Citation Nr: 21069210 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 20-20 351 DATE: November 17, 2021 ORDER Service connection for gastroesophageal reflux disease (GERD) is granted. Service connection intestinal metaplasia is granted. Service connection for chronic gastritis is granted. FINDINGS OF FACT 1. The preponderance of the competent medical evidence weighs for findings that the Veteran's GERD is causally related to his service. 2. The preponderance of the competent medical evidence weighs for findings that the Veteran's intestinal metaplasia is causally related to his service. 3. The preponderance of the competent medical evidence weighs for findings that the Veteran's chronic gastritis is causally related to his service. CONCLUSIONS OF LAW 1. The criteria for service connection for GERD have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for intestinal metaplasia have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for chronic gastritis have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1964 to July 1966. This matter is before the Board of Veterans Appeals (Board) on appeal from an August 2018 rating decision. In his April 2020 substantive appeal (VA Form 9), the Veteran requested a videoconference hearing before a Veterans Law Judge. In a recent October 2020 correspondence this request for a hearing was withdrawn. The Board therefore deems the hearing request withdrawn pursuant to 38 C.F.R. § 20.702 (e). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease incurred in service. 38 C.F.R. § 3.303 (d). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the disease or injury in service and the current disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical evidence. VA must also consider all favorable lay evidence of record. 38 U.S.C. § 5107 (b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Service connection for GERD 2. Service connection intestinal metaplasia 3. Service connection for chronic gastritis In June 2021 a medical opinion was received from a Dr. N.P.D., M.D. This opinion contains a review of the Veteran's individual medical history from military service to present. The physician explained that the Veteran has been afflicted with chronic gastrointestinal (GI) symptoms including abdominal pain, nausea, dysphagia, vomiting, weight loss, etc. The Veteran reported to the physician that he initially started with his GERD symptoms in August of 1965 when he reported losing weight, indigestion, and frequent loose stools during his military service. In April of 1967, approximately 9 months after his discharge from service, the Veteran was found to have gastritis and peptic ulcer disease. One year later it was determined that the peptic ulcer was healed in a permanently scarred duodenal cap. He continued to complain of upper GI symptoms (nausea, vomiting, abdominal pain, etc.). In July 1974, a reappearance of a peptic ulcer took place and the Veteran's chronic GI symptoms persisted. Since then, the Veteran has undergone a significant number of diagnostic procedures and treatment to manage his continuing disabilities of GERD, gastritis, and intestinal metaplasia. The Veteran reiterated to the physician that he did not have any GI symptoms prior to his service. It was noted that the Veteran's GI symptoms began when the Veteran was a little more than one year into his service. Specifically, his GERD began during this time and eventually progressed to Barrett's esophagus and intestinal metaplasia. The physician opined that it is more likely than not that the Veteran's gastritis, GERD with intestinal metaplasia, and Barrett's esophagus are causally related to his service. The physician connected that conclusion to the Veteran's unique medical facts with ample discussion of how these diagnoses, including his service-connected duodenal ulcer, share a common pathology, which is the presence of increased acidity of the gastric mucosa which began during service and his persisted to the present. Moreover, these diagnoses were also linked to the Veteran's service-connected psychiatric disability which the physician explained is a well-known risk factor for the development of the Veteran's GI disabilities. The physician provided citations to medical literature to support these opinions and provided his CV (curriculum vitae) to demonstrate his competence to render these conclusions. The Board finds that this positive nexus opinion is sufficient to establish the elements of service connection for the claimed disabilities on appeal. The physician provided a definitive nexus opinion using the correct standard of proof with an adequate supporting rationale, and there is no indication that they were not fully aware of the Veteran's past medical history or misstated any relevant fact in providing their opinions. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that the probative value of a medical opinion comes from the "factually accurate, fully articulated, sound reasoning for the conclusion"). Considering the above competent medical evidence, the Board finds that service connection is warranted for the claimed disabilities on appeal and the claims are granted. Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kyle McKone 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.