Citation Nr: 21061644 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 17-38 591 DATE: October 4, 2021 ORDER A rating in excess of 30 percent for gastroesophageal reflux disease (GERD) is denied. FINDING OF FACT The Veteran's GERD did not more nearly approximate a combination of symptoms productive of severe impairment of health. CONCLUSION OF LAW The criteria for a rating in excess of 30 percent for GERD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.114, Diagnostic Code 7346. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 2006 to December 2012. The case was previously before the Board in March 2019. At that time, the issue of entitlement to an initial rating in excess of 10 percent for GERD was remanded for further development of the evidence. Following development, in a June 2020 rating decision, the Veteran's rating for GERD was increased to 30 percent, effective December 12, 2012 (date of claim). He was also separately awarded service connection for hoarseness, as secondary to the service-connected GERD, rated 10 percent, effective December 12, 2012. The Veteran has not appealed the initial rating assigned for his service-connected hoarseness. However, for the increased rating claim for GERD, the Veteran has not indicated that he is satisfied with the 30 percent rating assigned; therefore, this claim remains on appeal. See AB v. Brown, 6 Vet. App. 35 (1993). Entitlement to a rating in excess of 30 percent for GERD The Veteran contends his GERD is more disabling than currently evaluated. The Veteran's GERD is rated by analogy to 38 C.F.R. § 4.114, Diagnostic Code (DC) 7346, for hiatal hernia. Pursuant to DC 7346, a 10 percent disability rating is warranted for two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent evaluation is warranted for persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. The maximum 60 percent evaluation is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. The Board notes that "considerable" is defined as "large in extent or degree." Merriam-Webster's Collegiate Dictionary (11th ed. 2012). "Severe" is defined as "very painful or harmful." Id. VA outpatient treatment records dated in March 2018 show that at that time the Veteran presented with intermittent diarrhea. It was noted that he had had years of reflux disease since 2007 and currently had nocturnal awakenings with acid and burning in his throat as well as nausea. When the Veteran fasted, he felt stomach acid building up and concomitant mild abdominal discomfort. He used Tums and "chewables," but had never been on antacid therapy. He slept at an angle. He also had chronic diarrhea, going three to four times per day. He was rarely constipated and stated that he experienced relief with a bowel movement. Abdominal discomfort was above the belly button with intermittent sharp pain. The pain also occurred with fasting. He had no history of pancreatitis and no weight loss. An examination was conducted by VA in December 2019. At that time, the diagnosis was GERD. The Veteran reported taking over-the-counter medications such as Zantac and Tums without significant relief. He underwent an examination and was started on a different medication. Symptoms included persistent recurrent epigastric distress, dysphagia, pyrosis, reflux, regurgitation, substernal pain, sleep disturbance caused by esophageal reflux four our more times per year lasting 10 days or more, nausea and vomiting occurring four times per year lasting less than one day. He did not have esophageal stricture, spasm, or diverticula or other pertinent physical findings. Laboratory testing from 2008 showed that the Veteran's hemoglobin was 15.3 and his hematocrit was 46.5, which were not described as abnormal. The Veteran's esophageal conditions impacted his ability to work in that he had nightly sleep disturbance that left him sleep-deprived and at risk for a work-related injury and poor job performance. For the reasons that follow, the Board finds that the Veteran's GERD has manifested in persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal pain that is productive of considerable impairment of health. On examination he was shown to have symptoms that included diarrhea, recurrent epigastric distress, dysphagia, pyrosis, reflux, regurgitation, substernal pain, sleep disturbance caused by esophageal reflux four our more times per year lasting 10 days or more, and nausea and vomiting occurring four times per year lasting less than one day. Accordingly, the Veteran's GERD manifested in symptoms that are productive of considerable impairment of health throughout the appeal period, corresponding to the criteria for a 30 percent rating under DC 7346. A higher 60 percent rating under DC 7346 is not warranted unless there are symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. Review of the record does not demonstrate such symptoms in that there are no findings of anemia, weight loss, hematemesis, or melena. Thus, the Veteran's GERD as not been shown to more nearly approximate a combination of symptoms productive of severe impairment of health. As such, the higher 60 percent rating under DC 7346 is not warranted. In conclusion, the Board finds that a preponderance of the evidence is against the Veteran's claim for a rating in excess of 30 percent for GERD, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joseph P. Gervasio 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.