Citation Nr: 18148024 Decision Date: 11/07/18 Archive Date: 11/06/18 DOCKET NO. 18-22 270 DATE: November 7, 2018 ORDER Entitlement to a rating in excess of 30 percent for esophageal dysphagia and mucosal irregularity (GERD) is denied. FINDING OF FACT During the period on appeal, the Veteran's GERD was manifested by epigastric distress with pyrosis, reflux, regurgitation, sleep disturbance caused by esophageal reflux, and infrequent hematemesis or melena, but without weight loss, anemia, or symptom combinations productive of severe impairment of health. CONCLUSION OF LAW The criteria for an evaluation in excess of 30 percent for the service-connected GERD with esophageal dysphagia and mucosal irregularity, have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.3, 4.7, 4.20, 4.112, 4.114, Diagnostic Code 7346 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from August 1996 to October 2001. This case is before the Board of Veterans’ Appeals (Board) on appeal from an April 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Evaluations Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C.§ 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Additionally, staged ratings must be considered, which are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods during the appeal. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). It is the Board’s responsibility to determine whether a preponderance of the evidence supports the claim or whether the evidence is in relative equipoise, with the veteran prevailing in either event, or whether there is a preponderance of evidence against the claim, in which case the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. The service connected GERD is rated under Diagnostic Code 7346. Symptoms of GERD are rated pursuant to the criteria for hiatal hernia by analogy under 38 C.F.R. § 4.114, DC 7346. 38 C.F.R. § 4.114. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. Under Diagnostic Code 7346, the maximum rating of 60 percent is warranted for 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 or arm or shoulder pain, productive of considerable impairment of health. A 10 percent rating is assigned for two or more symptoms associated with the 30 percent rating, but of less severity. 38 C.F.R. § 4.114, Diagnostic Code 7346. For purposes of evaluating digestive conditions, “material” weight loss is not defined. However, “substantial weight loss” is present when there is a loss of greater than 20 percent of the baseline weight and “minor weight loss” is found with weight loss of 10 to 20 percent of the baseline weight; the losses must be sustained for three months or longer. 38 C.F.R. § 4.112. Entitlement to a rating in excess of 30 percent for GERD is denied. The Veteran's claim for an increased rating for his GERD was received in December 2016. At that time, the disability was evaluated as 10 percent disabling. The RO denied the claim in the April 2017 rating decision. The Veteran subsequently perfected an appeal with the disability evaluation assigned. In October 2017, the RO granted an increased rating to 30 percent for the GERD, effective from the date of receipt of the claim in December 2016. The Veteran has not indicated that he is satisfied with the current disability evaluation assigned and the issue remains on appeal. A primary care note from October 2016 indicates the Veteran was on omeprazole to control his acid reflux. The Veteran reported some regurgitation when lying down at night. The treating medical professional discussed acid reflux and the Veteran's significant weight gain. The Veteran underwent a VA examination for his GERD in November 2016. The examiner detailed in the medical history that the Veteran was being followed at a VA hospital for his GERD. He remained on omeprazole. While there was no weight loss, he had weight gain. His signs and symptoms were reported to be pyrosis, reflux, regurgitation, and sleep disturbance caused by esophageal reflux. His symptoms recurred four or more times a year and lasted less than 1 day. There was no evidence of esophageal stricture, spasm of esophagus, or an acquired diverticulum of the esophagus. In December 2016 the Veteran was referred for a clinical dysphagia evaluation due to a complaint of globus sensation. He reported to be having the symptoms for a few years. He stated that he had issues with food getting caught, and that his symptoms increased when he laughed and ate. Drinking liquids was effective at reducing his symptoms half of the time. He also ate smaller bites and ate at a slower speed to decrease the symptoms. He reported severe problems with swallowing food, liquids, and pills in the past month. He also reported the following was mild to severe symptoms (3/5 and 5/5): having a sensation of something sticking in his throat, having a lump in his throat, heartburn, chest pain, and indigestion or stomach acid coming up. The clinical findings reported that the Veteran had oral and pharyngeal phases of swallowing within functional limits. He was recommended to have regular consistency with his diet, and referred to a physician who may consider ordering an x-ray due to his esophageal dysphagia. In February 2017 a barium swallow test showed mild mucosal irregularities in the Veteran's distal esophagus which was reported to most likely be reflux esophagitis. He also had significant gastroesophageal reflux with provocative maneuvers and up to the mid-third of his esophagus. The Veteran underwent an endoscopy in April 2017 which showed hiatal hernia and gastritis or duodenitis. An April 2018 gastroenterology attending note revealed the Veteran was referred for another colonoscopy to evaluate chronic intermittent hematochezia after a stool card in March 2018 was positive for blood. The colonoscopy revealed the Veteran had hemorrhoids. The Veteran denied weight loss, changes in stool caliber, or changes in bowel habits. He was reported to not be anemic. A June 2018 primary care note revealed there was no finding of reflux, no nausea, no vomiting, no changes in bowel movements, no abdominal pain, no blood in stool, no mucous in stool, and no weight loss. The Board finds that the Veteran’s overall disability picture during the appeal period is most consistent with the criteria for the assignment of a 30 percent rating, but not higher. At no time has the evidence of record shown that the Veteran’s GERD-related symptom combination produced severe impairment of health, and neither anemia nor material weight loss was indicated on any examination report discussed above, or in the outpatient treatment records. The Veteran is consistently reported as not being anemic, and the record actually indicates he had gained weight. Accordingly, the criteria for the assignment of a rating in excess of 30 percent for the service-connected GERD with hiatal hernia are not met or approximated at any time covered by this claim. In making its determination, the Board has considered the Veteran’s contentions in his May 2017 Notice of Disagreement and his April 2018 Form 9. He reported that he had undergone an endoscopy in April 2017; and that he is entitled to an 80 percent rating due to a stool test that showed helicabactor (sic) pylori prior to his April 2018 colonoscopy. The Veteran’s endoscopy results, noted above, did not indicate his symptoms warranted a higher rating under DC 7346. Moreover, the Veteran’s bloody stool found in March 2018 was attributed to his hemorrhoids after he underwent his April 2018 colonoscopy. Hemorrhoids do not warrant a higher rating for the Veteran’s GERD under DC 7346. Additionally, the highest rating available to the Veteran under DC 7346 is a 60 percent rating. Yet, as discussed above, the Veteran’s medical records do not show he has exhibited symptoms consistent with a 60 percent rating. There has be no material weight loss, moderate anemia, or symptom combinations productive of severe impairment of health during the appeals period. Accordingly, a higher rating for the Veteran’s GERD during the appeals period is not warranted, and his increased rating claim is denied. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs