Citation Nr: 21070879 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 16-42 959 DATE: November 26, 2021 ORDER Entitlement to service connection for a gastrointestinal disability, to include gastroesophageal reflux disorder (GERD), diverticulosis, and colon polyps (hereinafter "gastrointestinal disability"), is denied. FINDING OF FACT The evidence of record does not establish that a gastrointestinal disability was incurred in or is otherwise related to service. CONCLUSION OF LAW The criteria for service connection for a gastrointestinal disability have not been met. 38 U.S.C. §§ 1110, 1117; 38 C.F.R. §§ 3.303, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 2003 to April 2006 and from February 2008 to October 2008, including service in Southwest Asia. This matter appears before the Board of Veterans' Appeals (Board) on appeal of a May 2016 rating decision of the Regional Office (RO). In September 2019, the Veteran testified before the undersigned Veterans Law Judge via videoconference hearing from the RO in Nashville, Tennessee; a transcript is of record. This case was previously remanded by the Board in January 2020 and May 2021 for additional development. Service Connection Service connection may be granted for a present disability that resulted from an injury or disease incurred in or aggravated by active service. See 38 U.S.C. § 1110, 1131, 1153; 38 C.F.R. § 3.303 (a), 3.306 (a). Generally, a veteran must establish: "(1) evidence 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." See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability resulting from undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021 and cannot be attributed to any known clinical diagnosis by history, physical examination, or laboratory tests. 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a)(1). A qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): (A) An undiagnosed illness; (B) A medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms, such as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disabilities (excluding structural gastrointestinal diseases). 38 C.F.R. § 3.317 (a)(2)(i). The term medically unexplained chronic multi-symptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology are not considered medically unexplained. 38 C.F.R. § 3.317 (a)(2)(ii). Service connection for gastrointestinal disabilities The Veteran contends that service connection for gastrointestinal problems is warranted due to environmental exposures, particularly burn pits, during service in Southwest Asia. Service treatment records are silent for gastrointestinal complaints, other than for hemorrhoids for which the Veteran is already service connected. At the September 2019 Board hearing the Veteran testified he was diagnosed with GERD in approximately 2016, although he first started noticing symptoms for acid reflux or GERD around 2005 in service. He stated he did not seek treatment in service, and he took over the counter medication to control his symptoms. Post-service treatment records show the Veteran underwent a EGD in June 2016 and was diagnosed with GERD and a hiatal hernia. The Veteran was afforded VA examinations in March 2020. He underwent examination for esophageal conditions, rectum and anus conditions, and intestinal conditions. During the esophageal conditions examination, the Veteran was diagnosed with gastroesophageal reflux disease (GERD). During the rectum and anus conditions examination, the Veteran was diagnosed with internal or external hemorrhoids and colon polyp. This examination also mentioned the Veteran's April 2016 colonoscopy showed diverticulosis. During the intestinal conditions examination, the Veteran was not diagnosed with an intestinal condition. During the March 2020 esophageal conditions examination, the Veteran denied being seen for gastrointestinal symptoms during service. He stated he was started on acid medications in 2015, and he occasionally uses over the counter medication to treat breakthrough burning in the throat. The examiner stated the Veteran's GERD was less likely than not incurred in or caused by exposure to burn pits in service. The examiner explained there is no medical evidence linking the Veteran's GERD to exposure to burn pits in service. The examiner stated the most likely cause of the Veteran's GERD is lower esophageal sphincter relaxion. The Veteran underwent a Gulf War medical examination in November 2020. The Veteran was diagnosed with GERD, hemorrhoids, diverticulosis, and benign polyp. The examiner explained the Veteran's GERD was a disease with a clear and specific etiology and diagnosis. There is no medical evidence that the Veteran's condition is related to a specific exposure event experienced by the Veteran during service in Southwest Asia. The examiner stated that the Veteran's diverticulosis and benign polyp were diagnosable chronic multi-symptom illness with a partially explained etiology. There is no medical evidence that the Veteran's condition is related to a specific exposure event experienced by the Veteran during service in Southwest Asia. An addendum opinion regarding diverticulosis and benign polyp was provided in May 2021. The examiner stated that the Veteran's diverticulosis and benign polyp etiology and pathophysiology are partially understood. The examiner explained there is no medical evidence the Veteran's diverticulosis and benign polyp were incurred in or were caused by, or otherwise related to service, including as due to exposure to burn pits in Iraq. There is no medical evidence the Veteran's diverticulosis and benign polyp are related to a specific exposure event experienced by the Veteran during service in Southwest Asia. The Veteran has multiple risk factors for the development of diverticulosis and benign polyp such as obesity, smoking history and western diet, and physical inactivity combined with abnormal colonic motility. It is not likely that the Veteran's diverticulosis and benign polyp is due to a single risk factor and more likely due to his multiple risk factors as noted above. After considering the evidence of record, the Board finds that the evidence of record weighs against a finding that service connection is warranted for the Veteran's gastrointestinal disabilities. The Board assigns probative weight to the March and November 2020 and May 2021 examiner's opinion because the examiner considered the Veteran's lay statements, to include environmental exposures during service in Southwest Asia, and explained, based on medical expertise, why the Veteran's gastrointestinal disabilities were not caused by or a result of a specific exposure event in Southwest Asia. The Veteran contends that his gastrointestinal disabilities are due to environmental exposures during service in Southwest Asia. The Persian Gulf War presumption of service connection does not apply in this case because, as noted in the November 2020 and May 2021 VA examiner's opinions, the Veteran's symptoms were not due to an undiagnosed illness or a medically undeterminable chronic multisymptom illness. See 38 C.F.R. § 3.317; see also Atencio v. Rourke, 30 Vet. App. 74, 84 (2018) (holding that GERD is not a qualifying disability under 38 C.F.R. § 3.317). Further, as the diverticulosis and benign polyp were determined to be of a partially understood etiology and pathophysiology, they are not considered medically unexplained. 38 C.F.R. § 3.317 (a)(2)(ii). While the Veteran reported of experiencing gastrointestinal symptoms since 2005, medical examinations and medical history forms in April 2006 documented no gastrointestinal disabilities and no stomach or intestinal trouble. (Continued on the next page) Despite the Veteran's contention of a nexus to service, to include his hearing testimony, the issue of nexus is medically complex, and the Veteran has not shown that he possesses the medical training or expertise to provide such an opinion. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). The Board instead finds the VA opinions to be more probative than the Veteran's contentions. The Board finds that the weight of the evidence is against service connection for a gastrointestinal disability. Because the preponderance of the evidence is against the claim for service connection, the claim must be denied, and the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. St. Laurent, 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.