Citation Nr: 18155847 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 13-31 167A DATE: December 6, 2018 ORDER Service connection for a right shoulder disorder is denied. Service connection for a bilateral leg disorder is denied. Service connection for an upper gastrointestinal (GI) disorder, to include gastroesophageal reflux disease (GERD), is denied. FINDINGS OF FACT 1. A right shoulder disorder is not shown to be causally or etiologically related to any disease, injury, or incident in service and arthritis did not manifest within one year of service discharge. 2. A bilateral leg disorder is not shown to be causally or etiologically related to any disease, injury, or incident in service and arthritis did not manifest within one year of service discharge. 3. An upper GI disorder, to include GERD, is not shown to be causally or etiologically related to a disease, injury, or incident in service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disorder have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a bilateral leg disorder have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for an upper GI disorder, to include GERD, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from November 1977 to March 1979. This matter comes before the Board of Veteran’s Appeals (Board) on appeal from a June 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In January 2016, the Board remanded the case for additional development and it now returns for further appellate review. Service Connection Claims Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. §3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. §3.303(d). Direct service connection may not be granted without evidence of a current disability, in-service incurrence or aggravation of a disease or injury, and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996). Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as arthritis, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease enumerated in 38 C.F.R. § 3.309 (a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303 (b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309 (a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. §5107; 38 C.F.R. §3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for a right shoulder disorder. The Veteran contends that his current right shoulder disorder is related to his military service. In this regard, he asserts that he first experienced pain in his right shoulder approximately six months into working as a cook in service, while doing repeated, overhead lifting of heavy pots, pans, and other kitchen items, that has continued to the present time. Consequently, the Veteran claims that service connection for a right shoulder disorder is warranted. While the Veteran reported that he sought treatment at sick call for right shoulder pain during service, such is not reflected in his service treatment records. In this regard, such are negative for any complaints, treatment, or diagnosis referable to a right shoulder disorder. Further, at his February 1979 separation examination, the Veterans upper extremities were normal upon clinical evaluation, and he denied swollen or painful joints; arthritis, rheumatism, or bursitis; bone, joint, or other deformity; and painful or “trick” shoulder or elbow. Post-service VA treatment records reflect that, after reporting pain for the prior three years, the Veteran was diagnosed with subacromial bursitis of the right shoulder in September 2010 and acromioclavicular joint arthritis and moderate glenohumeral arthritis in right shoulder in October 2013. Pursuant to the January 2016 Board remand, the Veteran was afforded a VA examination in March 2016. Following a review of the record, an interview with the Veteran, and a physical examination, right rotator cuff tear was diagnosed. The examiner noted the Veteran’s report that his right shoulder pain and disorder began while he was working as a cook in service in 1977. In this regard, he indicated that such began approximately six months after basic training and he needed to miss duty due to shoulder pain. The Veteran further stated that he had not had very physical jobs since leaving the military, as he drove a forklift and a truck. He also reported that he had chronic low grade nabbing pain in the shoulder since service that became more symptomatic over time. The examiner also noted a detailed review of the Veteran’s service and post-service treatment records. In this regard, he observed that his February 1979 separation examination revealed no abnormality or complaint referable to the shoulder. Further, when the Veteran established VA care in February 2009, he complained of knee pain without mention of his shoulder and, in September 2010 and February 2011, he reported that he had been experiencing pain in his right shoulder for three years. Thereafter, the examiner opined that it was less likely than not that the Veteran’s right shoulder disorder is causally connected to his reported complaints and work activities during service. In support of such opinion, he noted that the tremendously long period of time between symptom onset and the finding of a rotator cuff tear would argue that an entire adulthood of experience would have overwhelmingly contributed the majority of factors that caused his cuff to tear. It was further observed that a significant onset of rotator cuff disease in the military, if it were to slowly worsen over time, would be expected to require care within a few years, not 20 to 25 years later. While an initial strain might have been compromising in the seventies and some lingering weakness might have contributed to later problems is possible, but the complete lack of documented important shoulder symptoms over the decades makes this highly unlikely. Something being possible is different from something being probable and, in the present case, the examiner found that the connection is very improbably. He again emphasized that very serious shoulder problems were documented in 2010 and there was no mention of three decades of pain in the shoulder was mentioned by any of the treatment providers. The Board places great weight on the March 2016 VA examiner’s opinion as such considered all of the pertinent evidence of record, to include the statements of the Veteran, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Notably, there is no medical opinion to the contrary. The Board acknowledges that the Veteran’s belief his current right shoulder disorder is related to his military service. However, while lay persons are competent to provide opinions on some medical issues, in this case, the cause of such disorder falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons are not competent to diagnose cancer); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Specifically, such matter involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In this regard, the etiology of bursitis, arthritis, and a rotator cuff tear concerns an internal process, and specialized knowledge is necessary to determine whether a specific injury or repeated motion led to such disorders. Moreover, whether the symptoms the Veteran reportedly experienced during or after service are in any way related to his currently diagnosed right shoulder disorder is a matter that also requires medical expertise to determine. Clyburn v. West, 12 Vet. App. 296 (1999) (“although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with.”). Accordingly, the Veteran’s opinion as to the onset and etiology of his right shoulder disorder is not competent evidence and, consequently, is afforded no probative weight. Moreover, the evidence of record fails to demonstrate that arthritis of right shoulder manifested within one year of the Veteran’s separation from service. In this regard, his February 1979 separation examination revealed that his upper extremities were normal upon clinical evaluation, and arthritis was not diagnosed until October 2013. Furthermore, while the Veteran has reported a continuity of right shoulder symptomatology, such is not supported by the contemporaneous records. In this regard, he denied swollen or painful joints; arthritis, rheumatism, or bursitis; bone, joint, or other deformity; and painful or “trick” shoulder or elbow at the time of his February 1979 separation examination. Moreover, when seeking treatment for his right shoulder complaints in September 2010 and February 2011, the Veteran reported an onset of pain within the prior three years. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (ascribing heightened credibility to statements made to clinicians for the purpose of treatment); see also Williams v. Gov. of Virgin Islands, 271 F.Supp.2d 696, 702 (V.I. 2003) (noting that statements made for the purpose of diagnosis or treatment “are regarded as inherently reliable because of the recognition that one seeking medical treatment is keenly aware of the necessity for being truthful in order to secure proper care”). Consequently, presumptive service connection, to include on the basis of a continuity of symptomatology, for arthritis of the right shoulder is not warranted. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309; Walker, supra. Based on the foregoing, the Board finds that a right shoulder disorder is not shown to be causally or etiologically related to any disease, injury, or incident in service and arthritis did not manifest within one year of service discharge. Therefore, service connection for such disorder is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim for entitlement to service connection for a right shoulder disorder. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. 5107; 38 C.F.R. 3.102; Gilbert, supra. 2. Entitlement to service connection for a bilateral leg disorder. The Veteran contends that his current bilateral leg disorder is related to his military service. In this regard, he asserts that he first noticed leg pain after playing basketball, running, and constant walking while in service, which has continued to the present time. Consequently, the Veteran claims that service connection for a bilateral leg disorder is warranted. The Veteran’s service treatment records are negative for any complaints, treatment, or diagnosis referable to his bilateral legs with the exception of a report of occasional leg cramps with excessive stress (athletics) at the time of his February 1979 separation examination. However, it was noted that no treatment was sought or required. Further, his lower extremities were normal upon clinical evaluation, and he denied swollen or painful joints; arthritis, rheumatism, or bursitis; bone, joint, or other deformity; “trick” or locked knee; and foot trouble. After service, the Veteran underwent a VA examination in April 2012, at which time mild degenerative joint disease in the bilateral knees was diagnosed. The examiner indicated that the Veteran injured his knees playing basketball during his childhood and experienced cramping in his legs while in service due to the type of work that he did therein. She further noted that, after service, in 1991, the Veteran suffered a gunshot wound to his right lower leg. When asked to address whether the Veteran’s bilateral leg disorder was incurred during, or due to, his military service, the examiner indicated that it was not. In providing her rationale, she stated that there were no joint issues noted in service or at the time of the Veteran’s separation. The examiner further indicated that the Veteran did not report any specific knee injury in service. In the January 2016 remand, the Board found that the April 2012 VA examiner’s opinion was inadequate to decide the claim. Consequently, it is afforded no probative weight. Pursuant to the January 2016 Board remand, an addendum opinion as to the nature and etiology of the Veteran’s claimed bilateral leg disorder was obtained in February 2016. At such time, the examiner provided a detailed review of the evidence of record, to include the aforementioned findings from the Veteran’s service treatment records. She further noted that a VA examination conducted in 1980 for a left foot disorder reflected the Veteran’s report that he had no other particular problems, and that VA treatment records dated from 1996 to 2006 were negative for any complaints regarding a leg disorder. In August 2006, it was observed that the Veteran reported left knee pain that occurred while working the prior month due to injury when he fell 6 feet in a manhole. At such time, it was also noted that he had sustained a gunshot wound to the right calf and hip with the bullet still lodged in the hip. Thereafter, a February 2009 VA treatment record reflected complaints of bilateral knee pain, at which time X-rays showed mild osteoarthritic changes. Based on the foregoing, the examiner indicated that the Veteran had diagnoses of gunshot wounds to the right calf and hip from 1991, and bilateral knee osteoarthritis shown as mild on 2009 X-rays. She noted the Veteran’s subjective complaints of leg cramps at the time of his separation from service, but indicated that such was not a chronic or current complaint. The examiner further explained that “leg cramps” is a very nonspecific complaint and is not typically used to describe a specific joint issue. Rather, it is related to muscle fatigue in the calf and thigh muscles. In this regard, it typically takes forceful trauma (not just playing sport, but an untoward event) to cause tears in the actual muscles. The examiner noted that there was no evidence that the Veteran was ever diagnosed with actual muscle tears in the leg muscles. She further observed that leg cramps are common complaints in those who spend a lot of time on their feet. Such symptoms resolve with rest and are common in the general population. The examiner found that there was no evidence in the record that such commonplace symptoms became a chronic disabling condition. The examiner opined that there was no clear and unmistakable evidence that any of the Veteran’s current leg disorders pre-existed his military service. Further, she noted that the Veteran’s gunshot wounds of the right calf and hip occurred in 1991, after he was discharged. Consequently, such was not likely due to his military service. The examiner further opined that it was not likely that the Veteran’s current bilateral knee disorder was incurred in or related to his military service. In support of such opinion, she noted that the service treatment records are absent any complaint or injury to any joint or musculoskeletal region, including the knees. Further, during the course of regular dental treatment, the Veteran indicated that his present health was excellent, good, or very good, and denied being under the care of a physician over the prior year. The examiner also observed that, at the Veteran’s separation from service, he denied having any joint issues, to include of the knee and feet. While he did not occasional leg cramps with excessive stress (athletics), he denied any concerns other than those pertaining to his left foot at a VA examination in 1980. Moreover, the examiner found that the VA treatment records reflected a specific injury to the left knee in 2006. She further determined that the medical evidence did not support a nexus of knee or leg problems stemming from the Veteran’s time in service. Finally, the examiner again noted that, while the Veteran reported subjective leg cramps at the time of separation, he was never seen or treated for it, and there was no evidence that such complaints became a chronic disabling condition. The Board places great weight on the February 2016 VA examiner’s opinion as such considered all of the pertinent evidence of record, to include the statements of the Veteran, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez, supra; Stefl, supra. Notably, there is no medical opinion to the contrary. The Board acknowledges that the Veteran’s belief his current bilateral leg disorder is related to his military service. However, while lay persons are competent to provide opinions on some medical issues, in this case, the cause of such disorder falls outside the realm of common knowledge of a lay person. See Jandreau, supra; Woehlaert, supra. Specifically, such matter involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In this regard, the diagnosis of muscle tears in the calf and the etiology of arthritis concern an internal process, and specialized knowledge is necessary to determine whether muscle tears exist and/or whether a specific injury or overuse led to the degeneration of the knee joint. Moreover, whether the symptoms the Veteran reportedly experienced during or after service are in any way related to his currently diagnosed bilateral leg disorder is a matter that also requires medical expertise to determine. Clyburn, supra. Accordingly, the Veteran’s opinion as to the onset and etiology of his bilateral leg disorder is not competent evidence and, consequently, is afforded no probative weight. Moreover, the evidence of record fails to demonstrate that arthritis of bilateral knees manifested within one year of the Veteran’s separation from service. In this regard, his February 1979 separation examination revealed that his lower extremities were normal upon clinical evaluation, and arthritis was not diagnosed until February 2009, at which point it was noted to be mild in nature. Furthermore, while the Veteran has reported a continuity of bilateral leg symptomatology, such is not supported by the contemporaneous records. In this regard, he denied swollen or painful joints; arthritis, rheumatism, or bursitis; bone, joint, or other deformity; and a “trick” or locked knee at the time of his February 1979 separation examination. Moreover, while the Veteran sought treatment throughout the years, he did not report any knee symptomatology until after he suffered an injury to his left knee in 2006. Rucker, supra; Williams, supra. Consequently, presumptive service connection, to include on the basis of a continuity of symptomatology, for arthritis of the bilateral knees is not warranted. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309; Walker, supra. Based on the foregoing, the Board finds that a bilateral leg disorder is not shown to be causally or etiologically related to any disease, injury, or incident in service and arthritis did not manifest within one year of service discharge. Therefore, service connection for such disorder is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim for entitlement to service connection for a bilateral leg disorder. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. 5107; 38 C.F.R. 3.102; Gilbert, supra. 3. Entitlement to service connection for an upper GI disorder, to include GERD. The Veteran contends that his current upper GI disorder, to include GERD, is related to his military service. In this regard, he asserts that he first experienced symptoms during basic training and again two or three times while at his permanent duty station, and such have continued to the present time. Therefore, the Veteran claims that service connection for an upper GI disorder is warranted. The Veteran’s service treatment records show that, in December 1978, he was treated for gastroenteritis and gastritis. Specifically, he was hospitalized for two days at such time with a diagnosis of acute gastritis. In this regard, at discharge, it was noted that his nausea and vomiting had resolved, and it was found that there was likely an infectious cause of his gastric distress. The remainder of his service treatment records are negative for any complaints, treatment, or diagnosis referable to a GI disorder. Further, at his February 1979 separation examination, the Veteran’s abdomen and viscera were normal upon clinical evaluation, and he denied frequent indigestion and stomach, liver, or intestinal trouble. After service, the Veteran underwent a VA examination in April 2012, at which time the examiner noted that, 10 years prior, the Veteran was seen for vomiting that was related to over-consumption of ibuprofen and that since then, he vomited easily. The examiner noted a history of heartburn and some vomiting of blood. She also noted an August 2009 VA treatment note in which the Veteran denied vomiting blood or experiencing GERD. Ultimately, the examiner found that the Veteran did not have a diagnosis of GERD at the time of the examination. However, subsequent VA treatment records reflected treatment for an impression of GERD in May 2013 and an esophagogastroduodenoscopy (EGD) revealed a diagnosis of mild near erosive antritis in June 2013. Therefore, in light of the additional evidence suggesting the presence of a current upper GI disorder, the Board remanded the case in January 2016 in order to obtain a new VA examination with an opinion addressing the etiology of such disorder. Thereafter, the Veteran was afforded a VA examination in March 2016. At such time, the examiner diagnosed GERD with an onset in 2013. She further noted the Veteran’s in-service hospitalization for acute gastritis as detailed above, and the absence of any further GI complaints in the service treatment records, to include at the time of the February 1979 separation examination. The examiner observed the Veteran’s report that he had symptoms of heartburn that he treated with over the counter medications for decades. She also noted that, in 2005, he was seen for a severe episode of vomiting blood in 2005 due to excess ibuprofen. Specifically, in July 2005, the Veteran was admitted for an upper GI bleed attributed to likely NSAID use for several months with secondary peptic ulcer disease. No source for the bleeding was found, but it was noted that he may have had a small MWT that had healed by the time the EGD was conducted. A follow up note indicated that the Veteran had erosions due to NSAID use. In August 2006, an assessment of GERD was rendered, and medications were prescribed, and such diagnosis and treatment were also noted as recently as May 2013. The examiner then opined that it was at least as likely as not that the Veteran’s current upper GI disorder is related to his complaints in service. In rendering such opinion, she presumed the Veteran’s report that he had GERD-type symptoms in service for which he took over the counter medications to be credible. The examiner further noted that the record documented a diagnosis and treatment for GERD as of 2006. She further indicated that she believed that it was medically reasonable to conclude that the Veteran was able to manage his upper GI disorder with over the counter antacids between his separation from service until it dramatically worsened when aggravated by NSAID use in 2005. The examiner found that it was at least as likely as not that the Veteran’s current upper GI condition is related to his complaints in service. However, the Board accords no probative weight to the March 2016 VA examiner’s opinion as such is based on an inaccurate factual premise, i.e., that the Veteran had GERD-type symptoms in service that he managed with over the counter medications. Specifically, while the VA examiner presumed the credibility of such report, the Board finds that, as it is in direct conflict with the contemporaneous medical evidence, it is not credible. Consequently, as the March 2016 VA examiner relied upon it in rendering her opinion, such is based on an inaccurate factual premise and thus entitled to no probative weight. See Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005); Coburn v. Nicholson, 19 Vet. App. 427, 432 (2006) (reliance on veteran’s statement renders a medical report not credible only if the Board rejects the statement of the veteran). In this regard, while the Veteran reported GERD-type symptoms in service, such is not supported by his service treatment records. Specifically, while such reflect hospitalization for acute gastritis, which was noted to be infectious in nature, the remainder of the records are negative for any complaints, treatment, or diagnosis referable to an upper GI disorder, to include symptoms associated with GERD. Further, at his February 1979 separation examination, the Veteran’s abdomen and viscera were normal upon clinical evaluation, and he denied frequent indigestion and stomach, liver, or intestinal trouble. Moreover, while he received treatment for numerous ailments over the years since service, he did not report any relevant symptomatology until 2005, at which time he was seen for a GI bleed to excessive ibuprofen, and GERD was not diagnosed until August 2006. Further, no medication referable to the treatment of GERD was noted until such time. Rucker, supra; Williams, supra. Consequently, the Board finds that the Veteran’s report of GERD-type symptoms in service and treatment of such with over the counter medication to be not credible. Therefore, the March 2016 VA examiner’s opinion based on such inaccurate history is entitled to no probative weight. See Nieves-Rodriguez, supra; Stefl, supra. Thereafter, in an April 2017 addendum opinion, a different VA examiner opined that the Veteran’s upper GI disorder, diagnosed as GERD, was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In this regard, he noted that a review of the Veteran’s service treatment records showed no evidence of a diagnosis or treatment for GERD. Rather, the Veteran was treated for gastritis, which is a completely separate condition from GERD. Specifically, “gastritis” is a term often used by endoscopists to describe the gastric mucosa rather than representing a particular endoscopic entity. A gastric mucosal biopsy is necessary to establish a definitive diagnosis of gastritis versus gastropathy. Gastritis is commonly secondary to infectious or autoimmune etiologies. Conversely, GERD is defined as a condition that develops when the reflux of the stomach content causes troublesome symptoms and/or complications. The Board places great weight on the April 2017 VA examiner’s opinion as such considered all of the pertinent evidence of record, to include the statements of the Veteran, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Id. The Board acknowledges that the Veteran’s belief his current upper GI disorder, to include GERD, is related to his military service. However, as previously discussed, the Board has found his report of GERD-type symptoms in service and treatment with over the counter medication to be not credible. Furthermore, while lay persons are competent to provide opinions on some medical issues, in this case, the cause of such disorder falls outside the realm of common knowledge of a lay person. See Jandreau, supra; Woehlaert, supra. Specifically, such matter involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In this regard, the diagnosis and etiology of an upper GI disorder such as GERD concern an internal process, and specialized knowledge is necessary to determine whether the Veteran’s reported in-service symptoms are related to his current diagnosis of GERD. Moreover, whether the symptoms he reportedly experienced during or after service are in any way related to his currently diagnosed upper GI disorder is a matter that also requires medical expertise to determine. Clyburn, supra. Accordingly, the Veteran’s opinion as to the onset and etiology of his upper GI disorder, to include GERD, is not competent evidence and, consequently, is afforded no probative weight. Based on the foregoing, the Board finds that an upper GI disorder, to include GERD, is not shown to be causally or etiologically related to any disease, injury, or incident in service. Therefore, service connection for such disorder is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim for entitlement to service connection for an upper GI disorder, to include GERD. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. 5107; 38 C.F.R. 3.102; Gilbert, supra. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Gardner Gaye, Associate Counsel