Citation Nr: 9814816 Decision Date: 05/13/98 Archive Date: 05/27/98 DOCKET NO. 96-04 661 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUE Entitlement to service connection for chronic gastritis secondary to medication administered for a service connected back disorder. REPRESENTATION Veteran represented by: New York Division of Veterans' Affairs ATTORNEY FOR THE BOARD S. M. Peace, Associate Counsel INTRODUCTION The veteran had active military service from November 1954 to December 1955. This matter came before the Board of Veterans’ Appeals (Board) on appeal from a September 1994 rating decision of the Philadelphia, Pennsylvania, Regional Office (RO) of the Department of Veterans Affairs (VA) that denied service connection for a stomach disorder secondary to medication administered for the veteran’s service connected back disability. CONTENTIONS OF APPELLANT ON APPEAL Primarily, it is the veteran’s contention that he developed a stomach disorder over the years due to medications taken to treat his back disability. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1997), 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 favors the grant of service connection for chronic gastritis secondary to medications taken for the service connected back disorder. FINDING OF FACT The veteran has been diagnosed with chronic gastritis as a result of non-steroidal anti-inflammatory drugs (NSAIDS) and Aspirin taken for his service-connected back disability. CONCLUSION OF LAW Service connection for chronic gastritis secondary to the service-connected back disability has been established. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.310(a) (1997). REASONS AND BASES FOR FINDING AND CONCLUSION I. Factual Background. Service medical records show that the veteran injured his back in service. He underwent two laminectomies in January and June 1955. After service, service connection was established and a 40 percent rating was assigned for residuals of a herniated nucleus pulposus with sciatic syndrome in July 1956. By way of a December 1966 rating decision, based on January and October 1966 VA examination, a 60 percent evaluation was awarded and continues to be in effect until this present date. The first complaint of a stomach problem is shown in a January 1989 VA outpatient treatment note. The veteran complained of lower abdominal pain and cramping that had worsened since December. Diagnoses of rule out cholelithiasis, peptic ulcer disease, and diverticulitis were made. Upper and lower gastrointestinal series indicated that the cause of the veteran’s stomach discomfort was cholelithiasis. He underwent surgery in April 1989. In November 1993, the veteran commenced a claim for secondary service connection for a stomach disorder caused by medication taken for the service-connected back disability. VA treatment notes, dated in 1993 and 1994, along with a list of veteran’s prescribed medications, were included into the claims folder in January and March 1994. The records note that the veteran’s stomach discomfort was aggravated by medications taken for his back disorder and an unrelated dental problem. VA examined the veteran in March 1994. The examination report notes that the veteran had taken large doses of cortisone in 1955, and Feldene, on and off, for approximately 6 months. At the time of the examination, he claimed he was taking 8 aspirin a day and indomethacin for his back disorder. He was also using Mylanta and Zantac in standard dose fashion. The veteran reported that an upper gastrointestinal series was performed with negative results. He denied melena or hematemesis. On examination, the veteran did not appear malnourished or dehydrated. There was tenderness observed on light palpation of the epigastrium. Additionally, no lasting residual related to the prior cholecystectomy incision was noted. It was the examiner’s impression that the veteran had discomfort from taking medication although there was no evidence of organic gastric disease. The examiner stated it was also unlikely that the abdominal pain was due to anti-inflammatory medications affecting the lining of the stomach. The examiner noted that in the absence of the prior upper gastrointestinal series that could support the diagnosis of ulceration, it was difficult to believe that the indomethacin and aspirin were causing significant problems. VA treatment records, dated in 1994 and 1995, and private medical evidence were received in June and October 1995. The veteran was seen for complaints of stomach pain possibly connected with an ulcer. Correspondence from William T. Kelly, M.D., Director of Emergency Services, at the Charles Cole Memorial Hospital, dated in September 1995, states that in response to an inquiry posed by the veteran, there is a contributory, if not causal, relationship between NSAIDS taken for traumatic arthritis of the low back and his current peptic ulcer disease. In January 1996, a request for copies of private treatment records and clinical reports was sent to Dr. Kelley. No response has been received. A VA examination was conducted in March 1996. Subjectively, the veteran claimed that he has had epigastric pain for approximately 3 years. It occurs generally when he is hungry and is resolved with food and antacids. He maintained that he has the pain daily. There was no evidence of exacerbation or remission or radiation to the back. His bowels and bladder moved normally. An upper gastrointestinal series showed a single metallic surgical clip in the right upper quadrant associated with the past cholecystectomy. A minimal degree of gastroesophageal reflux was shown. Otherwise, the stomach was normal as to size, type, and position. The sphincter was seen. The duodenal cap did fill and function, and the duodenal sweep was unremarkable. No ulcer was recognized. The veteran was not anemic. Examination of his other systems was unremarkable. There was tenderness at the epigastric region, but no rigidity or guarding was noted. The liver, spleen, or kidneys were not palpable. Bowel sounds were normal. There was weakness of the upper rectus abdominis muscle on the right side that according to the veteran had been weak since the cholecystectomy. It was observed that when the veteran coughed or raised his head this part of the stomach bulged forward. There were no hernias. No history of vomiting, melena, or hematemesis was noted. Diagnoses of gastroesophageal reflux disease, and “chronic gastritis, probably because of NSAIDS and aspirin” were recorded. II. Legal Analysis The veteran's claim is well-grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). He has presented a claim that is plausible. All relevant facts have been properly developed. No further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a) (West 1991). Service connection can be awarded for a disease or disability incurred or aggravated, or presumed to have been incurred in the line of duty while serving in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303(a) (1997). Service connection may be granted for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (1997). The service medical records are completely negative for complaints or findings referable to organic gastric disease. The post service evidence shows that the veteran has a history of treatment for a back disorder with a variety of medications. His private physician, Dr. Kelley, has stated that there is a contributory or causal connection between the veteran’s peptic ulcer disease and the NSAIDS taken for traumatic arthritis in the low back. Though the VA clinical evidence fails to show a peptic ulcer, it does show, in the 1996 VA examination, that it is probable that NSAIDS and Aspirin caused the veteran to develop chronic gastritis. Accordingly, service connection for chronic gastritis due to medications taken for the service-connected back disorder is warranted on a secondary basis. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 3.310 (1997). ORDER Service connection for chronic gastritis secondary to the service-connected back disability is granted. J. E. Day Member, Board of Veterans' Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1997), 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, 102 Stat. 4105, 4122 (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. - 2 -