Citation Nr: 21066630 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 17-30 921 DATE: November 1, 2021 ORDER A rating in excess of 10 percent for gastroesophageal reflux disorder (GERD) is denied. REMANDED Service connection for a nasal disorder. Service connection for a lung disorder. FINDINGS OF FACT 1. The Veteran had active duty from February 1989 to April 1991; he has been 100 percent disabled since October 2017. 2. For the entire period on appeal, GERD has been manifested by subjective complaints of difficulty chewing food and swallowing, constant chest pain, heartburn, shortness of breath, nausea, and episodes of regurgitation; objective findings include persistently recurring epigastric distress, dysphagia, regurgitation, substernal pain, a sleep disturbance, and no considerable impairment of health. CONCLUSION OF LAW The criteria for a rating in excess of 10 percent for GERD have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.20, 4.59, 4.114, Diagnostic Code (DC) 7346 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board remanded the claims in November 2020 for consideration of additional evidence. The case has now been returned to the Board for further appellate action. Turning to the relevant laws and regulations, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. GERD is rated under DC 7346 for hiatal hernias. The Board will consider all relevant diagnostic codes. Under the relevant regulations, a higher 30 percent rating will be warranted when the objective medical evidence shows persistently recurrent epigastric distress that is productive of considerable impairment of health, with symptoms to include dysphagia, pyrosis, and regurgitation, accompanied by substernal, arm, or shoulder pain. Turning to the medical evidence, the Veteran experienced persistently recurrent epigastric distress. To this end, he described symptoms of dysphagia and constant chest pain associated with heartburn, shortness of breath, and mild nausea in multiple medical treatment notes between March 2014 and March 2015. Of note, clinicians at the time found that his symptoms included non-traumatic chest or severe epigastric pain. Next, a June 2014 VA examination diagnosed GERD and noted that its symptoms included dysphagia, regurgitation, and substernal pain. Therefore, GERD was also characterized by dysphagia, regurgitation, and substernal pain and the threshold question is whether the evidence establishes that his symptoms were productive of considerable impairment of health. In April and June 2014 statements, the Veteran indicated that GERD symptoms prevented him from going to restaurants or eating among others unaware of his condition and that the disorder damaged his "social, mental, and physical outlook." In June 2014, a VA examiner noted that his GERD was characterized by a sleep disorder. While the Veteran worked at the Salvation Army at the time, the examiner found that GERD symptoms limited his ability to sit and concentrate on his occupational duties. However, the Veteran underwent a March 2014 procedure to treat the symptoms of his GERD and subsequently reported improvement in his symptoms. To this end, in a March 2015 treatment note, he described experiencing continued dysphagia and partial regurgitation but otherwise feeling well. Additionally, a December 2015 clinician noted that the Veteran had occasional difficulty chewing food but no ongoing gastrointestinal symptoms of dysphagia. In a subsequent March 2018 medical treatment note, he reported no problems with swallowing foods or liquids and said that he did not experience coughing or choking when eating or drinking. More recently in a January 2021 VA examination, the Veteran said that he felt a lot better, had fewer issues than he did before, was working part-time in a desk clerk job at a private place, and had not had any issues since his 2014-15 procedure. The examiner found that GERD did not impact his ability to perform occupational tasks. Ultimately, the lay statements and medical evidence establish that the GERD symptoms did not result in considerable impairment of health. Based on the above, a rating in excess of 10 percent is not warranted for GERD. In this regard, the lay statements, examinations, and clinical records demonstrate that GERD was characterized by persistent epigastric distress with dysphagia, regurgitation, and substernal pain. However, the evidence fails to establish that GERD was productive of considerable impairment of health. Rather, his symptoms improved to the point where, in his January 2021 examination, the Veteran reported feeling better with fewer issues than before. Accordingly, the medical evidence does not support a rating in excess of 10 percent for GERD. The Board has considered the lay statements submitted by the Veteran regarding the current severity of GERD. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to identify a specific level of disability according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of GERD has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical records) directly address the criteria under which these disabilities are evaluated. Moreover, as the examiners have the requisite medical expertise to render a medical opinion regarding the degrees of impairment caused by the disabilities and had sufficient facts and data on which to base their conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the subjective complaints of increased symptomatology submitted by the Veteran. Consideration has been given to assigning staged ratings for the Veteran's GERD. However, at no time during the period in question has the Veteran's disability warranted higher schedular ratings than those assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). Finally, the Veteran has not raised any other outstanding issues, nor have any other issues been reasonably raised by the record for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND In April 2017, an examiner found that it was less likely than not that the Veteran's nasal disorder, to include sinusitis and a deviated nasal septum, and lung disorder were incurred in or caused by service. The examiner noted that the Veteran was treated for sinus issues in service, but that his nasal complaints were acute conditions that resolved without residuals. The examiner found that he did not have a current diagnosis of either chronic sinusitis or a chronic sinus condition, that he was not being treated for a chronic sinus condition, and that the medical record did not document continuity of symptomatology. However, a December 2016 treatment note diagnosed sinusitis and a December 2017 treatment note observed that a deviated nasal symptom was an active medical problem and had been diagnosed in April 2013. Therefore, the record contains evidence of a then-current diagnosis of a sinus disorder and further development is required in order to determine its nature and etiology. As to a lung disorder, the examiner observed that the Veteran had a history of childhood asthma. While the Veteran was treated for pneumonia in service, the examiner found that his in-service lung conditions were acute and resolved without residuals. The examiner finally noted no medical documentation of continuity of symptomatology of the Veteran's asthma. However, the examiner did not address whether the Veteran's childhood asthma was aggravated beyond its natural progression by service. Furthermore, the examiner's rationale was reliant on the lack of documentation of continuity of symptomatology. Finally, in his January 2015 claim, the Veteran asserted that his lung disorder was secondary to his nasal disorder; however, the April 2017 opinion did not examine the relationship, if any, between his lung and nasal disorders. As such, further development is also required in order to determine the nature and etiology of the Veteran's lung disorder. The matters are REMANDED for the following actions: 1. Identify and obtain any pertinent, outstanding VA and private treatment records not currently of record and associate them with the claims file. 2. Direct the claims file to a clinician for an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that a nasal disorder, to include sinusitis and a deviated nasal septum, is etiologically related to service. The clinician is advised that for purposes of determining entitlement to service connection, a current diagnosis of a nasal disorder has been found. A rationale for all opinions must be provided. 3. Direct the claims file to a clinician for an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that a lung disorder is (a) etiologically related to service; or (b) caused or aggravated by a nasal disorder or by any other service-connected disability. The clinician must also opine as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's asthma was aggravated beyond the normal progress of the disorder by service. A rationale for all opinions must be provided. 4. If the clinician determines that an examination(s) is/are necessary in order to provide the requested opinions, then one should be scheduled. L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Spigelman, Associate Counsel 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.