Citation Nr: 20021437 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 17-03 460 DATE: March 25, 2020 ORDER Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied. FINDING OF FACT GERD did not have its onset during active service and is not otherwise related to active service. CONCLUSION OF LAW The criteria for entitlement to service connection for GERD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1977 to February 1978 and from November 1978 to July 1979. The Veteran had a hearing before the undersigned Veterans Law Judge in October 2019. A transcript of the hearing is of record. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (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. Service connection may 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). Entitlement to service connection for acid reflux (claimed as gastroesophageal reflux disease-GERD). The Veteran testified that he had severe abdominal pain in service at 17 or 18 years old when he drank milk or ate ice cream. The Veteran testified that he has not been diagnosed with a dairy allergy. The Veteran testified that he tries to eat healthy, exercise, and avoid foods that have acid. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for GERD. The reasons follow. As to evidence of a current disability, a June 2016 VA examination report shows that Veteran has been diagnosed with GERD. Therefore, the Veteran meets the first element of a service-connection claim. As to evidence of an in-service disease or injury, the service treatment records do not show a disease or injury involving the stomach or esophagus during the Veteran’s first period of service, but show a stomach complaint during the Veteran’s second period of service, which the Board finds is not indicative of GERD. For example, as to the first period of service, in an October 1977 Medical History, the Veteran denied ever having stomach trouble. On a December 1977 Report of Medical History (RMH) near separation from the first period of service, the Veteran denied a history of throat trouble, frequent indigestion, and stomach, liver, or intestinal trouble. The Veteran wrote in that document that he was in good health. In a December 1977 Report of Medical Examination (RME) near separation from the first period of service, it shows that clinical evaluations of the mouth and throat and the abdomen were both normal. These service treatment records do not support a finding that the Veteran had GERD or symptoms of GERD during his first period of service. As to the second period of service, in a November 1978 Medical History, the Veteran marked yes for ever having stomach trouble. On a May 1979 Chronological Record of Medical Care, the Veteran was seen for pain in the abdominal area where he reported he could not eat for two days, and he had not had a bowel movement for four days. The Veteran was diagnosed with constipation and given a laxative. On a June 1979 RME, it shows that clinical evaluations of the mouth and throat and the abdomen were both normal. In a June 1979 RMH, the Veteran denied a history of throat trouble, frequent indigestion, and stomach, liver, or intestinal trouble. The Veteran also wrote in that document that he was in good health. The Board finds that the first period service does not show that the Veteran had GERD or symptoms of GERD. The Board also finds that the service treatment records from the second period of service do not show an in-service disease or injury related to GERD. First, as to the report in November 1978 of a history of stomach trouble as he entered the second period of service, as noted above, the Veteran was not documenting esophageal or stomach trouble during his first period of service when he completed forms during that period of service. This admission in November 1978 followed a six-month break (approximately) between his first and second period of service, which does not establish that the stomach trouble began during the first period of service. Second, as to the diagnosis of constipation in May 1979, such diagnosis relates to a gastrointestinal problem versus an esophageal problem. GERD involves the esophagus. Thus, the Board finds that the preponderance of the evidence is against a finding that the Veteran had a disease or injury related to GERD during either period of service. Even if the Board conceded that a complaint of stomach pain during service was indicative of GERD, the preponderance of the evidence is against a nexus between the diagnosis of GERD and the Veteran’s service. For example, a May 2014 private treatment record had a “Current Problem List,” which did not include GERD, but included multiple other medical symptoms, which tends to show that the Veteran was not experiencing GERD at that time. VA treatment records from May 2012 to October 5, 2015 did not show complaints related to GERD, and VA’s “Problem List” during this time period did not include GERD, but listed 10, other medical problems, which tends to establish that the Veteran was not documenting GERD symptoms during this time frame. However, in an October 27, 2015 VA treatment record, while being seen for chronic medical problems, the Veteran reported experiencing acid reflux at least twice a week. The Veteran stated he had eaten a lot of Tums and Rolaids, but that antacids were not much help. Thus, the medical records first document the Veteran complaining of acid reflux in October 2015, which is more than 30 years (approximately 36 years) following service discharge and tends to establish that acid reflux or GERD did not have its onset in service. The Veteran testified that he experienced symptoms of GERD since 1979, which he treated with over-the-counter medications. He stated he did not realize he had GERD until he began VA treatment in 2012. However, as noted above, while VA treatment records begin in 2012, the first documentation of the Veteran reporting acid reflux while being treated by VA is in October 2015, which is three years into his treatment at VA and is evidence that tends to show that the Veteran was not reporting acid reflux from 2012 to later in 2015. The Veteran contended on his October 2016 Notice of Disagreement that he disagreed with the denial of service connection for GERD because he believes his constipation in service that was treated with a laxative is related to his current treatment for GERD. The Veteran reiterated this point on his January 2017 VA Form 9, Appeal to the Board. As stated above, the Board finds that constipation is not indicative of acid reflux, and the Veteran has not provided competent evidence that it is indicative of acid reflux or GERD. At the present time, there is no competent evidence of a nexus between the Veteran’s current diagnosis of GERD and service, to include the diagnosis of constipation during his second period of service. The Veteran testified that he would like a VA examination in connection with his claim for service connection for GERD. The Board does not find that the facts of this case establish entitlement to a VA examination is warranted. VA must provide a medical examination when 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, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the evidence does not show that an event, injury, or disease occurred in service involving the esophagus nor does it establish that GERD may be associated with the Veteran’s service, as discussed above. Again, GERD is first documented approximately 36 years after the Veteran’s service discharge. For a VA examination to be warranted, all the McLendon criteria have to be met, and at least one element is not met. Therefore, entitlement to a VA examination is not warranted. While the Veteran has attempted to establish a nexus through his own lay assertions that his GERD is related to service, he is not competent to offer opinions as to the etiology of GERD. GERD requires specialized training for determinations as to diagnosis and causation, and is, therefore, not susceptible to lay opinions on etiology. Therefore, the Veteran’s assertion that the constipation he experienced on one occasion in service is indicative of GERD is nonprobative evidence. At the present time, there is no competent evidence of a positive nexus between the current disability of GERD and service. For the reasons described above, the Board finds the preponderance of the evidence is against the Veteran’s claim for service connection for GERD. There is no reasonable doubt to be resolved, and the claim for service connection is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. McDaniels, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.