Citation Nr: 21003438 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 16-05 937 DATE: January 21, 2021 ORDER Service connection for a stomach condition, to include gastroesophageal reflux disease (GERD) is granted. FINDING OF FACT The Veteran's stomach condition, to included GERD, had its onset in service. CONCLUSION OF LAW The criteria for service connection for a stomach condition, to include gastroesophageal reflux disease (GERD), have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Air Force from May 1983 to March 1989, from July 2004 to August 2004 and from May 2008 to January 2009. The Veteran also served on active duty in the U.S. Army from April 1991 to August 1991. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). A Board hearing was held before the undersigned in August 2018; a transcript is of record. The claim was previously remanded in February 2019 to obtain a medical opinion that adequately addressed the Veteran's contentions. Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In order to establish service connection on a direct basis, the record must contain competent evidence of: (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). In adjudicating a claim, the competence and credibility of the Veteran must be considered. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). Competent lay evidence is any evidence not requiring that the person giving the evidence have specialized education, training or experience. 38 C.F.R. § 3.159(a)(2). When assessing the probative value of a medical opinion, the thoroughness and detail of the opinion must be considered. The opinion is considered probative if it is definitive and supported by detailed rationale. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). A Veteran is presumed to be in sound condition, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where clear and unmistakable evidence establishes that an injury or disease existed prior to service and was not aggravated by service. 38 U.S.C. §§ 1111, 1132, 1137. The Veteran contends that her GERD was incurred during her active duty service. She has consistently reported that she began having symptoms of GERD, including a persistent cough, excess mucus in her throat, difficulty swallowing, nausea and vomiting and chest discomfort on active duty. She reports that her symptoms worsened significantly during her most recent period of active service, in 2008 and 2009. Post-service treatment records show that the Veteran was diagnosed with GERD, satisfying the requirement of a current disability. No pre-existing medical abnormalities were noted on her examination for entry into service. 38 U.S.C. §§ 1111, 1132, 1137. The Veteran's service treatment records show that she was treated on multiple occasions throughout her active duty service for complaints of a dry and unproductive cough, laryngitis, sore throat and mucus in her throat, beginning in 1984. Doctors generally attributed her symptoms to allergic rhinitis or upper respiratory infections including recurrent sinusitis, but those same records also show that the Veteran consistently reported incomplete relief of her symptoms with allergy medication and decongestants. An MRI in August 2008 showed normal sinuses. Despite ongoing treatment for allergic rhinitis and upper respiratory infections, the Veteran repeatedly sought treatment on at least five occasions between September 2008 and January 2009 for a persistent cough that she routinely described as dry or unproductive. At the August 2018 hearing, the Veteran's friend testified that he had known the Veteran since her most recent active duty service. He described the Veteran's contemporaneous complaints regarding her reflux symptoms and his observations of her worsening symptoms of coughing and gagging in and since service. The Veteran and her friend are competent to report the nature, onset and course of her reflux symptoms. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran has consistently complained of symptoms, especially excess mucus in her throat, difficulty swallowing and a dry, unproductive cough in and since service. Likewise, her friend is competent to report his observations of her symptoms, including coughing and gagging, as well as the Veteran's contemporaneous, pre-claim statements regarding her symptoms. Doctors have repeatedly associated the symptoms reported by the Veteran with a diagnosis of GERD. As early as December 2003, the Veteran's treating provider noted that her complaints regarding excess phlegm in the morning could be indicative of “silent” reflux. A different physician attributed the Veteran's throat mucus to GERD in October 2012. The Board notes that the record contains two negative nexus opinions from VA examiners from March 2013 and November 2019. Both of these opinions are inadequate as they rely on the absence of in-service treatment records or an in-service diagnosis of GERD and fail to account for the Veteran's statements regarding the nature and onset of her symptoms. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). Moreover, these opinions fail to account for in service symptoms including a dry, unproductive cough and excessive throat mucus, symptoms which multiple doctors identified as manifestations of her GERD. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007). They are given no probative weight. Given the Veteran's consistent and repeated reports of symptoms associated with GERD while on active duty service, the credible and competent lay statements of continuity of those symptoms post-service and the association of such symptoms with her currently diagnosed condition, the Board finds that the Veteran's GERD had its onset in service. Service connection is therefore warranted. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Megan-Brady Viccellio 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.