Citation Nr: A22005243 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 191115-47422 DATE: March 24, 2022 ORDER Service connection for irritable bowel syndrome (IBS) is denied. Service connection for bilateral hearing loss is denied. Service connection for tinnitus is denied. REMANDED Entitlement to service connection for lung cancer, claimed as due to exposure to herbicide agents and/or asbestos, is remanded. Entitlement to service connection for prostate cancer, claimed as due to exposure to herbicide agents, is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD), claimed as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for a back disorder is remanded. FINDINGS OF FACT 1. At no time during the pendency of the claim did the Veteran have a current disability of IBS, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim. 2. Bilateral hearing loss is not shown to be causally or etiologically related to any disease, injury, or incident during service and did not manifest to a compensable degree within one year of separation from active duty. 3. Tinnitus is not shown to be causally or etiologically related to any disease, injury, or incident during service and did not manifest to a compensable degree within one year of separation from active duty. CONCLUSIONS OF LAW 1. The criteria for service connection for IBS have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. 3. The criteria for service connection for tinnitus have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1968 to June 1971. He died in March 2017 and the appellant is his surviving spouse who was accepted as a substitute claimant for the purpose of processing this appeal to its completion in April 2018. By way of background, in a September 2016 rating decision, a Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for a back disorder, prostate cancer, lung cancer, GERD, IBS, bilateral hearing loss, and tinnitus. Following the receipt of a notice of disagreement, the Agency of Original Jurisdiction (AOJ) issued a statement of the case in October 2019. In November 2019, the appellant submitted a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) in which she withdrew her legacy appeal and opted into the modernized appeals system known as the Appeals Modernization Act (AMA). In such submission, she requested a Board hearing before a Veterans Law Judge, which was conducted before the undersigned in August 2021. A transcript of the hearing is associated with the record. Based on the appellant's election, the Board may only consider the evidence of record at the time of the issuance of the decision on appeal, i.e., the statement of the case, on October 8, 2019 and any evidence submitted by the appellant at the hearing or within 90 days thereafter (i.e., by November 10, 2021). In regard to the characterization of the claim for service connection for a back disorder, the Board notes that service connection for such disorder was originally denied in a May 2005 rating decision. However, in the October 2019 statement of the case, the AOJ found that new and material evidence had been received and readjudicated such claim on the merits. As the Board is bound by such favorable finding, the claim will be reviewed on a de novo basis. 38 C.F.R. § 3.104(c). Service Connection Claims Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability"). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the United States Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as organic diseases of the nervous system, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In an October 4, 1995 opinion, VA's Under Secretary for Health determined that it was appropriate to consider high frequency sensorineural hearing loss an organic disease of the nervous system and therefore a presumptive disability. Tinnitus is deemed an organic disease of the nervous system where there is evidence of acoustic trauma. Fountain v. McDonald, 27 Vet. App. 258 (2015). Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz s 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The United States Court of Appeals for Veterans Claims (Court) has held that service connection can be granted for hearing loss where the veteran can establish a nexus between his current hearing loss and a disability or injury he suffered while he was in military service. Godfrey v. Derwinski, 2 Vet. App. 352, 356 (1992). The Court has also held that VA regulations do not preclude service connection for hearing loss which first met VA's definition of disability after service. Hensley, supra, at 159. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.R.F. § 3.102. 1. Entitlement to service connection for IBS, claimed as secondary to service-connected PTSD. The Veteran and appellant allege that he had IBS that was caused or aggravated by his service-connected PTSD. However, upon a review of the record, the Board finds that, as he did not have a current disability of IBS at any point proximate to the pendency of the February 2015 claim, service connection for such disorder is not warranted. In this regard, the Veteran's service and post-service treatment records are silent for a diagnosis of IBS. While VA treatment records dated throughout the appeal period reflect the Veteran's reports that he believed he had IBS, and complaints of diarrhea and constipation which he stated was due to his IBS, no findings or diagnosis referable to IBS were noted. Further, at a September 2016 VA examination, the examiner determined that the Veteran did not have a diagnosis of, or met the criteria for, IBS. Specifically, she indicated that, although there was medical documentation to show that the Veteran had hemorrhoids since 1968, there was no objective findings for complaints of constipation on his separation examination or on subsequent private medical records. Here, the examiner noted that a September 1973 disability evaluation showed no hemorrhoids and a 2005 VA examination revealed that "he gets constipated every now and then. Otherwise, no other problems." Subsequent medical records demonstrated an occasional mention of incontinence of bowel or bladder in relation to the Veteran's complaint of nerve damage due to his back problems and there was a notation of extensive opiod use to assist with pain control starting in 1996. Here, the examiner explained that there was objective evidence to show that long-term opioid use produced constipation as a side effect. She further explained that a 2015 VA examination includes a notation regarding exacerbation of hemorrhoids despite being on medication for constipation and a mention of medication for diarrhea, but the Veteran stated that such was rarely a problem. The examiner reported that the Veteran noted he noticed more problems with his bowels since his diagnosis of lung cancer and subsequent therapies. Thus, the examiner concluded that the Veteran did not meet the criteria for IBS, which was a disorder diagnosed by exclusion of contributing causes (near chronic narcotic use for chronic pain-related disorders). The Board affords great probative weight to the September 2016 VA examination report as such was completed by a trained medical professional who reviewed the record and performed an in-person examination of the Veteran. Furthermore, the examiner considered all of the pertinent evidence of record, to include the Veteran's statements and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). In this regard, the Board acknowledges the Veteran's arguments that the September 2016 VA examiner mischaracterized his use of opioids in a November 2016 written statement. However, his contentions essentially amount to disagreement in the way the September 2016 VA examiner analyzed the evidence in reaching her conclusions, and are not tantamount to an allegation that she is not competent to offer an opinion, or that the opinion itself was inadequate. See Francway v. Wilkie, 940 F.3d 1304, 1307 (Fed. Cir. 2019). Further, the examiner's statements regarding the Veteran's opioid use are supported in the record. In this regard, a November 2002 private treatment record reflects that his current medications included Percocet; a February 2003 private treatment record shows that the Veteran had a prescription of Percocet filled in October, he then ran out, and was requesting a refill; a June 2003 private treatment record indicates that his Percocet was refilled; and a November 2003 private treatment record includes the notation that a Percocet refill was needed. Accordingly, the Board finds the Veteran's arguments are without merit. The Board has considered the Veteran's and appellant's assertions that he had a diagnosis of IBS. While they reported that he self-treated his symptoms of constipation, abdominal pain, bloating, and diarrhea with medication, the diagnosis of IBS is not a simple question that can be determined based on mere personal observations by a lay person and, therefore, their lay testimony is not competent to establish a current disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons are not competent to diagnose cancer); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Therefore, the Board affords the Veteran's and appellant's statements regarding the diagnosis of IBS no probative weight. Consequently, the Board finds that at no time during the pendency of the appeal did the Veteran have a current disability of IBS, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim. See Brammer, supra. Therefore, service connection for such disorder is not warranted. As the evidence of record persuasively weighs against the appellant's claim, the benefit of the doubt doctrine is not applicable and her claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to service connection for bilateral hearing loss. 3. Entitlement to service connection for tinnitus. The Veteran contended that that he had bilateral hearing loss and tinnitus as a result of in-service noise exposure to artillery cannons and Howitzers without hearing protection. As an initial matter, the Board finds that the Veteran has current diagnoses of bilateral hearing loss and tinnitus, as noted at an August 2015 VA examination. 38 C.F.R. § 3.385. Additionally, while his service treatment records (STRs) are negative for any complaints, treatment, or diagnoses referable to bilateral hearing loss and tinnitus, an audiometric testing at entrance revealed normal hearing acuity under American Standards Association (ASA) and International Standards Organization - American National Standards Institute (ISO-ANSI) standards and a whisper voice test at separation showed 15/15, his reported in-service noise exposure is consistent with his military occupational specialty (MOS) as a Field Artillery Rocket Crewman/Cannon Fire Direction Specialist. Thus, the remaining question is whether the Veteran's currently diagnosed bilateral hearing loss and tinnitus are related to his acknowledged in-service noise exposure. In August 2015, following an interview with the Veteran, a review of the record, and audiological evaluation, a VA examiner opined that his bilateral hearing loss and tinnitus are less likely than not caused by or the result of an event in military service/military noise exposure. In support thereof, he reported that whispered voice testing only was done at the Veteran' separation examination in May 1971; however, a questionnaire on that examination asking if the Veteran had hearing loss was marked "no." The examiner further reported that the Veteran's entrance examination in September 1968 indicated normal hearing in both ears, and a September 1973 VA examination recorded no complaint of hearing loss or tinnitus. Additionally, the examiner indicated that the Veteran was in the artillery, but did not serve in Vietnam; rather, he trained in Germany. He further indicated that, as a civilian, the Veteran was mainly a truck driver, but worked in carpentry for a few years and was a mechanic off and on. The Veteran denied using guns recreationally. The examiner noted that the Veteran obtained his first set of hearing aids through VA approximately a year previously despite claiming hearing loss for over forty years. He further noted that the Veteran's hearing sensitivity was worse in the left ear, which was consistent with truck driving as that ear received more exposure to traffic and engine noise. The examiner explained that, although reliable measures of hearing were not done at separation, the Veteran's service records and medical examination two years following his discharge from service found no complaint of hearing problems. Thus, he determined that, based on no evidence or complaint of hearing loss in his service records or soon after leaving service, and the probability of occupational noise, the Veteran's hearing loss was less likely than not caused by noise exposure in service. Further, the examiner indicated that, while the Veteran reported the onset of his tinnitus in service, there was no complaint of tinnitus found in his service records or on medical examination in 1973, and there was no evidence of hearing loss in his service records that would be consistent with the effects of noise. He noted that the Veteran had a long-term history of noise outside of service working as a truck driver, mechanic, and in carpentry. The Board affords great probative weight to the August 2015 VA examiner's opinion as such considered all of the pertinent evidence of record, to include the Veteran's statements and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez, supra; Stefl, supra. Notably, there is no medical opinion to the contrary. The Board acknowledges the appellant's report during the August 2021 Board hearing that she did not notice the Veteran's work environment to be extremely loud. Here, she appears to indicate that she believed the noise exposure the Veteran experienced following service were not of comparable loudness/severity to his in-service noise exposure. Nonetheless, the August 2015 VA opinion does not rely upon any assertion that the Veteran's post-service noise exposure was as loud or as severe as his in-service noise exposure; rather, the opinion relies upon the finding that the Veteran was objectively shown to have retained normal hearing following his in-service noise exposure and his later post-service bilateral hearing loss and tinnitus followed his post-service occupational noise exposure. Here, the Board finds that the August 2015 VA audiologist is competent to characterize work as a truck driver, mechanic, and in carpentry as resulting in probable occupational noise. The Board has also considered the Veteran's and appellant's statements that his bilateral hearing loss and tinnitus are related to his in-service noise exposure; however, as lay people, they have not shown that they had specialized training sufficient to render such an opinion. See Jandreau, supra. In this regard, the etiology of such disorders is a matter not capable of lay observation and requires medical expertise to determine. Specifically, the question of the etiology of such disorders involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship as it requires the administration and interpretation of audiological testing, and knowledge of the impact hazardous noise has on the inner workings of the ear. See Woehlaert, supra. Consequently, the Veteran's and appellant's statements as to the etiology of his bilateral hearing loss and tinnitus are afforded no probative weight. Furthermore, the evidence of record fails to demonstrate that bilateral hearing loss or tinnitus manifested to a compensable degree during or within one year of the Veteran's separation from service. In this regard, his STRs are negative for any complaints, treatment, or diagnosis referable to such disorders. Moreover, at the time of his May 1971 separation examination, his hearing was within normal limits bilaterally as shown by a 15/15 whisper voice test and he denied hearing loss and ear, nose, or throat trouble. Further, a September 1973 VA examination, conducted shortly after the Veteran's discharge from service, specifically reports that hearing loss was not noted and his ears were not unusual. Moreover, the Veteran's post-service treatment records reflect that he first reported ear complaints in September 2013. Thus, while the Veteran reported that his tinnitus started in service at the August 2015 VA examination, such report is contradicted by the foregoing contemporaneous records, which renders such report not credible. Caluza v. Brown, 7 Vet. App. 498, 506 (1995) (VA adjudicators may properly consider internal inconsistency, facial plausibility and consistency with other evidence submitted on behalf of the veteran in weighing evidence); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (lack of corroborating contemporaneous evidence may be a factor in determining credibility). Consequently, in light of the above, the Board finds that the probative evidence demonstrates that bilateral hearing loss and tinnitus did not manifest to a compensable degree during service or within one year of separation from active duty. Therefore, presumptive service connection for bilateral hearing loss and tinnitus is not warranted. Therefore, the Board finds that bilateral hearing loss and tinnitus are not shown to be causally or etiologically related to any disease, injury, or incident during service and did not manifest to a compensable degree within one year of separation from active duty. Therefore, service connection for such disorders is not warranted. In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the evidence of record persuasively weighs against the Veteran's claims for service connection for bilateral hearing loss and tinnitus. As such, that doctrine is not applicable in the instant appeal, and such claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 4. Entitlement to service connection for lung cancer, claimed as due to exposure to herbicide agents and/or asbestos. 5. Entitlement to service connection for prostate cancer, claimed as due to exposure to herbicide agents. Throughout the pendency of the claim, the Veteran contended, as relevant, that his lung and prostate cancers were due to in-service exposure to herbicide agents. As an initial matter, the Board notes that VA treatment records reflect current diagnoses of lung and prostate cancers. Furthermore, such disorders are on the list of diseases presumed to be related to exposure to herbicide agents. However, the Veteran's alleged in-service exposure to herbicide agents has not been verified. In this regard, the Veteran and appellant reported that, while stationed at Fort Ord from September 1968 to December 1968, he was detailed to spray Agent Orange for weed control and clear unwanted vegetation on the perimeter and all the ranges. He indicated that herbicides were stored in warehouses located away from the barracks, in barrels marked with orange and purple stripes, and he never wore any protective gear while spraying. See September 2015 written statement. The Veteran further reported that he as exposed to Agent Orange while stationed at Fort Sill. Here, he explained that he routinely sprayed herbicide agents around the motor pool and perimeter fence as extra duties at such location. See October 2016 notice of disagreement. However, in November 2015, VA's Compensation Service noted that the Department of Defense (DoD) had provided them with a listing of locations outside Vietnam and the Korean DMZ where Agent Orange was used, tested, or stored, and DoD had not identified Fort Ord, California, as such a location. Further, it was noted that Fort Ord was not on any supply line for transporting Agent Orange to or from Vietnam and that the Veteran's references to herbicides were likely to commercial herbicide use. Thus, VA's Compensation Service determined that they could provide no evidence to support the Veteran's claim. Further, a January 2016 response from Joint Services Records Research Center (JSRRC) stated that they coordinated their research with the National Archives and Records Administration (NARA), but the US Army historical records that were available did not document the spraying, testing, transporting, storage, or usage of herbicides, to include Agent Orange, at Fort Ord during the relevant time period. Moreover, a March 2016 response from Armed Forces Pest Management Board indicated that their records showed that neither Agent Orange nor Agent Purple was used, tested, disposed of, transported through, or stored at Ford Ord during the relevant time period. In the instant case, the Board observes that records were only requested from the JSRRC and Armed Forces Pest Management Board regarding the Veteran's potential exposure to Agent Orange while stationed at Fort Ord, but no development was requested regarding his potential use and storage of herbicide agents while stationed at Fort Sill. Here, the Board observes that the Veteran's service personnel records reflect his assignment to Fort Sill in November 1968. Thus, the Board finds a remand is necessary in order to correct a pre-decisional duty to assist error by attempting to verify the Veteran's report in-service exposure to herbicide agents while stationed at Fort Sill. 6. Entitlement to service connection for GERD, claimed as secondary to service-connected PTSD. The Veteran and appellant advanced the narrow theory of entitlement to service connection for GERD as secondary to his service-connected PTSD. They do not contend, and the record does not suggest, that such disorder is otherwise related to his military service. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (2008). As favorably found by the AOJ, the Veteran had a current diagnosis of GERD. See February 2005 and August 2016 VA examinations. Further, he was service-connected for PTSD, and he and the appellant alleged that his gastrointestinal symptoms were exacerbated by any mental health incident, to include stress and anxiety. However, following a review of the record, an interview with the Veteran, and a physical examination, a September 2016 VA examiner opined that the Veteran's GERD was less likely than not proximately due to or the result of his service-connected PTSD. In support of such opinion, she reported that the Veteran was diagnosed with GERD in 2005, but was not on any medication for years and placed on a proton pump inhibitor in 2015. The examiner further reported that there was no objective evidence in the Veteran's STRs to indicate complaints of GERD, or like complaints, and there was no objective evidence in private medical records, until recently, of GERD. She concluded that there was no medical nexus to related GERD to PTSD. However, the Board finds that, as such opinion does not address whether the Veteran's PTSD aggravated his GERD, a remand is necessary to cure such pre-decisional duty to assist error by obtaining an addendum opinion addressing such matter. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (holding that findings of "not due to," "not caused by," and "not related to" a service-connected disability are insufficient to address the question of aggravation under § 3.310(b)). 7. Entitlement to service connection for a back disorder. The Board finds that a remand is necessary in order to correct a pre-decisional duty to assist error by obtaining the Veteran's outstanding Workers' Compensation records pertaining to a post-service back injury. In this regard, in an April 2005 written statement, the Veteran indicated that he had an in-service back injury that was exacerbated by an additional back injury following his discharge from service. He further indicated that X-rays and MRIs related to his most recent back injury determined that he had an old injury to the T-12 vertebra. Additionally, a May 2000 private treatment record indicates that the Veteran underwent a microlumbar discectomy for a Workers' Compensation injury over two years prior; a September 2000 private treatment record reflects that the Veteran had a work-related injury to his back 4 12 years prior; and a November 2002 private treatment record reveals that the Veteran had a long history of low back pain, and he was originally seen for neck and back problems from a Workers' Compensation injury that occurred approximately five years prior. Similarly, during the August 2021 Board hearing, the appellant indicated that: (1) while in service, the Veteran was involved in a motor vehicle accident and injured his back; (2) following his discharge from service, he got hurt at work, which exacerbated his previous back injury and resulted in two back surgeries; and (3) X-rays related to the Veteran's Workers' Compensation injury in the late 1980s/early 1990s showed a pre-existing back disorder. However, no records pertaining to the Veteran's Workers' Compensation claim have been requested or obtained. Thus, as any records in connection with such claim may provide support to the instant claim, a remand is necessary in order to attempt to obtain such records. The matters are REMANDED for the following action: 1. Contact any appropriate source in order to attempt to verify the Veteran's in-service exposure to herbicide agents while stationed at Fort Sill beginning in November 1968 by routinely spraying herbicide agents around the motor pool and perimeter fence as extra duties. In this regard, the AOJ should, if necessary, submit multiple requests covering the relevant time period in 60-day increments. All attempts to verify such exposure should be documented. 2. Any determination pertinent to the Veteran's claim for Workers' Compensation benefits based on a post-service back injury, as well as any medical records relied upon concerning that claim, should be obtained from the Department of Labor or any other appropriate source and associated with the record. 3. Return the record, to include a copy of this Remand, to the September 2016 VA examiner who offered an opinion addressing the etiology of the Veteran's GERD. If she is unavailable, forward the record to an appropriate examiner to offer the requested opinion. Following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not that the Veteran's diagnosed GERD was aggravated by his PTSD. If aggravation is found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. In offering such opinion, the examiner should consider the Veteran's and appellant's statements that his gastrointestinal symptoms were exacerbated by any mental health incident, to include stress and anxiety, and the medial treatise articles cited by the Veteran in his October 2016 notice of disagreement in regard to the correlations between GERD and anxiety/stress, and PTSD and the digestive system. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Department of Veterans Affairs 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.