Citation Nr: 21002929 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 17-47 672 DATE: January 19, 2021 ORDER A 30 percent rating for GERD effective February 29, 2016, is granted. REMANDED The claim of entitlement to service connection for a low back disability is remanded. The claim of entitlement to service connection for a left hip disability is remanded. The claim of entitlement to service connection for a right hip disability is remanded. The claim of entitlement to service connection for bilateral pes planus is remanded. FINDING OF FACT The Veteran’s GERD manifests with persistently recurrent epigastric distress, pyrosis, nausea, regurgitation, and pain in the shoulder, collarbone, and arm, and has been productive of considerable impairment in health since receipt of his intent to file. CONCLUSION OF LAW The criteria are met for a 30 percent rating for GERD effective from February 29, 2016. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, DC 7346. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 2000 to August 2005. This appeal is from a September 2016 rating decision. In November 2020, the Veteran had a personal hearing with the undersigned VLJ. A 30 percent rating for GERD effective February 29, 2016, is granted. The Veteran has appealed for a 30 percent rating for his GERD. As a threshold matter, the Board notes that the Veteran reported during his personal hearing that a 30 percent rating for his GERD, for the period on appeal, would satisfy his claim. Disability ratings are assigned in accordance with VA’s Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. See 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Separate diagnostic codes (DCs) identify the various disabilities. See generally 38 C.F.R. Part 4. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. The Veteran’s GERD is currently rated as 10 percent disabling under to 38 C.F.R. § 4.114, DC 7346, which pertains to hiatal hernia. Under DC 7346, a 10 percent rating is warranted when there are two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent rating requires persistently recurrent epigastric distress with dysphagia (difficulty swallowing), pyrosis (heartburn), and regurgitation, accompanied by substernal or arm or shoulder pain, causing considerable impairment of health. A 60 percent rating requires 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, DC 7346. After reviewing the evidence, the Board finds that a 30 percent rating is warranted, as his symptoms more closely approximate that level of disability. The record shows his GERD was under suboptimal control in February 2016, and that he had severe heartburn if he missed a dose of his omeprazole. He reported nausea and vomiting twice a week, and that he felt food stuck in his throat. In March 2016, it was noted he had dysphagia and reported that he felt a burning in his throat when swallowing. He had an EGD (esophagogastroduodenoscopy) in April 2016, which showed erosive esophagitis and hiatal hernia. At that time, his omeprazole was increased. The June 2016 VA examiner noted the Veteran had severe heartburn with coughing and reflux into mouth as well as dysphagia. He noted the Veteran vomited four or more times per year. In February 2017, it was noted he vomited approximately every two to three weeks. In June 2017, he had another EGD, which showed esophagitis and hiatal hernia. He reported he takes his medicine as directed and still has heartburn and the feeling of food stuck in his throat. His doctor noted his esophagitis was stable, but indicated that the Veteran could move forward with having biopsies of esophageal tissue if the dysphagia was pronounced. The Veteran indicated that, because the symptoms were stable, he would prefer watchful observation. At the November 2020 VA examination, the Veteran reported that he still had heartburn, and that he was generally fine swallowing solids and liquids. At his personal hearing, he reported that he does have trouble swallowing, and does regurgitate a few times a month, but that he has learned how to control that to a certain degree. He reported that he has pain in the shoulder and arm, back and collarbone. The above symptoms well-exceed the severity of the current 10 percent rating, and the Board finds that this evidence shows persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, and that it causes considerable impairment of health. As mentioned above, during his personal hearing, both the Veteran and his representative indicated that a 30 percent rating would constitute a full grant for their purposes. The Board notes that the file contains treatment records through February 2020, and a November 2020 VA examination, which the Veteran has not raised any objection to. Based on a review of the evidence, the Board finds that a 30 percent rating is warranted since receipt of the claim, February 29, 2016. As this is the benefit sought on appeal, further discussion is not required. REASONS FOR REMAND 1. The claim of entitlement to service connection for a low back disability is remanded. 2. The claim of entitlement to service connection for a left hip disability is remanded. 3. The claim of entitlement to service connection for a right hip disability is remanded. 4. The claim of entitlement to service connection for bilateral pes planus is remanded. The Veteran was given VA examinations in 2016 for opinions on whether the above disabilities are related to his service. Unfortunately, those examinations are inadequate on their own for adjudication. The Veteran has asserted that his bilateral knees caused or aggravated these disabilities, and the VA examiner only considered the left knee. On remand, examination opinions regarding both knees must be obtained. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. After completion of directive 1, schedule the Veteran for an appropriate examination for report on whether it is as likely as not (50/50 probability or greater) that any low back, right hip, left hip, and/or bilateral foot disabilities are related to his service. The examiner is asked to review the record and to elicit from the Veteran a detailed history of the onset of his symptoms. The Veteran reports that his service-connected knees have changed his gait, leading to current disabilities. The examiner is asked to conduct a thorough physical examination and to opine on whether the knees caused or aggravated any low back, right hip, left hip, and/or bilateral foot disabilities. “Aggravated” means to cause any increase in severity that is beyond the normal progression of the disability, and it need not be permanent in nature. All opinions must be accompanied with explanation. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Gibson 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.