Citation Nr: 21003398 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 16-61 691 DATE: January 21, 2021 ORDER Entitlement to service connection for hiatal hernia, to include as proximately due to or aggravated by service-connected duodenal ulcer or heart condition, is denied. FINDING OF FACT The Veteran’s hiatal hernia is not secondary to service-connected duodenal ulcer or heart condition and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for hiatal hernia 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 honorably in the United States Army from March 1978 until November 1985. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. In February 2020, the Veteran testified before the undersigned Veterans Law Judge. In June 2020, the Board remanded the appeal to obtain an additional medical opinion. The Board finds that there has been substantial compliance with the prior Board remand directives and the appeal is ripe for adjudication upon the merits. The Veteran contends that service connection is warranted for hiatal hernia, to include as proximately due to or aggravated by service-connected duodenal ulcer or heart condition. Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). In general, service connection requires competent and credible evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Secondary service connection is warranted where a claimed disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The threshold legal requirements for a successful secondary service connection claim are evidence of (1) a current disability for which secondary service connection is sought; (2) a disability already service-connected; and (3) competent evidence that the already service-connected disability caused or aggravated the disability for which service connection is sought. Id. Entitlement to service connection for hiatal hernia, to include as proximately due to or aggravated by service-connected duodenal ulcer or heart condition As noted at the time of the hearing before the undersigned, the Veteran’s contentions and questions in appellate status relate to secondary service connection. Direct service connection has also been addressed by the AOJ, and the Board will also address direct and secondary service connection. Although the Board previously found the April 2016 VA examination inadequate as to secondary service connection, the Board does not find that the inadequacies of this examination extend to the questions of direct service connection. The STRs are silent as to any complaints, treatment, or diagnosis of hiatal hernia. Additionally, the Veteran’s hiatal hernia was not diagnosed until 2016, more than 30 years after separation from service. For these reasons, the Board finds that service connection on a direct basis is not warranted for the Veteran’s hiatal hernia. The Veteran underwent a VA examination for hiatal hernia in April 2016. A diagnosis of hernia hiatus was shown within the report. The examiner opined that the Veteran’s hiatal hernia is less likely than not incurred in or caused by military service or duodenal ulcer. The examiner stated that there is no evidence that military service or duodenal ulcer caused or worsened this condition. Further, the examiner stated that a duodenal ulcer would be less likely than not to cause a hiatal hernia. The examiner opined that based on review of medical records and the present examination, the Veteran’s hiatal hernia is less likely than not incurred in or caused by military service or duodenal ulcer. At the time of Veteran’s August 2020 VA examination, after review of the file, the examiner opined that it is less likely than not the hiatal hernia is due to his service connected duodenal ulcer. It was explained that a hiatus hernia is a common condition and it is separate and distinct from a duodenal ulcer. There is no causal association between duodenal ulcers and hiatal hernia. Further clarification from the examiner was that it is also less likely than not that medication for his service connected duodenal ulcer and/or heart condition has caused or aggravated his non-service connected hiatal hernia. It was explained that: “In hiatal hernia the upper part of the stomach bulges through an opening in the diaphragm. There is no scientific basis to explain aggravation of hiatal hernia by a duodenal ulcer or medications for its treatment. There is no scientific basis for aggravation of hiatal hernia by vet’s service connected heart condition or its treatment. Heart condition or its treatment does not aggravate hiatal hernia.” After considering all of the evidence of record, the Board concludes that the preponderance of the evidence is against finding that the Veteran’s hiatal hernia is the result of, or aggravated beyond its natural progression, by his service-connected duodenal ulcer or heart condition. The Board finds the August 2020 VA examination and medical opinion to be probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) In reaching this decision, the Board has considered the Veteran’s lay contentions. However, the Board finds that the Veteran does not possess the requisite training or credentials needed to render a competent opinion as to a medical nexus. The Veteran, as a layperson, is not competent to speak to such medically complex matters, such as the etiology of the claimed disability. 38 C.F.R. § 3.159 (a)(2); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Thus, the Board gives more probative weight to the opinion of the September 2018 VA examiner. Accordingly, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Ottley III 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.