Citation Nr: 21002393 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 14-36 474 DATE: January 13, 2021 ORDER Entitlement to service connection for gallbladder removal, to include as secondary to service-connected gastroesophageal reflux disorder (GERD) is denied. FINDING OF FACT The most probative evidence indicates that the Veteran’s gallbladder removal is not related to service or caused or aggravated by his service-connected GERD. CONCLUSION OF LAW The criteria for entitlement to service connection for gallbladder removal have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1963 to February 1984. This matter comes before the Board of Veterans’ Appeals (Board) from a December 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In September 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The case was last before the Board in October 2019, and has returned to the Board for further appellate review. This appeal has been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.902(c). 1. Entitlement to service connection for gallbladder removal, to include as secondary to service-connected gastroesophageal reflux disorder (GERD) Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, to prove service connection there must be: (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). Service connection may also be established for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439 (1995). However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice- connected disease or injury. 38 C.F.R. § 3.310. The Veteran seeks service connection for removal of his gallbladder removal, which he asserts was a result of his service-connected GERD. The Veteran also asserts that the abdominal pain he complained about during service was actually pain related to his gallbladder. As an initial matter, the Board notes the Veteran has been diagnosed with cholecystectomy (surgical removal of the gallbladder) as shown on his August 2019 VA gallbladder examination. Accordingly, the first criterion, a current disability, for establishing service connection has been met. The question becomes whether the Veteran’s gallbladder removal is related to service or his service-connected GERD. With respect to direct service connection, a review of the Veteran’s service treatment records documents complaints of abdominal pain and a diagnosis of appendicitis; however, they reveal no treatment for or a diagnosis of a gallbladder disability. Post-service treatment records do not reflect treatment for a gallbladder disability until December 2013, approximately 30 years following separation from service, when he was diagnosed with acute cholecystitis, and subsequently underwent a cholecystectomy. During an August 2019 VA examination, the examiner indicated that the Veteran’s cholecystectomy is a result of having cholelithiasis/cholecystitis (gallstones). The examiner explained that the Veteran’s complaint of abdominal pain during service is not the same as gallbladder pain, and his subsequent appendicitis and resulting appendectomy are not related to the gallbladder. As such, the examiner opined that the Veteran’s cholecystectomy is less likely than not related to or caused by service. In August 2020, the VA examiner reaffirmed their August 2019 opinion and explained that the Veteran’s service treatment records show the Veteran never had a gallbladder problem, related complaint, evaluation, or treatment during service. Accordingly, as the competent evidence of record does not reflect a diagnosis of a gallbladder disability during service, and there is no evidence linking the Veteran’s gallbladder removal to service, service connection for gallbladder removal is not warranted on a direct basis. Regarding secondary service connection, the Veteran underwent a VA examination in August 2019, during which the examiner explained that the etiology and effects of GERD are different from the etiology and effects of cholelithiasis/cholecystitis. The examiner opined that the Veteran’s cholecystectomy is less likely than not proximately due to or caused by his service-connected GERD. Further, the examiner opined that there is no known objective evidence to support a hypothesis that the Veteran’s service-connected GERD would cause aggravation of his cholelithiasis/cholecystitis beyond normal progression. In an August 2020 addendum opinion, the examiner explained that there is no objective evidence showing that the Veteran’s GERD caused his cholecystectomy and that his gallbladder was removed because of acute cholecystitis, as documented in the December 2013 surgical note. Citing the Mayo Clinic, the examiner explained that cholelithiasis results when the fluid within the gallbladder contains too much cholesterol or bilirubin, or the gallbladder doesn’t empty correctly. He further explained that cholecystitis is inflammation of the gallbladder and can be caused by gallstones, a tumor, bile duct blockage, infection, or blood vessel problems, whereas, GERD occurs when stomach acid frequently flows back into the esophagus, irritating the lining of the esophagus causing it to be inflamed. As such, the examiner opined that the Veteran’s cholecystectomy is less likely than not proximately due to or caused by his service-connected GERD, and there is no evidence to support that finding that his cholelithiasis/cholecystitis was aggravated by his GERD. The Board notes that in October 2019, the Veteran’s private physician opined cholecystitis is as likely an not related to the Veteran’s military service; however the physician provided no rationale and the opinion appears to have been made based on the Veteran’s subjective report that his appendicitis in service was really gallbladder pain. Thus, the Board finds that the October 2019 private opinion is not supported by an adequate rationale for the conclusion reached. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Moreover, as the Veteran actually underwent an appendectomy in service that revealed an acute suppurative appendicitis, any opinion suggesting he was misdiagnosed with appendicitis in service is based on an inaccurate factual premise. See Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) ("If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely"). Accordingly, the Board affords the October 2019 opinion no probative weight. To the extent that the Veteran believes that his gallbladder removal is related to service or to his service-connected GERD, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of a gallbladder disability is a matter that requires medical training and expertise to determine. Accordingly, his opinion as to the diagnosis or etiology of his gallbladder removal is not competent evidence. Thus, the Board finds the opinion of the VA examiner to be significantly more probative than the Veteran’s lay assertions. In sum, the preponderance of the competent, credible, and probative evidence indicates that the Veteran’s gallbladder condition was not shown in service, and the most probative evidence of record is against a finding that the Veteran’s gallbladder removal is related to service or caused or aggravated by his service-connected GERD. Accordingly, the claim for service connection for gallbladder removal is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Lance, 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.