BVA9422815 DOCKET NO. 93-01 234 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for a stomach disability secondary to medication taken for service connected left knee and ankle disabilities. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD James L. March, Associate Counsel INTRODUCTION The veteran had active service from October 1959 to November 1965. This appeal comes to the Board of Veterans' Appeals (Board) on appeal of a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. CONTENTIONS The veteran contends that he has a stomach disability which is attributable to the medication he takes for his service-connected disorders. DECISION OF THE BOARD The Board in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence supports the claim for secondary service connection for stomach disability. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appeal has been obtained. 2. The veteran's left knee and left ankle disabilities are service connected. 3. The veteran has stomach disability which was caused by the medication he was taking for his service-connected disabilities. CONCLUSION OF LAW Stomach disability is proximately due to or the result of service-connected disabilities. 38 C.F.R. § 3.310(a) (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, the Board finds that the appellant's claim is plausible and capable of substantiation, and thus well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). When an appellant submits a well-grounded claim, VA must assist him in developing facts pertinent to that claim. Id. The Board is satisfied that all relevant evidence has been obtained and that no further assistance to the veteran is required to comply with 38 U.S.C.A. § 5107(a). In this case, there is no argument that stomach disability should be service connected on other than a secondary basis. For secondary service connection to be granted, it must be shown that the disability for which the claim is made is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). In determining whether service connection is warranted for disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet.App. 49 (1990). The veteran has been granted service connection for postoperative residuals of left medial meniscectomy with traumatic arthritis and residuals of left ankle injuries. The record reflects that the veteran was treated over a period of years with nonsteroidal anti-inflammatory drugs (NSAID's), including aspirin, Zyloprim, Ecotrin, and Motrin. In July 1991, the veteran's representative submitted this claim. He alleged that because of the medication the veteran was required to take for pain, he had developed a stomach disorder. Submitted with the claim were reports from Southwest Florida Regional Medical Center dated in August 1990. The veteran complained of acute chest pain. A. Joseph Piccola, M.D., noted that he had treated the veteran for many years for significant GI symptoms. The diagnoses included chest pain secondary to reflux esophagitis and hiatus hernia. Also received was an August 1990 clinic record from Dr. Piccola concerning the veteran. It was noted that the major reason for most of the veteran' gastric acidity and problems with reflux was the recent addition of Motrin to his treatment program. A September 1990 letter from Dr. Piccola indicated that the veteran had been taking NSAID's for his ankle and knee disabilities. He stated that the veteran was unable to take any NSAID's because of severe esophagitis. An August 1991 letter was received from Robert B. Maggiano, D.O., of Dr. Piccola's office. He stated that the veteran had been taking NSAID's, and that this had aggravated his hiatal hernia and esophagitis. In his notice of disagreement, the veteran stated that he was not seeking service connection for hiatal hernia or esophagitis, but instead he was requesting service connection for a stomach disorder. Medical reports dated in February 1992 from John C. Kagan, M.D., indicate that the veteran had a problem with his stomach lining while on Motrin. Dr. Kagan treated the veteran for left shoulder pain. A February 1992 medical report from Dr. Piccola indicates that the veteran complained of some diarrhea and an upset stomach. It was noted that the veteran was placed on Cortisone, which was contributing to his stomach problem. The impression was gastritis, probably secondary to Prednisone along with possible viral gastroenteritis. VA medical records dated in March 1992, concerning treatment for his left knee disability, indicate that the veteran could not take NSAID's. In April 1992, a hearing was held before a hearing officer at the RO. The veteran test,ified that he had started taking Motrin for his service-connected disabilities approximately four to five years earlier. He indicated that after taking it for about one to two years, his stomach became upset. He and his spouse alleged that Dr. Piccola stated that the veteran's stomach lining had been destroyed because of the Motrin. In May 1992, a VA medical examination was conducted. The veteran complained of recurrent stomach pain which was present most of the time. The examination revealed tenderness in the mid- epigastric area. An upper-GI examination revealed a normal esophagus, with no apparent hiatal hernia or reflux. Similarly, examination of the stomach showed no abnormality; however, the duodenal bulb was irritable, and there was some deformity along the lesser curvature side, with prominence of the mucosa. The diagnosis was severe gastritis probably due to arthritis therapy (Motrin). Based on this evidence, the RO denied entitlement to service connection for a stomach disability, holding that the veteran had a hiatal hernia and esophageal reflux prior to taking Motrin, and that the Motrin simply exacerbated the problem. However, the veteran was taking NSAID's for his service-connected disorders through the years. Specifically, an April 1976 VA examination report indicates that the veteran was taking time-released aspirin and Zyloprim, apparently on a regular basis. The RO has conceded that Zyloprim can cause gastrointestinal abnormalities such as gastritis. The May 1992 VA examination report and most of the private medical report show a direct relationship between the NSAID's and the veteran's upper-GI problems. Neither the RO nor the Board may substitute its own medical judgment for medical conclusions that are in the record. Colvin v. Derwinski, 1 Vet.App. 171, 175 (1991). Accordingly, the Board finds that the evidence is at least in relative equipoise; therefore, service connection for the veteran's upper-GI disability secondary to the medication taken for his service-connected disabilities is warranted. ORDER Secondary service connection for upper-GI disability is granted. Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.