Citation Nr: 19121908 Decision Date: 03/26/19 Archive Date: 03/23/19 DOCKET NO. 17-48 169A DATE: March 26, 2019 ORDER Entitlement to service connection for residuals of stomach surgery and repair is denied. FINDINGS OF FACT 1. The Veteran underwent surgery on his abdomen region in January 1978, while in service. 2. The preponderance of the evidence of record, however, is against finding that the Veteran had any residuals of that stomach surgery and repair at any time during or approximate to the pendency of this claim. CONCLUSION OF LAW The criteria for service connection for residuals of stomach surgery and repair are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from June 1972 to May 1979. This appeal is before the Board of Veterans’ Appeals (Board) on appeal from an August 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran passed away in September 2017, and his wife, the appellant, was substituted in May 2018 for the purpose of processing this claim to completion. Entitlement to service connection for residuals of stomach surgery and repair The appellant-widow contends that the Veteran suffered from residuals of surgery he had on his abdomen region while in service because a zipper was left in his abdomen. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran had a current disability during the pendency of this appeal that began during service or is at least as likely as not related to an in-service injury, event, or disease – in particular, the surgery mentioned. The Board concludes that the Veteran did not have a current disability as a residual of the stomach surgery and repair at issue and did not at any time during the pendency of this claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Consequently, the appeal must be denied. The Board has determined that, while the Veteran did indeed undergo surgery in January 1978, during his time in service, where an appendectomy, ureterolysis, and exploratory laparotomy were performed, there is no probative evidence that a zipper was used or involved and there was not a zipper, or other foreign object, left in his abdomen as a result of that surgery or any other procedure owing to or during his service. In September 2016 the Veteran underwent a CT scan of his chest and abdomen after reporting to the hospital with complaints of chest pain. The CT scan results for the abdomen region showed there was asymmetric thickening of the left iliacus muscle with minimal amount of fluid seen anteriorly, and that there was a low-attenuation area in the liver along the falciform ligament. No other remarks were made noting any abnormalities in his abdomen, including the presence of a foreign object such as a zipper. As such, at the time of his death and throughout the pendency of this appeal, he did not have a foreign object in his abdomen as a result of his January 1978 surgery in service. Moreover, there is no suggestion of any consequent disability. Entitlement to service connection could still be warranted if the Veteran had a current disability as a residual of that January 1978 surgery during his time in service. Unfortunately, however, the Board finds that this is not the case as he did not have a current disability resulting from his January 1978 surgery at any point throughout the pendency of this appeal.   The Veteran’s VA treatment records dating back to October 2008 do not reveal any treatment for or complaint of ongoing issues or symptoms in the abdomen region that could have been related to or the result of his in-service surgery. On VA treatment records dated in September 2016, October 2016, and March 2017, the Veteran’s medical history noted that he had previously had a blocked ureter by abdominal vasculature status post unknown abdominal surgery, an apparent reference to his January 1978 surgery in service. But the post-surgery notes from January 1978 state that he had a blocked ureter at that time, but the operating urologist decided against performing any exploratory surgery requiring opening of the Veteran’s ureter. As such, there was no surgical procedure performed on the Veteran’s ureter and this blockage was not the result of any in-service incurrence, including his January 1978 surgery. The medical evidence of record does not show any complaints of pain referable to his abdomen surgery or complaints related to his ureter blockage. While the appellant believes the Veteran suffered from residuals of the stomach surgery and repair, she is not competent to give a probative opinion on this determinative issue. This issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body, including the digestive system and the urinary tract. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. See Kahana v. Shinseki, 24 Vet. App. 428 (2011) (explaining that the determination of whether medical versus lay evidence is needed to support a claim is fact specific (i.e., a case-by-case judgment), based on the specific type of condition being claimed, including in terms of whether it is simple or instead complex); King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the issue of medical causation).   Accordingly, as there is no probative (competent and credible) evidence that the Veteran had a current disability resulting from his abdomen surgery during service in January 1978, this claim of entitlement to service connection for residuals of that stomach surgery and repair is denied. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K Pak, Associate Counsel