Citation Nr: 1012839 Decision Date: 04/05/10 Archive Date: 04/14/10 DOCKET NO. 06-26 423 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUE Entitlement to service connection for peptic ulcer disease. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Lynne M. Yasui, Associate Counsel INTRODUCTION The Veteran served on active duty from July 1978 to June 2002. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an August 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Honolulu, Hawaii. Jurisdiction over this claim is now with the RO in Sand Diego, California. The Veteran testified before the undersigned Veterans Law Judge at a Videoconference hearing in March 2009. A copy of the hearing transcript is associated with the claims file. In February 2009, the Board remanded this matter to the RO via the Appeals Management Center (AMC) in Washington DC to afford the Veteran a VA gastroenterology examination. That action completed, the matter has properly been returned to the Board for appellate consideration. See Stegall v. West, 11 Vet. App. 268 (1998). FINDING OF FACT The Veteran's peptic ulcer disease had its onset in service and is etiologically related to her active service. CONCLUSION OF LAW The criteria for service connection for peptic ulcer disease have been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. § 3.303 (2009). REASONS AND BASES FOR FINDING AND CONCLUSION Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303(a) (2009). In general, service connection requires (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in- service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in- service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Service treatment reports are absent for any treatment for or complaints of an ulcer. A separation report of medical examination from January 2002 indicated normal clinical evaluations of the Veteran's abdomen and viscera. In an associated report of medical history, the Veteran reported that she did not have nor ever had stomach or cramping problems, providing evidence against her own claim. The Veteran submitted copies of January 2002 and May 2002 prescription medication for ranitidine, which she indicated she self-prescribed (the Veteran is a physician) for complaints of ulcers she had in service. Dorland's Illustrated Medical Dictionary indicates that ranitidine is an antagonist to histamine H2 receptors; used as ranitidine hydrochloride in the treatment of gastroesophageal reflux. See Dorland's 28th Edition, p. 1422. The Veteran also submitted a July 2003 clinical diagnosis positive for Helicobacter (H) pylori infection and ulcers along with an article establishing the relationship between H. pylori infection and ulcers. A VA outpatient treatment report from July 2007 indicated a medical history of peptic ulcer disease. It was also noted that the Veteran had a history of H. pylori positive status, peptic ulcer disease, and gastroesophageal reflux documented on prior upper gastrointestinal series. The Veteran, who has a background in medicine, contends that the prescription medication in service, the positive clinical finding of H. pylori in July 2003 (one year after discharge from active service), and a current diagnosis of peptic ulcer disease in enough to warrant service connection. In March 2009, the Veteran's primary care physician submitted a letter for the record. In her letter, Dr. "L.J." indicated that the Veteran reported symptoms of dyspepsia with onset in 2002. The Veteran did not seek immediate medical attention for her symptoms at that time; rather, she treated herself with Ateprex and Ranitidine, two medications used to reduce gastric acid and to treat conditions such as esophageal reflux, gastritis, and peptic ulcer disease. Dr. L.J. goes on to explain, in her letter, that the Veteran was subsequently tested for the presence of H. pylori antibodies in 2003 and was found to be positive. A reassessment of the Veteran's H. pylori antibody status in 2006 again revealed a positive test. Pursuant to a Board remand in February 2009, the Veteran was afforded a VA gastroenterology examination. The examiner noted that the Veteran last tested positive for H. pylori via serum antibody testing in June 2006. She also concluded that it is highly likely that the Veteran contracted H. pylori during childhood and was thus infected during her time of service. However, the February 2009 examiner also indicated that the Veteran had an upper endoscopy in November 2007 which revealed gastric antral erosions and no H. pylori on biopsy. Regardless, the examiner noted the strong association between peptic ulcer disease and H. pylori. She concluded that "it is just as likely that [the Veteran] had gastric erosions/ulcers during her time of service (in the presence of a Helicobacter pylori infection)." In a July 2009 addendum to her medical opinion from February 2009, the VA examiner opined that "it is at least as likely as not that [the Veteran's] possible peptic ulcer disease was a result of her H. pylori infection which she had during her military service." This opinion provides favorable evidence to the Veteran's claim as it establishes the requisite nexus between the Veteran's active service and her current peptic ulcer disease. Based on the above, the criteria for service connection for peptic ulcer disease has been met, and the Veteran's claim should be granted. As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (VA) has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2009). In this case, the Board is granting in full the benefit sought on appeal. Accordingly, assuming, without deciding, that any error was committed with respect to either the duty to notify or the duty to assist, such error was harmless and will not be further discussed. ORDER Entitlement to service connection for peptic ulcer disease is granted. ____________________________________________ JOHN J. CROWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs