Citation Nr: 19133003 Decision Date: 04/26/19 Archive Date: 04/26/19 DOCKET NO. 15-44 676 DATE: April 26, 2019 ORDER Entitlement to service connection for irritable bowel syndrome (IBS) is denied. Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has IBS due to a disease or injury in service, to include specific in-service event, injury, or disease. 2. The preponderance of the evidence is against finding that the Veteran has GERD due to a disease or injury in service, to include specific in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for IBS have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for entitlement to service connection for GERD have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran has served with the Air National Guard since August 2005, with active duty service during the following periods: November 2005 to April 2006, January 2007 to April 2007, August 2007 to May 2008, June 2008 to September 2008, May 2011 to July 2011, February 2012 to June 2012, May 2015 to October 2015, May 2016 to March 2017, April 2017 to September 2017, and October 2017 to September 2018. This case comes before the Board of Veterans’ Appeals (Board) on appeal of January 2014, January 2015 and January 2018 rating decisions by Department of Veterans Affairs (VA) Regional Offices (RO). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; 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, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for IBS is denied. The Veteran contends that he has IBS that is related to an in-service injury, event, or disease. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has IBS, the preponderance of the evidence is against finding that it began during active service, or that it is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Board acknowledges that the Veteran was not afforded a VA examination for his claim for service connection for IBS. Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in initial service connection claims, the VA must provide a VA medical examination where there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service; and (4) insufficient competent medical evidence on file for VA to make a decision on the claim. In this regard, the Board finds that the Veteran has submitted insufficient evidence to indicate that his IBS is related to an event, injury, or disease that occurred in service. Accordingly, the Board finds that no further development of the Veteran’s claims for service connection for IBS is required. The Veteran deployed to Afghanistan from January 2007 to March 2007. An October 2007 post-deployment health assessment documented that the Veteran had not experienced diarrhea, vomiting, or frequent indigestion/heartburn. The Veteran deployed to Afghanistan again from February 2012 to April 2012. An April 2012 post-deployment health assessment documented that the Veteran had not experienced diarrhea, vomiting, or frequent indigestion/heartburn. An October 2012 post-deployment health re-assessment documented that the Veteran had not experienced diarrhea, vomiting, or frequent indigestion/heartburn. A September 2013 VA post-deployment screening reported that the Veteran did not experience abdominal pain, nausea, vomiting, or bowel changes. An April 2014 private gastroenterology clinic note reported that the Veteran complained of abdominal pain, occasional constipation, and bloody stools. The Veteran reported that he first noticed rectal bleeding a few times a year in 2007 when he was overseas in Afghanistan. He reported that the bleeding has increased in the last few years. In May 2014, the Veteran underwent an upper gastrointestinal endoscopy that showed a normal stomach and duodenum. The Veteran was diagnosed with internal hemorrhoids without mention of complication. A September 2014 private gastroenterology clinic note reported that the Veteran was experiencing daily abdominal pain. He was diagnosed with abdominal pain and bloating. A November 2014 private gastroenterology clinic note reported that the Veteran returned with continued complaints of abdominal pain. He was diagnosed with abdominal pain and constipation. A February 2015 private gastroenterology clinic note reported that the Veteran returned with continued complaints of abdominal pain. He was diagnosed with abdominal pain, constipation, bloating, and IBS. A June 2015 medical record from a military treatment facility reported that the Veteran had a history of IBS and had been experiencing abdominal pain for two weeks. No abnormal results have been reported with colonoscopy and endoscopy within the past two years. He was diagnosed with esophageal reflux, IBS, and obesity. An August 2015 medical record from a military treatment facility reported that the Veteran had experienced upper abdominal pain for two months. He stated that there was no memorable injury. He denied GERD symptoms though he reported being previously treated for GERD. The Veteran was diagnosed with bloating. An October 2018 Board hearing, the Veteran testified that he started noticing heartburn when he was overseas in Afghanistan. He reported that, since his deployment to Afghanistan, his condition has progressed to being worse, which requires medication. He testified that he was first diagnosed with GERD and IBS sometime in 2013. According to the Veteran, he experienced chronic stomach symptoms in 2013. He described the IBS pain as an 8 or 9 on a scale of 1 to 10. To treat his IBS and GERD, the Veteran has been utilizing a GI clinic in Cleveland. An October 2018 private medical record reported that the Veteran had a history of reflux and IBS. According to the Veteran, his problems started when he deployed to Afghanistan in 2012. At that time, he was noticing heartburn and blood in his stools. He started noticing abdominal pain and underwent endoscopic workup in 2014 with both a gastroscopy and colonoscopy. At an October 2018 Board hearing, the Veteran testified that he was first diagnosed with IBS sometime in 2013. However, a September 2013 VA post-deployment screening reported that the Veteran did not experience abdominal pain, nausea, vomiting, or bowel changes. Furthermore, at post deployment health assessments competed in October 2007, April 2012, and October 2012, the Veteran reported that he had not experienced diarrhea, vomiting, or frequent indigestion/heartburn. The earliest evidence of IBS was the Veteran’s diagnosis of IBS in February 2015, which was between the Veteran’s periods of active service. The Veteran completed a period of active service in June 2012 and began his next subsequent period of active service in May 2015. The Board acknowledges the Veteran’s contentions that his IBS is related to service. While the Veteran is competent to report symptoms observable to a layperson, such as pain, to the extent that he seeks to establish a nexus between a current disability and service or onset in service, the Board finds lay witnesses are not competent to opine on such medical questions of etiology as this requires medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). For this purpose, the Board finds the Veteran’s statements are not competent medical evidence. Furthermore, there is no medical evidence indicating a link between the Veteran’s IBS and service. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claims for service connection for IBS. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claims, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran’s claim for IBS must be denied. 2. Entitlement to service connection for GERD is denied. The Veteran contends that he has GERD that is related to an in-service injury, event, or disease. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has been diagnosed with GERD, the preponderance of the evidence is against finding that it began during active service, or that it is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran deployed to Afghanistan from January 2007 to March 2007. An October 2007 post-deployment health assessment documented that the Veteran had not experienced diarrhea, vomiting, or frequent indigestion/heartburn. The Veteran deployed to Afghanistan again from February 2012 to April 2012. An April 2012 post-deployment health assessment documented that the Veteran had not experienced diarrhea, vomiting, or frequent indigestion/heartburn. An October 2012 post-deployment health re-assessment documented that the Veteran had not experienced diarrhea, vomiting, or frequent indigestion/heartburn. A September 2013 VA post-deployment screening reported that the Veteran did not experience abdominal pain, nausea, vomiting, or bowel changes. After the Veteran filed a claim for “gastrial reflux” in April 2013, the Veteran was afforded a VA examination for esophageal conditions in December 2013. The Veteran reported that he had heartburn from time to time. He reported taking antacids three to four times a week but denied a specific work impact. He denied receiving a diagnosis of GERD. The examiner reported that the Veteran did not have any signs or symptoms due to any esophageal conditions, including GERD. An April 2014 private gastroenterology clinic note reported that the Veteran complained of abdominal pain, occasional constipation, and bloody stools. The Veteran first noticed rectal bleeding a few times a year in 2007 when he was overseas in Afghanistan. He reported that the bleeding has increased in the last few years. In May 2014, the Veteran underwent an upper gastrointestinal endoscopy that showed a normal stomach and duodenum. The Veteran was diagnosed with internal hemorrhoids without mention of complication. A September 2014 private gastroenterology clinic note reported that the Veteran was experiencing daily abdominal pain. He was diagnosed with abdominal pain and bloating. A November 2014 private gastroenterology clinic note reported that the Veteran returned with continued complaints of abdominal pain. He was diagnosed with abdominal pain and constipation. A February 2015 private gastroenterology clinic note reported that the Veteran returned with continued complaints of abdominal pain. He was diagnosed with abdominal pain, constipation, bloating, and IBS. An April 2015 private gastroenterology clinic note reported that the Veteran complained of intermittent reflux/heartburn. He continues to have intermittent attacks of right-sided abdominal pain, though they are less frequent and severe. He was diagnosed with reflux esophagitis and IBS. A June 2015 medical record from a military treatment facility reported that the Veteran had been experiencing abdominal pain for two weeks. No abnormal results have been reported with colonoscopy and endoscopy within the past two years. He was diagnosed with esophageal reflux, IBS, and obesity. An August 2015 medical record from a military treatment facility reported that the Veteran had experienced upper abdominal pain for two months. He stated that there was no memorable injury. He denied GERD symptoms though he reported being previously treated for GERD. The Veteran was diagnosed with bloating. A January 2016 private gastroenterology clinic note reported that the Veteran occasionally had reflux. He admitted to eating poorly, as his diet consisted mostly of processed food from fast food chains and gasoline stations. The Veteran was diagnosed with reflux esophagitis, IBS, and constipation. An October 2016 private gastroenterology clinic note reported that the Veteran’s abdominal pain had improved significantly. The treating physician reported that the Veteran had no reflux, dysphagia, or gastrointestinal bleeding. In December 2017, a VA examiner reviewed the Veteran’s records and opined that his GERD was less likely than not (less than 50% probability) incurred in or caused by an in-service injury, event, or illness. As rationale, the examiner explained that occasional episodes of heartburn or reflux are not a chronic GERD condition. No evidence of record found that he was diagnosed with GERD during his active duty military service. An October 2018 Board hearing, the Veteran testified that he started noticing heartburn when he was overseas in Afghanistan. He reported that, since his deployment to Afghanistan, his condition has progressed to being worse, which requires medication. He testified that he was first diagnosed with GERD sometime in 2013. According to the Veteran, he experienced chronic stomach symptoms in 2013. To treat his GERD, the Veteran has been utilizing a GI clinic in Cleveland. An October 2018 private medical record reported that the Veteran had a history of reflux and IBS. According to the Veteran, his problems started when he deployed to Afghanistan in 2012. At that time, he was noticing heartburn and blood in his stools. He started noticing abdominal pain and underwent endoscopic workup in 2014 with both a gastroscopy and colonoscopy. The Board notes that an October 2018 medical record documents the Veteran’s report that his reflux began when he was deployed to Afghanistan in 2012 and the Veteran testified at an October 2018 Board hearing that he was first diagnosed with GERD sometime in 2013. However, these statements conflict with post deployment screenings of record. At post-deployment health assessments competed in October 2007, April 2012, and October 2012, the Veteran reported that he had not experienced diarrhea, vomiting, or frequent indigestion/heartburn. A September 2013 VA post-deployment screening reported that the Veteran did not experience abdominal pain, nausea, vomiting, or bowel changes. The Veteran’s statements that his GERD began in 2013 also conflict with the December 2013 VA examination report. The examination report documented the Veteran’s denial of having received a diagnosis of GERD. Furthermore, the December 2013 VA examiner reported that the Veteran did not have any signs or symptoms due to any esophageal conditions, including GERD. The earliest evidence of GERD was the Veteran’s diagnosis of reflux esophagitis in April 2015, which was between the Veteran’s periods of active service. The Veteran completed a period of active service in June 2012 and began his next subsequent period of active service in May 2015. The Board acknowledges the Veteran’s contentions that his GERD is related to service. While the Veteran is competent to report symptoms observable to a layperson, such as pain, to the extent that he seeks to establish a nexus between a current disability and service or onset in service, the Board finds lay witnesses are not competent to opine on such medical questions of etiology as this requires medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). For this purpose, the Board finds the Veteran’s statements are not competent medical evidence. Consequently, the Board gives more probative weight to the December 2017 VA examiner’s medical opinion. The examiner opined that the Veteran’s GERD was less likely than not (less than 50% probability) incurred in or caused by an in-service injury, event, or illness. As rationale, the examiner explained that occasional episodes of heartburn or reflux are not a chronic GERD condition, and no evidence of record found that he was diagnosed with GERD during his active duty military service. Furthermore, the Veteran did not provide any medical evidence indicating a link between the Veteran’s GERD and service. (Continued on the next page)   Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claims for service connection for GERD. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claims, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran’s claim for GERD must be denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Moore, Associate Counsel