanded for a new medical opinion. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007) (once VA undertakes to provide an examination, it must provide an adequate one). This is so because the RO's failure to ensure that the opinion obtained was adequate to rely upon for adjudication purposes constitutes a pre-decisional duty to assist error and remand is therefore required for correction of such error. See 38 C.F.R. § 20.802. The Board also notes that a January 1994 service treatment record (STR) indicates that the Veteran experienced heartburn during service. No medical opinion was obtained regarding whether the Veteran's current GERD is due to service. This was also a pre-decisional duty to assist error, and such an opinion must be obtained. 2. Entitlement to service connection for hypertension is remanded. The Veteran asserted on his August 2022 claim form that he is entitled to service connection for hypertension as secondary to his service-connected PTSD. The VA physician who reviewed the Veteran's records in September 2022 opined that the Veteran's hypertension is less likely than not proximately due to or the result of his service-connected PTSD. However, the VA physician did not provide a coherent opinion regarding whether the Veteran's PTSD aggravates his hypertension disability. First she said that increased stress and anxiety "can" likely aggravate his hypertension, but then she went on to say that PTSD "may" aggravate the Veteran's hypertension. The Board notes that the opinion is speculative. Speculative language is not enough for VA benefits purposes. See Polovick v. Shinseki, 23 Vet. App. 48, 54 (2009). Accordingly, the Board finds that the RO's failure to ensure that the opinion obtained was adequate to rely upon for adjudication purposes constitutes a pre-decisional duty to assist error and remand is therefore required for correction of such error. See 38 C.F.R. § 20.802. The Board also notes that the STR indicate that the Veteran had a number of elevated blood pressure measurements (diastolic of 90mm or higher) during service. No medical opinion has been obtained regarding whether the Veteran's current hypertension first developed during service or as a result of service. This was also a pre-decisional duty to assist error and an opinion regarding the etiology of the Veteran's hypertension must be obtained The matters are REMANDED for the following action: 1. Provide the Veteran a VA GERD examination. After reviewing the claims file and examining the Veteran the examiner should respond to the following: (a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's GERD first developed during service, or is otherwise due to service? In providing this opinion, the examiner should discuss the Veteran's in-service complaints of heartburn in January 1994. (b.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's GERD disability has been aggravated by his service-connected PTSD? If aggravation is found, the examiner should identify, to the extent possible, the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to the Veteran's service-connected disability. 2. Provide the Veteran a VA hypertension examination. After reviewing the claims file and examining the Veteran the examiner should respond to the following: (a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's hypertension first developed during service, or is otherwise due to service? In providing this opinion the examiner should discuss the Veteran's in-service elevated blood pressure measurements. (b.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's hypertension disability has been aggravated by his service-connected PTSD? If aggravation is found, the examiner should identify, to the extent possible, the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to the Veteran's service-connected disability. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jones, R. E. 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.