Citation Nr: 20023977 Decision Date: 04/08/20 Archive Date: 04/08/20 DOCKET NO. 16-25 715 DATE: April 8, 2020 ORDER Entitlement to a 10 percent rating for gastroesophageal reflux disease (GERD) is granted. REMANDED Entitlement to a compensable rating for hypertension is remanded. FINDING OF FACT The Veteran’s GERD has been manifested by persistently recurrent epigastric distress with dysphagia, pyrosis, and sleep disturbance but not substernal or arm or shoulder pain. CONCLUSION OF LAW With resolution of reasonable doubt in the Veteran’s favor, the requirements for an increased disability rating of 10 percent, but no higher, for GERD have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107, 7104 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.1, 4.3, 4.7, 4.10, 4.14, 4.20, 4.21, 4.114, Diagnostic Code 7346, (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from June 2006 to August 2013. Increased Rating Entitlement to a compensable rating for GERD Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. The evaluation of a service-connected disorder requires a review of a veteran’s entire medical history regarding that disorder. 38 U.S.C. § 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Evidence to be considered in an appeal from an initial disability rating is not limited to current severity, but will include the entire period of the disorder. Additionally, it is possible for a veteran to be awarded separate percentage evaluations for separate periods (staged ratings), based on the facts. See Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 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; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran’s disability is currently rated under Diagnostic Code 7346. 38 C.F.R. § 4.114. This Diagnostic Code provides that a 10 percent disability rating is assigned for a hiatal hernia with two or more symptoms for the 30 percent evaluation of less severity. A 30 percent disability rating is awarded 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 60 percent disability rating is assigned 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. 38 C.F.R. § 4.114, Diagnostic Code 7346. In regard to closely related conditions, VA regulations recognize that there are diseases of the digestive system, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. 38 C.F.R. § 4.113. Consequently, certain coexisting diseases in this area do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in § 4.14. Rather, a single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.114. The Board also notes that, with regard to the schedule of ratings for the digestive system, section 4.114 expressly prohibits, in pertinent part, the combination of ratings under Diagnostic Codes 7301 to 7329, inclusive, and 7345 to 7348 inclusive, which include the schedular criteria for Diagnostic Code 7346. The Veteran filed a claim of service connection for GERD in June 2014. He was afforded a VA examination in May 2015. The examiner noted a diagnosis of GERD. The Veteran takes continuous medication for his disorders. The examiner noted 4 or more episodes of pyrosis and reflux per year. The Veteran did not have any epigastric distress, dysphagia, regurgitation, esophageal stricture, spasm, or acquired diverticulitis of the esophagus. A September 2015 rating decision granted service connection for GERD and assigned a noncompensable rating based on pyrosis. The Veteran filed a notice of disagreement, contending that he warranted a higher rating as his GERD produced “considerable impairment of health.” In a June 2016 statement, the Veteran argued that he took medication for his GERD, but if he was to stop taking the medication, his condition would worsen. In his August 2016 substantive appeal, the Veteran reported periumbilical abdominal pain and acute GI bleeding, along with broken and cracked teeth, were causing a considerable impairment of health due to his GERD. The Veteran underwent a VA examination in November 2018. The examiner diagnosed GERD and hiatal hernia. He reported daily episodes of pyrosis and feeling his throat tighten. The Veteran takes continuous medication for his disorders. The examiner noted symptoms of persistently recurring epigastric distress, dysphagia, pyrosis, reflux, and sleep disturbance caused by esophageal reflux. His symptoms recur 4 or more times per year and have an average duration of 10 days or more. An April 2018 treatment record was negative for abdominal distension, pain, bleeding, diarrhea, nausea, rectal pain, or vomiting. With consideration of the evidence of record and resolution of the doubt in favor of the Veteran, the Board finds that a 10 percent evaluation is warranted. The evidence shows two or more of the symptoms listed in the 30 percent rating but not the requite substernal or arm or shoulder pain as required for the 30 percent rating. Therefore, the higher 30 percent rating is not approximated. Therefore, resolving all doubt in the Veteran’s favor, the Board finds that the level of severity of the Veteran’s GERD symptoms satisfy the criteria for a higher 10 percent disability evaluation under Diagnostic Code 7346 and the Veteran’s claim for an increased 10 percent rating is granted. As noted, there is no basis to assign a higher rating under any applicable code. REASONS FOR REMAND Entitlement to a compensable rating for hypertension is remanded. Remand is necessary to afford the Veteran a VA examination to assess the current severity of his hypertension. In a February 2020 statement, the Veteran asserted that his hypertension had increased in severity since his most recent VA examination in August 2015. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his hypertension. The matters are REMANDED for the following action: 1. Obtain and associate all outstanding, relevant treatment records with the claims file. The Veteran’s assistance in identifying and obtaining the records should be solicited as needed. All attempts to obtain records should be documented in the claims file. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected hypertension. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. Any appropriate tests should be conducted with the findings reported in detail. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shana Z. Siesser, 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.