Citation Nr: 1322119 Decision Date: 07/10/13 Archive Date: 07/18/13 DOCKET NO. 08-04 987 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUES 1. Entitlement to service connection for a variously diagnosed psychiatric disorder, to include posttraumatic stress disorder (PTSD). 2. Entitlement to a compensable rating for gastroesophageal reflux disease (GERD) with Barrett's esophagus. REPRESENTATION Veteran represented by: New Jersey Department of Military and Veterans' Affairs WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD Megan C. Kral, Associate Counsel INTRODUCTION The appellant is a Veteran who served on active duty from July 1980 to July 1983. These matters are before the Board of Veterans' Appeals (Board) on appeal from December 2007 and November 2009 rating decisions of the Philadelphia, Pennsylvania Department of Veterans Affairs (VA) Regional Office (RO) that, respectively, denied service connection for PTSD, and granted service connection for GERD with Barrett's esophagus, rated 0 percent, effective January 13, 2009 (date of claim). In February 2011, a hearing was held before a Decision Review Officer (DRO) at the RO. In December 2011, a videoconference hearing was held before the undersigned. Transcripts of these hearings are associated with the Veteran's claims file. In March 2012 the case was remanded for additional development. As the Board previously noted, the Veteran has raised a claim of service connection for peptic ulcer disease. Such claim has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. FINDINGS OF FACT 1. The record shows the Veteran has a diagnosis of PTSD in accordance with 38 C.F.R. § 4.125 based on a stressor event in service that is corroborated by credible supporting evidence. 2. The Veteran's GERD with Barrett's esophagus is reasonably shown to have been manifested throughout by two or more of the symptoms for a 30 percent rating, to a lesser severity; at no time during the rating period is it shown to have been manifested by persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health;. CONCLUSIONS OF LAW 1. Service connection for PTSD is warranted. 38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2012). 2. A 10 percent rating is warranted for the Veteran's GERD with Barrett's esophagus. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.114, Diagnostic Code (Code) 7346 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). Regarding the claim of service connection for PTSD, inasmuch as the benefit sought is being granted, there is no reason to belabor the impact of the VCAA on the matter; any notice defect or duty to assist failure is harmless. Regarding the rating for GERD with Barrett's esophagus, as the rating decision on appeal granted service connection and assigned a disability rating and effective date for the award, statutory notice had served its purpose, and its application was no longer required. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd, Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). An August 2010 statement of the case (SOC) provided notice on the "downstream" issue of entitlement to an increased initial rating; while an October 2011 supplemental SOC (SSOC) readjudicated the matter after the appellant and his representative responded and further development was completed. 38 U.S.C.A. § 7105; see Mayfield v. Nicholson, 20 Vet. App. 537, 542 (2006). The Veteran has had ample opportunity to respond/supplement the record. He has not alleged that notice in this case was less than adequate. See Goodwin v. Peake, 22 Vet. App. 128, 137 (2008) ("where a claim has been substantiated after the enactment of the VCAA, the appellant bears the burden of demonstrating any prejudice from defective VCAA notice with respect to the downstream issues"); see also Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (discussing the rule of prejudicial error). The Veteran's pertinent treatment records have been secured. The RO arranged for VA examinations in April 2009, November 2009, July 2011, and February 2013; the Board finds the examinations adequate for rating purposes. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (VA must provide an examination that is adequate for rating purposes).] The March 2012 Board remand ordered the RO to adjudicate the issue of peptic ulcer disease prior to readjudicating the matter of the rating for GERD with Barrett's esophagus. This sequence was ordered because of a possibility that ulcer disease may be inextricably intertwined with the Veteran's service-connected GERD with Barrett's esophagus. The RO did not follow the Board's instructions; however, the Board finds corrective action under Stegall v. West, 11 Vet. App. 268 (1998) is not necessary as the evidence needed to adjudicate the matter of the rating for GERD is now adequately developed. The Board finds that issue is not in fact inextricably intertwined with the issue of service connection for ulcer disease (and, as has been noted, the Board does not have jurisdiction over a claim of service connection for ulcer disease) . The Board finds that the record as it stands includes adequate competent evidence to allow the Board to decide these matters, and that no further development of the evidentiary record is necessary. See generally 38 C.F.R. § 3.159(c)(4). The Veteran has not identified any pertinent evidence that remains outstanding. VA's duty to assist is met. Legal Criteria, Factual Background and Analysis The Board notes that is has reviewed all of the evidence in the Veteran's claims file, as well as in "Virtual VA" (VA's electronic data storage system), with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000)(VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence as appropriate and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claims. Service Connection for PTSD Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. Service connection also may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). To establish service connection for a claimed disorder, a claimant must submit: (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. Hickson v. West, 12 Vet. App. 247, 253 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a) . Service connection for PTSD requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link, or causal nexus, between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). Where the veteran did not engage in combat with the enemy, or the claimed stressors are not related to combat, then the veteran's testimony alone is not sufficient to establish the occurrence of the claimed stressors, and his testimony must be corroborated by credible supporting evidence. Cohen v. Brown, 10 Vet. App. 128 (1997). Service department records must support, and not contradict, the claimant's testimony regarding noncombat stressors. Doran v. Brown, 6 Vet. App. 283 (1994). On July 12, 2010, VA amended its adjudication regulations governing service connection for PTSD by liberalizing, in certain circumstances, the evidentiary standard for establishing the required in-service stressor. Specifically, the final rule amends 38 C.F.R. § 3.304(f) by redesignating current paragraphs (f)(3) and (f)(4) as paragraphs (f)(4) and (f)(5), respectively, and adding a new paragraph (f)(3) that states: If a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of [PTSD] and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. For purposes of this paragraph, "fear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire; including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304(f)(3). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, 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 fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). As a preliminary matter, the Board notes that the Veteran does not allege that he engaged in combat or that his stressor to support a diagnosis of PTSD is combat-related; rather, he alleges that three specific stressor events while he was in service were factors in his developing PTSD. The first of these stressors is corroborated (as discussed in greater detail below). The Veteran's accounts describing the other stressors are supported by official records, and the occurrences may also be conceded. Regarding the first stressor, the Veteran stated that while he was serving aboard the USS John F. Kennedy in either May or June 1983, while on the overnight shift, he was maintaining the salinity cells in the pipe room when something went wrong and one of the pipes would not budge. As a result, he decided to put a pipe wrench on the pipe itself while simultaneously trying to close the valve. In doing so, the pipe blew apart and a salinity cell flew out of the pipe, narrowly missing him. He described this experience as a harrowing one, noting that he could have been seriously injured if the salinity cell had hit him. He described the salinity cell as a solid six pound brass piece that rocketed from the pipe and just missed his face. He also stated that after the pipe burst, there was steam and hot water everywhere. Eventually, his Master Chief, managed to turn off the valve. However, in doing so, he was burned by steam and hot water. Service personnel records confirm the Veteran served aboard the USS John F. Kennedy from September 1982 through July 1983. Deck logs for the USS John F. Kennedy for April 1983 through May 1983 show that on May 16, 1983, at 0008 hours there was a leak in a pipe and that crewmembers were taking corrective action in Pump Room Number Four. The deck logs do not specifically identify the crewmembers involved in the corrective action. Accordingly, the RO continued to deny service connection for PTSD based on a finding that an alleged stressor has not been verified. However, the Board finds the Veteran's descriptions of the event consistent with the deck logs to corroborative of his presence at the event (i.e., the deck logs constitute credible corroborating evidence). Regarding the Veteran's two other claimed stressors, these occurred while he was stationed aboard the USS Deyo. Regarding the first, there is no specific "event" to corroborate. Rather, the Veteran notes that the summer of 1981 was a particularly stressful and tense time for those serving on the USS Deyo. He explained that they were stationed mostly off the waters off of Libya, where two Libyan jets tried to attack their ship, and also patrolled the Persian Gulf. Later, they traveled to Somalia, which was controlled by warlords at the time, and a contingent of Somalian nationals was granted access to the ship. No explanation was given for their presence, and servicemen were ordered to stay in the front part of the ship to make sure that no one else came aboard the ship. Later, the ship tried to seek passage through the Suez Canal, but was unable to do so due to the assassination of Anwar El Sadat, the then president of Egypt. The Veteran states that for a day and a half, they had nowhere to go, tensions aboard the ship were high, and everyone was in a constant state of readiness until they were able to get through the Suez Canal. As for the second stressor that allegedly occurred aboard the USS Deyo, the Veteran states that sometime between December 1981 and February 1982, the ship was stationed in the waters off of El Salvador when they were approached by a Nicaraguan gunboat which wanted to send an official aboard their ship. He described this situation as very stressful and frightening, and stated that they were in a "cat and mouse" game with the Nicaraguan gunboat. To corroborate these claimed stressors, the USS Deyo's December 1981 deck logs and command history reports for calendar years 1981 and 1982 were secured and associated with the record. These show that in June 1981, the ship deployed to the U.S. Naval Station in Rota, Spain. From there, the ship traveled to Port Said, Egypt; Djibouti, Djibouti; and then Mogadishu, Somalia. In Somalia, the ship made a port call and hosted a formal dinner onboard for the United States Ambassador to Somalia and the Ambassadors of the Peoples Republic of China, France, and Great Britain. It also hosted an open house in Somalia, which was attended by the Chief of the Somalian Naval Staff and other international and diplomatic visitors. After Somalia, the ship traveled through the Persian Gulf, eventually returning to the Suez Canal in October 1981. The report states that the USS Deyo remained anchored at Port Suez overnight to await October 11 passage in honor of the October 10 funeral for President Sadat of Egypt, and then eventually proceeded into the Mediterranean Sea before arriving in Naples, Italy. See USS Deyo's 1981 command history report. They also show that in January 1982, the USS Deyo "departed U.S. Naval Base, Rodman, Panama Canal Zone for Joint Chiefs of Staff Special Operations Jittery Prop in the Pacific Ocean. [The USS Deyo] conducted these highly sensitive operations through 14 February with virtually no material support." See USS Deyo's 1982 command history report (emphasis added). While these records do not provide insight into the environment and climate aboard the ship during the time periods in question, and do not document an incident with a Nicaraguan gunboat, they corroborate his report of the ship's itinerary during the summer of 1981 and from January to February 1982 as he has described it. To further support his claim, the Veteran submitted copies of various orders that he received while serving aboard the USS Deyo. Pertinent orders show that while traveling through the Straits of Hormuz, the sailors were told to expect "an at least daily visit" from a P-3, possibly F-4s, and a "look see" from a SAAM class frigate. They were further instructed that while they were not restricted from moving around the ship, they were to immediately clear certain areas if they heard a bell or alarm from the gun mounts, missile launchers, or other stations. It was further noted such armaments would be tested daily and be ready for immediate use, if necessary. In another order, regarding the ship's schedule, the servicemen were advised that following the assassination of President Sadat, an American carrier battle group was being positioned in the Mediterranean for "contingency operations." After the USS Deyo's passage through the Suez Canal, it would join the battle group for at least a few days. Beyond that, it was projected that they might have a port visit in Naples, Italy, but before that, they had to "concentrate on getting through the Suez Canal and back in the Mediterranean." These orders thus shed some light on the conditions faced by those serving on the USS Deyo during the summer and autumn of 1981. Likewise, regarding the Nicaraguan gunboat incident, the Veteran submitted a newspaper article dated in February 1982, which discusses the United State's positioning of destroyer ships near El Salvador, and notes that the USS Deyo was stationed "in the Pacific off El Salvador starting sometime in January." It also states that one source "passed on a report that said the Deyo had been hailed by a gunboat from an unspecified navy, believed to be Nicaraguan, which asked to send an officer aboard, but the request was refused. A Navy spokesman refused to discuss any details of the Deyo's mission, but [stated] 'at no time did any ship from any foreign navy try to stop' [the Deyo]." Given the "highly sensitive" operation that was being carried out by the USS Deyo during this period of time, it is not inconceivable that the details of a challenge from a foreign gunboat may have been officially reported in a sanitized manner. In light of the foregoing, as well as the Veteran's credible testimony offered at the February 2011 videoconference hearing before the undersigned, the Board finds that his claimed stressors from his service aboard the USS Deyo are corroborated by the record. It appears, based on the stressor development to date, that further corroboration of the full details of these claimed stressors may not be possible; the Board finds no reason to reject the Veteran's accounts. The Veteran's service treatment records are silent for any complaint, treatment, or diagnosis of PTSD or other psychiatric disability. Postservice, the Veteran sought treatment with Dr. C. Hankins, PTSD Therapist. PTSD was diagnosed in June 2007. Dr. Hankins found the Veteran's PTSD was the result of his military experiences, to include the stressors identified above. On May 2007 initial examination at a VA medical center (VAMC), it was noted that the Veteran would seek treatment at the behavioral health clinic. VAMC treatment records show the Veteran was treated and attended counseling sessions for PTSD. On November 2012 VA examination, the Veteran received a diagnosis of PTSD that conforms with the DSM-IV criteria. No other mental disorder was diagnosed. On examination the Veteran described the stressor event aboard the USS John F. Kennedy in May 1983 when the salinity cell burst in the steam room. He reported that the six inch cell blew right past his face into the wall, as well as the steam and hot water in the room. He reported that during the episode he was thinking he was going to be injured and that his parents would be devastated by the news that their only son had been injured. He stated that he was not burned because he was wearing the proper protective gear and clothing. He believed that if he had not been wearing the proper gear, he would have been severely burned and injured, and that he would have been injured if the salinity cell had hit him. The examiner concluded that this stressor event was adequate to support an Axis I diagnosis of PTSD. The Veteran also described the events aboard the USS Deyo, including the events with the Nicaraguan and Somalian gunboats and Libyan jets. The examiner concluded that these stressor events were not adequate to support a diagnosis of PTSD, however, they were related to the Veteran's fear of hostile military or terrorist activity. As the record shows that the Veteran has a diagnosis of PTSD; contains credible supporting evidence corroborating the occurrence of a stressor event in service; and shows a VA diagnosis of PTSD based on a corroborated stressor event in service (which the Board has no reason to reject), all of the criteria for establishing service connection for PTSD are met, and service connection for PTSD is warranted. Entitlement to a compensable rating for GERD with Barrett's esophagus Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earnings capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. There are no listed diagnostic codes for either GERD or Barrett's esophagus. When an unlisted condition is encountered, it is permissible to rate such disability under the criteria for a closely related disease or injury with closely analogous functions affected, anatomical location, and symptomatology. 38 C.F.R. § 4.20. Based on similarity of symptoms, the Veteran's GERD has been rated as hiatal hernia. 38 C.F.R. § 4.114, Code 7346. Under Code 7346 (for hiatal hernia), a 60 percent rating requires symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. A 30 percent rating is warranted for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal arm or shoulder pain, productive of considerable impairment of health. A 10 percent rating is warranted when there are 2 or more of the symptoms in the criteria for a 30 percent rating, of lesser severity. 38 C.F.R. § 4.114. In every instance where the schedular criteria do not provide a 0 percent rating for a diagnostic code, a 0 percent rating shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. When a question arises as to which of two ratings applies under a particular code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 U.S.C.A. § 5107; 38 C.F.R. §§ 3.102, 4.3. With the initial rating assigned following a grant of service connection, separate (staged) ratings may be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). VA treatment records from February 2009 note the Veteran has Barrett's Esophagus and GERD without nausea, vomiting, diarrhea, or constipation; but does have trouble swallowing and abdominal pain. Medication was prescribed. On April 2009 VA examination, the Veteran stated that he had heartburn (pyrosis), self-medicated with antacids and over-the-counter Tagament. The examiner noted a December 3, 2008 endoscopy showed that the upper mid-esophagus was normal; there were two tongues of Barrett's, an isolated proximal island biopsy with minimal blood loss. An August 2008 upper GI series showed changes that were related to GERD in the esophagus but there were no mucosal lesions in the esophagus. On November 2009 VA examination, GERD with Barrett's esophagus was diagnosed. The Veteran was not in any distress at the examination. At this examination, the examiner concluded that the Veteran's GERD with Barrett's esophagus was related to his ulcer in service. January 2010 VA treatment records show the Veteran was seen for increased burning in the back of his throat (dysphagia) without vomiting. His medication was increased and he was referred to a GI consult. In April 2010, he reported he had gastroenteritis and recurrent epigastric burning associated with non-bloody, non-bilious vomiting, which resolved in 24 hours. In September 2010, the Veteran reported trouble swallowing, throat pain, epigastric pain and regurgitation controlled better with medication. On GI consult in November 2010, it was noted that the Veteran's appetite was good, there was no dysphagia, odynophagia, or regurgitation. Esophagogastroduodenoscopy (EGD) in December 2010 found that the upper and mid-esophagus were normal; there were a number of tongues of Barrett's epithelium which were biopsied; and there was a 3 centimeter hiatal hernia. A July 2011 VA examination was non-specific for GERD. At the February 2011 DRO hearing, the Veteran reported he had no pain when asked about his current symptoms. He testified that when taking the medication the acid was suppressed and the burning in his stomach and throat were not there. He stated that before the medication he sometimes vomited once or twice a month after eating and would have burning in his throat. He further testified that he very rarely had shoulder pain. At the December 2011 videoconference hearing, the Veteran testified he has monthly stomach problems, including pain, occasional vomiting (once every couple of months), soreness and burning. He stated that these symptoms depend on what he eats and if he takes medication. On February 2013 VA examination, the Veteran described his treatment for a peptic ulcer in 1981. He reported that he had episodes of heartburn for which he took over-the-counter Maalox. The examiner noted the results of the December 2008 and December 2010 endoscopies, which both showed Barrett's esophagus. The Veteran reported taking Nexium since December 2010, and that despite the medication he still gets periodic episodes of heartburn once a week for which he takes Maalox. He reported flare-ups of his upper GI disability from fatty foods and psychological stress, alleviated by Maalox. On examination, the Veteran denied heartburn, dysphagia, hematemesis, nausea, vomiting, and melanotic stools. He stated he gets regurgitation 2 to 3 times a week. It was noted that he is employed as a mail handler with the United States Postal Service, and that this condition has no effected on his occupation. His activities of daily living were opined to not be affected by the condition. The examiner opined that the Veteran has mild GERD with Barrett's esophagus as reported in the December 2010 EGD. The Board notes that symptoms associated with GERD are observable by the person experiencing them. The Veteran has reported two or more of the symptoms required for a 10 percent rating, including pyrosis, regurgitation, and dysphagia, throughout the appeal period (albeit not all simultaneously, and with apparently quiescent periods). Notably, he takes medication for GERD symptoms, and the medication prescribed had to be increased due to unalleviated symptoms. The Board finds no reason to question the credibility of his accounts of his symptoms; they are consistent with the symptoms noted in his treatment records and on examination. As the symptoms described meet the schedular criteria for a 10 percent rating under Code 7346, the Board finds that such rating is warranted. The evidence does not show symptoms that meet (or approximate) the above-listed criteria for a 30 percent rating any time during the evaluation period. While the Veteran has variously reported pyrosis, regurgitation, and dysphagia, at no time during the appeal period is it shown that he had persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, to a severity productive of considerable impairment of health. See opinion of 2013 VA examiner. Consequently, the Board finds that the criteria for a 30 percent rating are not met at any time under consideration. The Board finds that the evidentiary record presents no reason to refer this matter for consideration of an extraschedular evaluation under 38 C.F.R. § 3.321(b). There is no evidence of symptoms or impairment not encompassed by the schedular criteria, so as to render those criteria inadequate. See Thun v. Peake, 22 Vet. App. 111 (2008). Finally, as the record shows that the Veteran is employed full-time with the United States Postal Service, and has been throughout, the matter of entitlement to a total rating based on individual unemployability is not raised by the record. See Rice v. Shinseki, 22 Vet. App. 447 (2009). ORDER Service connection for PTSD is granted. A 10 percent rating is granted for the Veteran's GERD with Barrett's esophagus, subject to the regulations governing payment of monetary awards. ____________________________________________ George R. Senyk Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs