Citation Nr: 21070809 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 17-41 806 DATE: November 26, 2021 ORDER Entitlement to service connection for chest pains is denied. Entitlement to service connection for a gastric condition, including gastroesophageal reflux disease (GERD) and as secondary to the service-connected disability of post-traumatic stress disorder (PTSD), is denied. FINDINGS OF FACT 1. The Veteran does not have a disease manifested by chest pains. 2. The Veteran's GERD is not related to service. CONCLUSIONS OF LAW 3. The criteria for entitlement to service connection for chest pains are not met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for GERD are not met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1969 to November 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes the Veteran's December 2012 notice of disagreement (NOD) included claims of service connection for collapsed veins and entitlement to individual unemployability (TDIU). However, an April 2017 rating decision granted the TDIU effective October 9, 2009 and a July 2017 granted service connection for peripheral vascular disease of the right and left lower extremity, also claimed as collapsed veins, effective October 9, 2009. As such, these claims are no longer before the Board. Also, the Board notes since the July 2017 statement of the case (SOC) treatment records relevant to the claims have been added to the file. In October 2021 the Veteran's representative submitted correspondence indicating the Veteran wished to waive RO initial review of the additional records. As such the Board will proceed with the merits. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (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); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). In addition, for certain chronic diseases, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307, 3.309(a). When a chronic disease is not shown within one year after service, under 38 C.F.R. § 3.303(b) for the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. §§ 3.303(b), 3.309(a); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. 1. Entitlement to service connection for chest pains The Veteran claims his chest pains are related to service. The Veteran did not provide a specific theory of entitlement. For the reasons discussed below, the Board finds the evidence weighs against a finding that the Veteran has a current disability manifested by chest pain. Therefore, service connection is not warranted. Service treatment records (STRs) do not reflect any symptoms, diagnosis, or treatment for a chest disability. An October 1969 x-ray of the chest and right rib cage revealed no fractures. On the November 1971 separation examination, normal clinical findings were noted for the chest. On the concurrent report of medical history, the Veteran denied pain or pressure in his chest. Post service, in October 2008 VA treatment records, the Veteran was admitted to the hospital for intermittent atypical chest pain in the left chest which radiated down the arm into the hand. An x-ray of the chest indicated the chest was unremarkable. It was noted mild elevation of the right hemidiaphragm can be of no clinical significance. In May 2009 VA treatment records indicated upon examination the chest was clear and the Veteran was in no distress. In October 2009 VA treatment records the Veteran denied chest pains. An x-ray of the chest revealed an impression of no active disc disease. A cardiovascular examination indicated the Veteran suffered from occasional shooting chest pain radiating to the left arm which was attributed to hypokalemia. In December 2009 VA treatment records the Veteran reported dull left chest pain in the past, however he had no pain at the time of examination. In a July 2010 statement the Veteran reported chest pain. He indicated his doctors told him the EKG for his heart revealed a heart murmur. In December 2010 VA treatment records reflected a normal x-ray for the chest. A small nodule in the right upper lobe was discovered and the Veteran was referred to pulmonary. In March 2015 VA treatment records the Veteran denied chest pain. In April 2019 VA treatment records reflected a normal chest. The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the Veteran does not have a current chest disability. The threshold requirement for the granting of service connection is evidence of a current disability. In the absence of evidence of a current disability, in this matter a diagnosis of a back disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement in a claim of service connection of current disability "is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim and that a claimant may be granted service connection even though the disability resolves prior to the Secretary's adjudication of the claim." See McClain v. Nicholson, 21 Vet. App. 319 (2007). Additionally, for the purposes of service connection, pain alone, without any underlying pathology or disease process, can constitute a current disability if there is objective evidence that the pain causes functional impairment resulting in a decrease of earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1363 (Fed. Cir. 2018). Here, the totality of the competent evidence does not reflect that the Veteran has or has had a disability related to his chest. In fact, in October 2009 VA treatment records indicated the occasional chest pain the Veteran experiences is related to hypokalemia. To the extent the Veteran argues the hypokalemia disability which is manifested by chest pains is related to service, the Board finds there is no competent and credible evidence linking in-service chest pains to hypokalemia or evidence linking the hypokalemia directly to service. Furthermore, there were no post service treatment records identifying a chest condition. All of the chest rays have revealed unremarkable results. The Veteran does not contend that the alleged chest pain impairs his ability to work. Thus, there is no objective evidence that the Veteran's alleged chest pain condition causes functional causes functional impairment, which results in a decrease of earning capacity. See Saunders, 886 F.3d at 1363. Likewise, the Board finds a VA examination is not warranted. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The Board acknowledges that the evidence established in-service chest complaints. However, as noted above there are no other STRs related to the chest, and the service separation examination did not identify any chest complaints or pathology. As such, any in-service injury to the chest appears to have been acute and transitory and resolved prior to discharge. Accordingly, service connection for a chest pain disability is denied. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable. See 38 U.S.C.§5107(b); 38 C.F.R.§ 3.102; see also Gilbert, 1 Vet. App.at 53-56. 2. Entitlement to service connection for a gastric condition The Veteran asserts his GERD is related to service or in the alternative to the service-connected PTSD. For the reasons discussed below, the Board finds the evidence weighs against a finding that the Veteran has a current disability related to service. Therefore, service connection is not warranted. A December 1969 STR reflect complaints of stomach trouble and indigestion. There was a diagnosis listed but it was illegible. In February 1970 the Veteran reported stomach cramps. In September 1970 he reported vomiting many times in the past 3 days with an inability to keep anything down in the last 48 hours. A physical examination revealed inflamed pustular pharyngitis sinusitis. In January 1971 the Veteran complained of stomach pains while on a plane. On the November 1971 separation examination, normal clinical findings were noted for the abdomen. On the concurrent report of medical history, the Veteran denied stomach trouble and frequent indigestion. Post service, July 2009 VA treatment records reflect a diagnosis of GERD. In an October 2009 VA treatment record, an assessment indicated the Veteran had "GI bleed." A January 2014 VA treatment record indicated the Veteran had a GERD diagnosis. The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the current disability is not related to service. In this regard the Board acknowledges the Veteran was not provided a VA examination. VA has a duty to provide a medical examination where there is (1) competent evidence of a current disability or symptoms thereof; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability is associated with service; and (4) insufficient competent medical evidence to decide the claim. McLendon, 20 Vet. App. at 81; see 38 U.S.C. § 5103A (d)(2); 38 C.F.R. § 3.159 (c)(4)(i). Although the record indicates the Veteran suffers from a current disability, GERD, there is no evidence of an in-service event, injury, or disease resulting in GERD. The Board acknowledges that the evidence established in-service stomach and indigestion complaints. However, as noted above there are no other STRs related to the stomach, and the service separation examination did not identify any stomach or indigestion complaints or pathology. As such, any in-service injury to the stomach appears to have been acute and transitory and resolved prior to discharge. Accordingly, service connection for a GERD is denied. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable. See 38 U.S.C.§5107(b); 38 C.F.R.§ 3.102; see also Gilbert, 1 Vet. App.at 53-56. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Jackman, 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.