Citation Nr: 20042015 Decision Date: 06/19/20 Archive Date: 06/19/20 DOCKET NO. 16-14 495 DATE: June 19, 2020 ORDER Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s GERD began during active service, manifested in continuity of symptomatology, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for GERD have not been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had qualifying service from May 1981 to December 1984. In October 2018, the Board remanded for further development. Direct service connection generally requires 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). Although a competent medical opinion is generally required to establish etiology, competent and credible lay evidence of chronicity and continuity of symptomology may also establish etiology. 38 C.F.R. § 3.303(b); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994). Notably, in this case, the evidence does not show that the Veteran has the medical background necessary to competently identify or opine regarding symptoms or diagnoses that are not lay observable; however, the Veteran, as a layperson, is competent to identify or opine regarding any lay-observable symptoms or diagnoses. Jandreau, supra; Layno, supra. The Veteran generally contends that his GERD began during and has continued since service; the Veteran further contends that he was misdiagnosed in service, such that he should have been diagnosed with GERD. See January 2014 Fayetteville VAMC record (the Veteran reported stomach pain possibly due to acid reflux and stated that he was diagnosed during service); May 2015 Notice of Disagreement (NOD) (the Veteran contended that he was treated in service for GERD and continuously suffered with and treated it since service); April 2016 VA Form 9 (the Veteran contended that GERD began in service, worsened over the years, and that it was misdiagnosed in service); August 2019 VA esophageal conditions examination report (the Veteran contended that GERD began in service and has worsened over time). The service treatment records (STRs) contain no pertinent abnormalities in the entrance examination or separation examination. However, the Veteran had in-service treatment, in pertinent part, for stomach cramps, nausea, abdominal pain, vomiting, and diarrhea; the Veteran had in-service diagnoses of gastroenteritis in June 1982 and gastritis in August 1982. Notably, the Veteran was never diagnosed with GERD in service or upon separation. Preliminarily, the Board finds that lay evidence regarding continuity of symptomatology is inconsistent. Specifically, in the May 2015 NOD, the April 2016 VA Form 9, and the August 2019 VA examination report, the Veteran contended that he had continuous GERD symptoms since service; however, an October 2011 Fayetteville VAMC record documented the Veteran’s denial of a significant history of GI issues and both VA treatment records and private treatment records from Dr. JK lacked any reports of pertinent symptoms, signs, or diagnoses prior to 2014 (nearly 30 years after separation). Then, in January 2014, the Veteran reported “some GERD symptoms” to private provider Dr. JK; also in January 2014, the Veteran reported “stomach pain possibly due to acid reflux” to a Fayetteville VAMC provider, who then prescribed Omeprazole in June 2014. The Veteran has not contended that he self-treated any pertinent, lay-observable symptoms before 2014; further, the Veteran has not provided any competent medical evidence or opinion indicating that the onset of his GERD was before 2014. Although the Veteran is competent to report esophageal pain, because it is a lay-observable symptom, his contention of continuous GERD symptomatology since service is simply inconsistent with the longitudinal record (including the STRs and post-separation medical evidence). Based on the inconsistent lay evidence regarding continuous GERD symptomology since service, the Board finds it insufficient to establish an etiological relationship to service based on continuity of symptomology. 38 C.F.R. § 3.303(b). Additionally, the Board finds that the Veteran’s GERD is not etiologically related to service on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). As discussed above, although the Veteran contends that his GERD is etiologically related to his in-service symptoms/diagnoses, the evidence does not demonstrate that he has the medical background necessary to render a competent etiological opinion; thus, the Board finds that his etiological opinion is of no probative value. Jandreau, supra; Layno, supra. Further, the Veteran was afforded an August 2019 VA examination with an etiological opinion, in which the examiner rendered an unfavorable opinion. During the examination, the Veteran reported that he: had heartburn, vomiting, chest pain, and a bad taste in his mouth/throat after eating or drinking certain items in the Philippines during service; sought care in 1985 by a primary care provider in North Carolina, but the provider rendered no diagnosis or treatment; currently has heartburn, burning throat, reflux, chest pain, and vomiting that worsens when he does not watch what he eats and drinks; and had never seen a gastroenterologist or had a barium swallow. The examiner noted the STRs and post-separation medical evidence; however, he opined that the Veteran did not have GERD in service (rather, he was clearly diagnosed with gastroenteritis, which is a lower GI issue) and that the Veteran’s GERD was not etiologically related to his in-service diagnosis because GERD is an upper GI issue and is unrelated to gastroenteritis. The Board finds the examiner’s opinion to be probative because it was fully supported and sufficiently explained how the in-service condition and the GERD involve different sections of the GI tract. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion “must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Finally, the Veteran has not submitted any private etiological opinions that contradict the August 2019 examiner’s opinion. Thus, the Board finds the probative evidence insufficient to establish an etiological relationship to service on a direct basis. As such, the claim must be denied. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Daus, 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.