Citation Nr: 21002816 Decision Date: 01/15/21 Archive Date: 01/15/21 DOCKET NO. 16-63 172 DATE: January 15, 2021 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, or is otherwise related to an in-service injury or disease, to include exposure to radiation. CONCLUSION OF LAW The criteria for service connection for GERD are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from May 2001 to June 2006. In May 2019, the Veteran testified at a videoconference Board hearing. In June 2019, the Board remanded this matter to obtain VA treatment records, provide the Veteran with a VA medical examination and opinion, and to conduct further development regarding the Veteran’s possible exposure to radiation. As the updated treatment records have been obtained, the VA medical examination and opinion has been provided, and the radiation development has been conducted, there has been substantial compliance with the prior remand directives and the matter is again before the Board. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for gastroesophageal reflux disease (GERD) The Veteran contends his current diagnosis of GERD is related to his active duty service. The Veteran contends that his GERD was incurred during service aboard the submarine USS Albany, or his GERD was caused by exposure to radiation during service aboard the submarine. Legal Criteria Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be established for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d at 1372. Service connection may also be established for a disability due to exposure to ionizing radiation. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.3.07, 3.309. The Veteran’s claimed disability is not among the diseases for which presumptive service connection based upon exposure to radiation may be granted (38 C.F.R. § 3.309) or among the diseases that may be considered as potentially radiogenic (38 C.F.R. § 3.311). However, service connection due to radiation exposure may also be established on a direct basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Medical and Lay Evidence Post-service treatment records, including medical records from the Dallas VA Medical Center obtained after the Board remand, reflect a current diagnosis of GERD. The question for the Board is whether the Veteran’s GERD was incurred during his active duty military service, or was caused by exposure to radiation during service. At the Board hearing, the Veteran testified that he had stomach irritation while he was at sea and was treated by a doctor aboard the submarine. In August 2007, the Veteran completed a medical history questionnaire and indicated that he did not experience frequent indigestion or stomach, liver, or intestinal trouble. In December 2019, the Veteran was provided with a VA esophageal condition examination. The VA examiner conducted an in-person examination and reviewed the Veteran’s VA e-folder. The VA examiner noted a diagnosis of gastroesophageal reflux disease (GERD). The Veteran reported onset of GERD in service with stomach irritation while at sea, which was treated with Dexilant. The Veteran reported that he had an esophagogastroduodenoscopy (EGD) examination post-service in Louisiana with no major findings and was advised to continue using Dexilant. He reported that he is currently treated through the VA Dallas Polk clinic, with treatment including omeprazole once or twice per day. He reported symptoms including infrequent indigestion, reflux, and heart burn. The VA examiner noted symptoms including infrequent episodes of gastric distress, pyrosis, reflux, and regurgitation. After the examination and a review of the Veteran’s medical history, the VA examiner concluded that the Veteran’s GERD was less likely than not incurred in service. To support this conclusion, the examiner noted that the Veteran’s service treatment records (STRs) do not contain any diagnosis or treatment for GERD or stomach irritation. The examiner noted that, while medical records show current treatment for GERD, there is a 13-year gap between separation from service and treatment for GERD. The examiner therefore concluded that a nexus between the Veteran’s current GERD and his active duty service has not been established. The Veteran submitted a radiation risk activity information sheet in March 2015. He alleged that he was exposed to radiation aboard the USS Albany. He indicated that a film badge was issued and worn. In an August 2020 letter, the Navy Dosimetry Center confirmed that the Veteran was exposed to DDE-Photon radiation during his service aboard the USS Albany. In October 2020, the Veteran’s claims file was returned to another VA examiner to consider whether the Veteran’s GERD was caused by exposure to radiation. The VA examiner found that the Veteran’s diagnosis of GERD is less likely than not incurred in or caused by the Veteran’s verified radiation exposure during service. The VA examiner explained that GERD is a digestive disease in which stomach acid or bile irritates the food pipe lining. The VA examiner cited medical literature which listed causes or risk factors for GERD, which do not include radiation. The VA examiner cited causes of GERD to include transient lower esophageal sphincter (LES) relaxation, hypotensive lower esophageal sphincter, anatomic disruption of the gastroesophageal junction. The VA examiner cited risk factors for LES relaxation to include obesity, bulging of the top of the stomach up into the diaphragm (hiatal hernia), pregnancy, connective tissue disorders such as scleroderma, delayed stomach emptying. The VA examiner cited factors that can aggravate acid reflux to include smoking, eating large meals or eating late at night, eating certain trigger foods such as fatty or fried foods, drinking certain beverages, such as alcohol or coffee, and taking certain medications such as aspirin. Based on the VA examiner’s review of medical literate, exposure to radiation was not a cause or risk factor for GERD. Analysis The Board acknowledges the lay statements made by the Veteran indicating that his GERD is related to service. The Veteran is competent to provide testimony concerning factual matters of which he has first-hand knowledge (i.e., experiencing symptoms either in service or after service). See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). However, a layperson without the appropriate medical training and expertise is simply not competent to provide a probative opinion on a complex medical matter, such as an etiological relationship between any current disability and military service or exposure to radiation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The VA examiner who provided the December 2019 opinion reviewed the record and examined the Veteran, and the VA examiner who provided the October 2020 reviewed the record and conducted medical research. The examiners’ opinions were based on the specific facts of this case as presented in the record and by the Veteran at an in-person examination. The examiners reviewed the record and provided appropriate rationales that are factually accurate, fully articulated, and soundly reasoned. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); see also Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Accordingly, the Board accepts the VA examiners’ opinions as the most probative evidence as to whether it is less likely than not that the Veteran’s GERD is related to service, to include exposure to radiation. In sum, the competent evidence of record weighs against the Veteran’s assertion that his GERD was incurred in service, or caused by exposure to radiation. The December 2019 VA examiner found a 13-year gap between separation from service and treatment for GERD. The October 2020 examiner found that exposure to radiation was not known to cause or aggravate GERD. Although grateful for the Veteran’s honorable service, the Board concludes that the preponderance of the evidence is against the claim for service connection and the benefit of the doubt rule does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Casey 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.