Citation Nr: 1319282 Decision Date: 06/13/13 Archive Date: 06/21/13 DOCKET NO. 06-14 784 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to service connection for respiratory allergies, to include as due to herbicide exposure. 2. Entitlement to service connection for asthma, to include as due to herbicide exposure. 3. Entitlement to service connection for a stomach and gastrointestinal disorder, to include gastroesophageal reflux disease (GERD), to include as due to herbicide exposure. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD L. Barstow, Counsel INTRODUCTION The Veteran had active military service from December 1966 to November 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. The case was remanded in March 2010 and September 2011 to obtain additional treatment records and afford the Veteran VA examinations. Review of the record indicates substantial compliance. See Stegall v. West, 11 Vet. App. 268, 271 (1998). FINDINGS OF FACT 1. Respiratory allergies were not present during service and the currently diagnosed respiratory allergies did not develop as a result of any incident during service, including herbicide exposure. 2. Asthma was not present during service and the currently diagnosed asthma did not develop as a result of any incident during service, including herbicide exposure. 3. A stomach and gastrointestinal disorder, to include GERD, was not present during service and the currently diagnosed GERD did not develop as a result of any incident during service, including herbicide exposure. CONCLUSIONS OF LAW 1. The criteria for service connection for respiratory allergies have not been met. 38 U.S.C.A. §§ 1101, 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 2. The criteria for service connection for asthma have not been met. 38 U.S.C.A. §§ 1101, 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 3. The criteria for service connection for a stomach and gastrointestinal disorder have not been met. 38 U.S.C.A. §§ 1101, 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. VA' Duties to Notify and Assist The VA has duties 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); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012); see also Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Dingess v. Nicholson, 19 Vet. App. 473 (2006). The Veteran was notified in letters dated in April 2005, June 2005 and March 2010 regarding the type of evidence necessary to establish his claims and the claims were subsequently readjudicated, most recently in July 2012. Regarding VA's duty to assist, VA obtained the Veteran's service treatment records (STRs), post-service medical records and also secured examinations in furtherance of his claim. Pertinent VA examinations were obtained in September 2010 with an October 2011 addendum and in May 2012 with June 2012 and July 2012 addendums. 38 C.F.R. § 3.159(c)(4). The VA examinations obtained in this case are collectively sufficient, as the examiners conducted complete examinations, recorded all findings considered relevant under the applicable law and regulations, and offered well-supported opinions based on consideration of the full history of the disorders. The Board finds that VA's duty to assist the Veteran with respect to obtaining a VA examination concerning the issues adjudicated herein has been met. 38 C.F.R. § 3.159(c)(4). VA has no duty to inform or assist that was unmet. The Veteran has not identified any additional pertinent medical records that have not been obtained and associated with the claims folder. In this regard, the Board observes that the case was remanded in September 2011, in part, to obtain private treatment records from Dr. W. The Appeals Management Center (AMC) sent the Veteran an Authorization and Consent to Release Information form in order to obtain those records. However, while the Veteran returned that form, he did not list Dr. W. as a treatment provider; consequently, the additional private records were not obtained. Wood v. Derwinski, 1 Vet. App. 190 (1991) (the duty to assist is not a one-way street). The record also indicates that the Veteran receives disability benefits from the Social Security Administration (SSA). The December 2007 SSA decision shows that the Veteran receives benefits due to his PTSD. As the evidence fails to show that the SSA records are pertinent to the issues on appeal, they were not obtained. See Golz v. Shinseki, 590 F.3d 1317 (Fed. Cir. 2010) (holding that VA had no duty to request a veteran's SSA records when there was no specific allegation that the evidence, reports, or evaluations in conjunction with the SSA decision are relevant to the current claim and the SSA decision found in the record also does not identify testimony, documents, and/or medical reports relating to the veteran's claim). Therefore, the Board reiterates that VA has not duty to inform or assist that was unmet. II. Analysis Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C.A. § 1110. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). Certain diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam during the Vietnam era will be presumed to have been incurred in service. 38 U.S.C.A. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). The presumption requires exposure to an herbicide agent and manifestation of the disease to a degree of 10 percent or more within the time period specified for each disease. 38 C.F.R. § 3.307(a)(6)(ii). Furthermore, even if a veteran does not have a disease listed at 38 C.F.R. § 3.309(e), he or she is presumed to have been exposed to herbicides if he or she served in Vietnam between January 9, 1962, and May 7, 1975, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 U.S.C.A. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). In general, for service connection to be granted for most of the presumed diseases, they must be manifested to a degree of 10 percent or more at any time after service. Chloracne, porphyria cutanea tarda, and acute and subacute peripheral neuropathy, however, must be manifest to a degree of 10 percent within one year after the last date on which the veteran performed active military, naval, or air service in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. See 38 U.S.C.A. § 1116 (West 2002 & Supp. 2012); 38 C.F.R. § 3.307(a)(6)(ii); Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). The diseases for which service connection may be presumed to be due to an association with herbicide agents include AL amyloidosis, chloracne or other acneform disease consistent with chloracne, type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes), Hodgkin's disease, ischemic heart disease [including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina], all chronic B-cell leukemias [including, but not limited to, hairy cell leukemia and chronic lymphocytic leukemia], multiple myeloma, non-Hodgkin's lymphoma, Parkinson's disease, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). 38 U.S.C.A. § 1116(a)(2); 38 C.F.R. § 3.309(e). Even where the criteria for service connection under the provisions of 38 C.F.R. § 3.309(e) are not met, a veteran is not precluded from establishing entitlement to service connection by proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). In the current appeal, the Veteran's personnel records verify that he was stationed in the Republic of Vietnam during service. Furthermore, the Veteran has been awarded service connection for PTSD due to stressors incurred while stationed in the Republic of Vietnam. Therefore, his in-service exposure to herbicides is conceded. 1. Respiratory Allergies The Veteran contends that he has respiratory allergies that are due to in-service herbicide exposure. See, e.g., April 2006 substantive appeal. The Veteran does not contend that they are presumptively due to herbicide exposure; rather, he is seeking service connection on a direct basis. Id. The Board has conducted a careful review of the record, and concludes that the record is without sufficient evidence supportive of a finding that the Veteran's current respiratory allergies became manifest or otherwise originated during his period of service or are otherwise related to his military service, to include his conceded in-service herbicide exposure. There is no finding that any respiratory allergy disorder was treated or diagnosed during service. The Veteran's pre-induction examination in October 1966 revealed clinically normal sinuses, nose, and lungs and chest. Chest X-rays were negative. In his October 1966 report of medical examination, he denied symptoms such as sinusitis, hay fever, nose trouble and chronic cough. He answered "yes" to having throat trouble and reported occasional sore throats. His November 1968 separation examination revealed clinically normal sinuses, nose, and lungs and chest. Chest X-rays were negative. In his November 1968 report of medical examination, the Veteran answered "no" to symptoms such as sinusitis, hay fever, nose trouble and chronic cough. The Board observes that in its March 2010 and September 2011 remands, it was noted that the Veteran reported a history of sinusitis at discharge. However, a review of the Veteran's STRs fails to show any such report. There is no indication in the Veteran's STRs that he incurred a specific event, injury or disease to his respiratory system other than his conceded in-service herbicide exposure. There is also no indication that respiratory allergies had their onset in service. There is no indication in any of his STRs that he was treated for any respiratory allergies, nor is there a diagnosis of respiratory allergies in his STRs. The Veteran's contemporaneous service records fail to show that the onset of any respiratory allergies occurred during service. The totality of the evidence fails to show that the onset of any current respiratory allergies occurred during the Veteran's service. Although the Veteran reported in his March 2003 claim that his respiratory allergies began in 1968, his service records fail to show that the onset of his respiratory allergies occurred during his military service. No medical professional has reported that the onset of any current respiratory allergies began during the Veteran's military service. The pertinent medical evidence that has been presented shows current complaints of respiratory allergies; however, the evidence does not contain medical opinions relating any current respiratory allergies to the Veteran's military service. The first indication of any allergies is in August 1978 when the Veteran was prescribed allergy medication. Records since then show continued allergy treatment and diagnoses of allergic rhinitis and allergies. An herbicide registry examination in August 2005 shows a diagnosis of respiratory allergies, but no nexus opinion was provided. None of the Veteran's treatment records contain any opinion regarding the etiology of the Veteran's respiratory allergies. No treatment provider has provided any medical opinion relating the Veteran's respiratory allergies to his military service, to include his in-service herbicide exposure. The Veteran was afforded a VA examination in September 2010. He reported being diagnosed with respiratory allergies since 1968 after he came home from Vietnam. He stated his allergies were aggravated by dust, smoke and weather changes. Following examination, the Veteran was diagnosed with chronic allergies. The examiner noted that there was no clinical evidence that the Veteran was seen for respiratory allergies while in military service. The earliest mention of allergies they were able to locate was dated in 1978. The examiner was unable to decipher the entire date; however, it was clear that the year was 1978. The Veteran currently did have respiratory allergies. The etiology could be dust, smoke and weather changes. The onset of his claimed respiratory allergies appeared to be the year 1978. The examiner noted that the Veteran's entrance examination recorded an occasional sore throat; however, no cause was listed; therefore, they were unable to give the etiology of the Veteran's occasional sore throat prior to military service without resort to mere speculation. His separation physical reported no sinusitis, hay fever or asthma, and once again, the onset of his allergies appeared to be 1978. Therefore, based on the above facts, it was the examiner's opinion that the Veteran's respiratory allergies were not caused or aggravated beyond service to include being caused by exposure to herbicides, and it was notable that respiratory allergies were not on the list of diseases associated with herbicides as set forth by VA's Office of Public and Environmental Hazards. The Board remanded the claim in September 2011 to obtain a medical opinion that addressed the Veteran's pre-induction examination showing the occasional sore throat and the discharge history of sinusitis, as well as whether there was a direct relationship between herbicides and respiratory allergies. Subsequently, in an October 2011 addendum opinion, a different VA examiner noted that sinusitis was an acute infection, which might involve frontal, maxillary, or ethmoid sinuses, or a combination thereof. Once the infection was treated, it was no longer an active condition. Occasional sore throats were most commonly viral in etiology and required no medical intervention. They might also be bacterial, for which antibiotics were required, as in strep A. There was no relationship between allergies and occasional sore throats or acute sinusitis. It was less likely as not that the Veteran's allergies were related to the circumstances of his active duty service, including his herbicide exposure. The Veteran was afforded a VA examination in May 2012. The only diagnosis was asthma. The examiner noted that the Veteran denied symptoms or conditions other than asthma and his described allergies were the cause of his asthma (extrinsic asthma). The Board will discuss this opinion in detail below when addressing the Veteran's asthma claim. In this case, the only medical opinions of record, those from VA examiners, show that the Veteran's respiratory allergies are not related to his military service. Even when taking into account a reported history of sinusitis at discharge from service, the October 2011 addendum opinion shows that there was no relationship between allergies and acute sinusitis. The VA opinions are uncontradicted. No medical professional has provided any opinion indicating that the Veteran's respiratory allergies are related to his military service. As discussed above, the Veteran's post-service medical records show continuous treatment for respiratory allergies; however, such records do not contain opinions relating the respiratory allergies to his military service, to include his conceded in-service herbicide exposure. The probative medical evidence simply fails to adequately establish any nexus between any current respiratory allergies and the Veteran's military service. Without competent evidence of an association between current respiratory allergies and his active duty, service connection for respiratory allergies is not warranted. To the extent that the Veteran's contentions indicate a continuity of respiratory allergy symptomatology since service, respiratory allergies are not listed as a chronic condition in 38 C.F.R. § 3.309(a). As such, to the extent that the Veteran's assertions indicate a continuity of symptomatology, absent evidence that his symptoms led to a diagnosed chronic condition listed in 38 C.F.R. § 3.309(a), establishing a nexus based on a continuity of symptomatology under 38 C.F.R. § 3.303(b) is precluded. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Although as a lay person, the Veteran is competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet.App. 428, 435 (2011), as to the specific issue in this case, the etiology of respiratory allergies falls outside the realm of common knowledge of a lay person. See Jandreau at 1377 n.4 (lay persons not competent to diagnose cancer). As such, his own assertions as to etiology have no probative value. Without evidence of the onset of respiratory allergies in service or competent evidence of an association between respiratory allergies and the Veteran's active duty, service connection for respiratory allergies is not warranted. Based on this evidentiary posture, the Board concludes that the preponderance of the evidence is against the Veteran's claim for service connection for respiratory allergies. As the preponderance of the evidence is against this issue, the benefit-of-the-doubt rule does not apply, and the Veteran's claim of entitlement to service connection for respiratory allergies is denied. See 38 U.S.C.A §5107 (West 2002 & Supp. 2012). 2. Asthma The Veteran contends that he has asthma that is due to in-service herbicide exposure. See, e.g., April 2006 substantive appeal. The Board has conducted a careful review of the record, and concludes that the record is without sufficient evidence supportive of a finding that the Veteran's current asthma became manifest or otherwise originated during his period of service or is otherwise related to his military service, to include his conceded in-service herbicide exposure. There is no finding that asthma was treated or diagnosed during service. The Veteran's pre-induction examination in October 1966 revealed clinically normal sinuses, nose, and lungs and chest. Chest X-rays were negative. In his October 1966 report of medical examination, he denied symptoms such as sinusitis, asthma, nose trouble and chronic cough. He answered yes to having throat trouble and reported occasional sore throats. His November 1968 separation examination revealed clinically normal sinuses, nose, and lungs and chest. Chest X-rays were negative. In his November 1968 report of medical examination, the Veteran answered no to symptoms such as sinusitis, asthma, nose trouble and chronic cough. There is no indication in the Veteran's STRs that he incurred a specific event, injury or disease to his respiratory system other than his conceded in-service herbicide exposure. There is also no indication that asthma had its onset in service. There is no indication in any of his STRs that he was treated for asthma. There is also no indication of a diagnosis of asthma in his STRs. The Veteran's contemporaneous service records fail to show that the onset of any asthma occurred during service. The totality of the evidence fails to show that the onset of any current asthma occurred during the Veteran's service. Although the Veteran reported in his March 2003 claim that his asthma began in 1968, his service records fail to show that the onset of his asthma occurred during his military service. No medical professional has reported that the onset of any current asthma began during the Veteran's military service. The pertinent medical evidence that has been presented shows a current diagnosis of asthma; however, the evidence does not contain medical opinions relating any current asthma to the Veteran's military service. As discussed above, the Veteran's post-service treatment records reflect allergy complaints beginning in 1978; the first diagnosis of asthma was the March 2005 herbicide registry examination. None of the Veteran's treatment records contain any opinion regarding the etiology of the Veteran's asthma. No treatment provider has provided any medical opinion relating the Veteran's asthma to his military service, to include his in-service herbicide exposure. The Veteran was afforded a VA examination in September 2010. He reported having asthma since 1968. Following examination, the Veteran was diagnosed with asthma. The examiner noted that it was apparent upon recent pulmonary function test that the Veteran did have respiratory asthma. The examiner was unable to find records of asthma in medical records until the year 2005; the separation physical dated in November 1968 recorded no asthma; and there was no evidence that he was ever treated for asthma while in military service. There were multiple etiologies of asthma including allergies. The examiner noted that asthma was not on the list of diseases associated with herbicides as set forth by VA's Office of Public and Environmental Hazards; and asthma was not recorded in medical records until the year 2005; therefore, based on the above facts, it was the examiner's opinion that the Veteran's asthma was not caused by or aggravated by service to include being exposed to herbicides. The Board remanded the claim in February 2011 to obtain a medical opinion that addressed the Veteran's pre-induction examination showing the occasional sore throat and the discharge history of sinusitis, as well as whether there was a direct relationship between herbicides and asthma. Subsequently, in an October 2011 addendum opinion, a different VA examiner opined that asthma was not a diagnosis for the Veteran according to pulmonary function test results. He was not being treated for asthma now. As noted above, the examiner discussed the Veteran's sore throat and history of sinusitis. There was no relationship between asthma and occasional sore throats or acute sinusitis. The Veteran did not have asthma; thus, that condition was not caused by or a result of his active duty service, including herbicide exposure. The Veteran was afforded a VA examination in May 2012. He reported that he was first diagnosed with asthma in the mid-1970s. The Veteran felt that his asthma was due to exposure to herbicides while serving in Vietnam. The initial thought was that that was induced by allergic bronchitis. He had to stop the shots after developing a local allergic reaction to the vaccine. He was then put on albuterol, which helped with the allergies. He was also placed on other medication. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The Veteran stated that he first developed symptoms of asthma (bronchial allergies) five to seven years after he left Vietnam and the military service. He felt that his asthma problem was due to herbicide exposure. After a review of the medical literature, the examiner found one article that found a slight increase in asthma among the chemical corps personnel who processed the herbicides for use in aircraft. Those personnel were exposed to roughly 1000 times the concentration of herbicides as troops on the ground would be. [The factor of 1000 times was a commonly used estimate to compare production workers to surrounding populations.] That study had not been confirmed by other studies the examiner could find and compared very small numbers (about 1500) in exposed versus non-exposed cohorts, making it highly susceptible to selection bias. Based on the current status of medical knowledge, it was less likely than not that that Veteran's or any veteran's (with the possible exception of chemical corps workers) asthma was related to herbicide exposure. An addendum opinion was provided in June 2012. The examiner opined that the fact that the Veteran had sore throats prior to enlistment and a history of sinusitis noted on his discharge physical had no bearing on the fact that he had no symptoms of asthma or sinusitis and was on no treatment for those conditions. He described no current rhinitis symptoms and had no evidence of chronic sinusitis, certainly no impairment. His asthma was well defined, but could not be related to sore throats as a child or what appeared to be a single episode of sinusitis which had resolved. In a July 2012 addendum opinion, the examiner stated that all other causes having been eliminated, see previous opinion, it was apparent to them that the Veteran has extrinsic asthma, which developed five to seven years after separation from service and was not related to his military service. The only medical opinions of record, those from VA examiners, show that the Veteran's asthma is not related to his military service. After reviewing medical literature, the May 2012 examiner opined that the Veteran's asthma was not due to herbicide exposure. Even when taking into account the Veteran's reported history of sinusitis at discharge from service, the June 2012 addendum opinion shows that there was no relationship between asthma and sinusitis. The VA opinions are uncontradicted. No medical professional has provided any opinion indicating that the Veteran's asthma is related to his military service. As discussed above, the Veteran's post-service medical records show treatment for asthma; however, such records do not contain opinions relating asthma to his military service, to include his conceded in-service herbicide exposure. The probative medical evidence simply fails to adequately establish any nexus between any current asthma and the Veteran's military service. Without competent evidence of an association between current asthma and his active duty, service connection for asthma is not warranted. To the extent that the Veteran's contentions indicate a continuity of asthma symptomatology since service, since asthma is not a chronic condition in 38 C.F.R. § 3.309(a), establishing a nexus based on a continuity of symptomatology is precluded by Walker, 708 F.3d 1331. Although as a lay person, the Veteran is competent to provide opinions on some medical issues, see Kahana at 435, as to the specific issue in this case, the etiology of asthma falls outside the realm of common knowledge of a lay person. See Jandreau at 1377 n.4. As such, his own assertions as to etiology have no probative value. Without evidence of the onset of asthma in service or competent evidence of an association between asthma and the Veteran's active duty, service connection for asthma is not warranted. Based on this evidentiary posture, the Board concludes that the preponderance of the evidence is against the Veteran's claim for service connection for asthma. As the preponderance of the evidence is against this issue, the benefit-of-the-doubt rule does not apply, and the Veteran's claim of entitlement to service connection for asthma is denied. See 38 U.S.C.A §5107. 3. Stomach and Gastrointestinal Disorder The Veteran contends that he has a stomach and gastrointestinal disorder, to include GERD, that is due to in-service herbicide exposure. See, e.g., April 2006 substantive appeal. The Board has conducted a careful review of the record, and concludes that the record is without sufficient evidence supportive of a finding that the a current stomach and gastrointestinal disorder, to include GERD, became manifest or otherwise originated during his period of service or is otherwise related to his military service, to include the Veteran's conceded in-service herbicide exposure. There is no finding that a stomach and gastrointestinal disorder, to include GERD, was treated or diagnosed during service. The Veteran's pre-induction examination in October 1966 revealed a clinically normal abdomen and viscera. In his October 1966 report of medical examination, he denied symptoms such as frequent indigestion and stomach or intestinal trouble. His November 1968 separation examination also revealed clinically a normal abdomen and viscera. In his November 1968 report of medical examination, the Veteran answered "no" to symptoms such as frequent indigestion and stomach trouble or intestinal trouble. There is no indication in the Veteran's STRs that he incurred a specific event, injury or disease to his stomach or gastrointestinal system other than his conceded in-service herbicide exposure. There is also no indication that a stomach and gastrointestinal disorder, to include GERD, had its onset in service. There is no indication in any of his STRs that he was treated for any stomach and gastrointestinal disorder. There is also no indication of a diagnosis of any stomach and gastrointestinal disorder in his STRs. The Veteran's contemporaneous service records fail to show that the onset of any stomach and gastrointestinal disorder occurred during service. The totality of the evidence fails to show that the onset of any current stomach and gastrointestinal disorder occurred during the Veteran's service. His service records fail to show that the onset of any stomach and gastrointestinal disorder occurred during his military service. No medical professional has reported that the onset of any current a stomach and gastrointestinal disorder began during the Veteran's military service. The pertinent medical evidence that has been presented shows a current diagnosis of GERD; however, the evidence does not contain medical opinions relating any current GERD, or any other stomach and gastrointestinal disorder, to the Veteran's military service. The Veteran's post-service treatment records reflect gastrointestinal complaints such as diarrhea as early as December 1974. Upper gastrointestinal X-rays in August 1977 did not reveal any stomach or gastrointestinal disorder, while X-rays in February 1978 were opined to be normal. Irritable colon syndrome was diagnosed in May 1984. The first diagnosis of GERD was in March 1998 when diagnostic testing showed esophagitis suggestive of GERD. While his records show continuous treatment, none of the Veteran's treatment records contain any opinion regarding the etiology of his gastrointestinal complaints. No treatment provider has provided any medical opinion relating a stomach and gastrointestinal disorder, to include GERD, to the Veteran's military service, to include his in-service herbicide exposure. The Veteran was afforded a VA examination in September 2010. He reported having problems with acid reflux since 1968. He stated that he had had chronic diarrhea since 1977. Following examination, the Veteran was diagnosed with chronic diarrhea and chronic GERD. The examiner noted that it was apparent that the Veteran did have problems with GERD. There were multiple causes of GERD; however, there were no clinical records in the Veteran's medical records that indicated specifically what the cause of his GERD was; however, the etiology of GERD could be contributed to such factors as lower sphincter relaxation, decreased resting tone, delayed stomach emptying, obesity, lifestyle patterns including smoking, stress and inadequate sleep, Candida infections, genetic tendencies and dietary intake. The first instance where the examiner was able to find where the Veteran was seen and treated for GERD was a diagnostic test dated in March 1998, which showed esophagitis suggestive of GERD. That was well beyond his service date from December 1966 to November 1968. Therefore, based on the above facts, it was the examiner's opinion that the Veteran's diagnosis of GERD was not due to or aggravated by military service. It was also the examiner's opinion that the Veteran definitely did have GERD. The examiner noted that GERD was not on the list of diseases associated with herbicides as set forth by VA's Office of Public and Environmental Hazards and GERD was not documented until the 2005; therefore, based on the above facts, it was the examiner's opinion that the Veteran's current diagnosis of GERD did not begin in military service to include being caused by exposure to herbicides. The Board remanded the claim in February 2011 to obtain a medical opinion that addressed whether there was a direct relationship between herbicides and GERD. Subsequently, in an October 2011 addendum opinion, a different VA examiner noted that according to "Up to Date," GERD might have various etiologies including hiatal hernia, relaxed esophageal sphincter, obesity, age, acute illness, chronic gastritis, and peptic ulcer disease (PUD). "Up to Date" did not state that there was any association to herbicide exposure. GERD was a distinct condition with identifiable pathology, which did not include herbicide exposure. It was their medical opinion that the Veteran's condition of GERD was not caused by or a result of an event, injury or disease incurred in service or herbicide exposure. The Veteran was afforded a VA examination in May 2012. He was diagnosed with GERD. The date of diagnosis was in the early 1970s. The Veteran reported developing GERD in association with an acute episode of diarrhea. Following examination, the examiner opined that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The Veteran reported that he had no symptoms related to pyrosis or GERD prior to about the mid-1970s when he developed those symptoms after a severe bout of diarrhea. That was five to seven years after he left Vietnam and separated from the military. His contention was that GERD was related to herbicides. The examiner did an online search of herbicides and GERD and came up with nearly 2000 references, none of which was able to make a link between the two. In fact, there was one blog in which several veterans who had been searching the issue all stated that there was no evidence to connect the two. Based on the current state of medical science, it was less likely than not that Veterans' or any veteran's GERD was related to herbicide exposure. In this case, the only medical opinions of record, those from VA examiners, show that the Veteran's GERD is not related to his military service. In this case, after researching the issue, the October 2011 and May 2012 examiners opined that the Veteran's GERD was not due to herbicide exposure. The VA opinions are uncontradicted. No medical professional has provided any opinion indicating that the Veteran's GERD, or any other stomach and gastrointestinal disorder, is related to his military service. As discussed above, the Veteran's post-service medical records show treatment for GERD; however, such records do not contain opinions relating a stomach and gastrointestinal disorder, to include GERD, to his military service, to include his conceded in-service herbicide exposure. The probative medical evidence simply fails to adequately establish any nexus between any current stomach and gastrointestinal disorder, to include GERD, and the Veteran's military service. Without competent evidence of an association between a current stomach and gastrointestinal disorder, to include GERD, and his active duty, service connection for a stomach and gastrointestinal disorder, to include GERD, is not warranted. To the extent that the Veteran's contentions indicate a continuity of stomach and gastrointestinal symptomatology since service, since the Veteran has not been diagnosed with a stomach or gastrointestinal disorder that is a chronic condition in 38 C.F.R. § 3.309(a), establishing a nexus based on a continuity of symptomatology under 38 C.F.R. § 3.303(b) is precluded by Walker, 708 F.3d 1331. Although as a lay person, the Veteran is competent to provide opinions on some medical issues, see Kahana at 435, as to the specific issue in this case, the etiology of a stomach and gastrointestinal disorder, to include GERD, falls outside the realm of common knowledge of a lay person. See Jandreau at 1377 n.4. As such, his own assertions as to etiology have no probative value. Without evidence of the onset of a stomach and gastrointestinal disorder, to include GERD, in service or competent evidence of an association between a stomach and gastrointestinal disorder, to include GERD, and the Veteran's active duty, service connection for a stomach and gastrointestinal disorder, to include GERD, is not warranted. Based on this evidentiary posture, the Board concludes that the preponderance of the evidence is against the Veteran's claim for service connection for a stomach and gastrointestinal disorder, to include GERD. As the preponderance of the evidence is against this issue, the benefit-of-the-doubt rule does not apply, and the Veteran's claim of entitlement to service connection for a stomach and gastrointestinal disorder, to include GERD, is denied. See 38 U.S.C.A §5107. ORDER Entitlement to service connection for respiratory allergies to include as due to herbicide exposure is denied. Entitlement to service connection for asthma to include as due to herbicide exposure is denied. Entitlement to service connection for a stomach and gastrointestinal disorder, to include GERD, to include as due to herbicide exposure is denied. ____________________________________________ M. E. LARKIN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs