Citation Nr: 21072854 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 20-30 216 DATE: December 6, 2021 ORDER Entitlement to service connection for a gastroesophageal reflux disorder (GERD) is denied. REMANDED Entitlement to service connection for a gastrointestinal disability, not to include GERD, is remanded. Entitlement to service connection for diabetes mellitus to include as secondary to a gastrointestinal disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability to include instability and patellofemoral pain syndrome with shin splint is remanded. Entitlement to service connection for a lumbar spine disability is remanded. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has been diagnosed with a GERD at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for entitlement to service connection for GERD have not been met. 38 U.S.C. §§ 1112, 1113,1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from February 2000 to January 2005. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office. The Board notes that the Veteran's service connection claim for an obstructive sleep apnea disability was also denied in the May 2016 rating decision but the Veteran did not submit a notice of disagreement to that issue. As such it is not before the Board. The Board further note that his service connection claim for pseudofolliculitis barbae was also on appeal before the Board but was granted in an October 2020 rating decision. This represents a full grant of benefits on appeal and that issue is no longer on appeal before the Board. As an initial matter, the Board observes that the Veteran is claiming service connection for a left knee instability and left knee patellofemoral pain syndrome with shin splints. As such, the Board has recharacterized the Veteran's claims as being for entitlement to service connection for a left knee disability to include instability and patellofemoral pain syndrome with shin splints in order to encompass all conditions reasonably contemplated by the claim. Clemons v. Shinseki, 23 Vet. App. 1 (2009). 1. GERD The Veteran seeks service connection for a GERD. Specifically, he asserts that he had intestinal problems in service which have worsened over the years. He also asserts that it is due to his diabetes. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). VA will also grant service connection on a secondary basis. Service connection on a secondary basis is merited if there is (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Unfortunately, the Board concludes that the Veteran does not have a current diagnosis of GERD and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). A review of the available VA treatment records fails to show that he has been diagnosed with GERD. There is also no evidence that he has been treated for any symptoms associated with GERD such as acid reflux or heart burn. The Board acknowledge that he reported having occasional diarrhea in October 2007. However, a GERD diagnosis was not rendered at that time. He further reported having diarrhea in March 2016, but the VA doctor noted it was attributed to a high dose of medication for his diabetes mellitus condition. Notably, upon review of the Veteran's records, an October 2020 VA examiner indicated he did not have any stomach or duodenum conditions. The VA examiner considered his report that the onset of his GERD began in 2001, that he had gurgling in his stomach after eating Meals Ready to Eat (MREs), and that he had diarrhea with occasional constipation about once a month after eating red meat. However, the VA examiner indicated he did not have any signs or symptoms due to any stomach or duodenum conditions to include recurring symptoms that were less severe or severe, abdominal pain, anemia, weight loss, nausea, vomiting, hematemesis, or melena. There was also no evidence of any incapacitating episodes due to any signs or symptoms related to a stomach or duodenum condition. Even considering the Veteran's report of occasional diarrhea and constipation about once a month, the Board notes that these symptoms, in and of itself, are not recognized disabilities for VA compensation purposes nor are they severe enough to be a disability for VA purposes. While the Veteran believes that his GERD began in service after eating MREs and that it has increased in severity causing him to have diarrhea, he is not competent to provide a diagnosis in this case. Consequently, the Board finds the Veteran's medical treatment records and the October 2020 VA examination to be most probative. Specifically, his VA treatment records reflects his reported diarrhea is related to his medication for his diabetes mellitus. Moreover, the October 2020 VA examiner's statement that he does not have a current GERD disability is based on a full review of his records and consideration of his reported symptoms found throughout the record. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). As such, the Board finds that the preponderance of the evidence weighs against a finding that the Veteran has a current GERD disability. Thus, the benefit of the doubt doctrine does not apply, and claim must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). REASONS FOR REMAND 1. Gastrointestinal disability, other than GERD 2. Diabetes mellitus to include as secondary to a gastrointestinal disability 3. Right knee disability 4. Left knee disability to include instability and patellofemoral pain syndrome with shin splint 5. Lumbar spine disability The Board finds additional remand is warranted before the Board can adjudicate merits of these claims. The Veteran was initially provided with a VA examination for his bilateral knee and lumbar spine disability in July 2020, however, no medical opinion was provided at that time. He was also not provided with a VA examination for his gastrointestinal disability, excluding GERD, at that time either. As such, the VA Regional Office requested a clarification examination for the Veteran's disabilities. He was provided with a VA examination in October 2020 for his gastrointestinal disability, not to include GERD, and the VA examiner further rendered medical opinions for his gastrointestinal, bilateral knee, and lumbar spine disability in October 2020. However, the Board finds that the October 2020 VA medical opinions are conflicting, conclusory, and lacks an adequate rationale. Specifically, the VA examiner generally states that his left and right knee disability were not incurred in service or caused by his complaints for knee pain noted while on active duty as there is no service treatment record with knee pain. However, the Veteran's service treatment records do reflect that he sought treatment for knee pain in January 2001 and again in March 2004. Thus, it does not appear that the VA examiner's medical opinion is based on an accurate review of his claims file. Moreover, the VA medical opinion lacks an adequate rationale. Similarly, for his lumbar spine disability, the VA examiner based the medical opinion on the absence of treatment for chronic back pain after June 2006. The VA examiner does not actually address the Veteran's in-service treatment for low back pain found in his service treatment record. As such, the medical opinion for his lumbar spine disability is at best conclusory and lacks an adequate rationale. With regards his gastrointestinal disability, the VA examiner simply states that it was not related to service as there was no diagnosis of irritable bowel syndrome in service. While not diagnosed in service, the Veteran was treated on several occasions for diarrhea, acute gastroenteritis, and bloody stool. The VA examiner did not address whether his current diagnosis of irritable bowel syndrome is related to his in-service treatments for gastrointestinal issues. The medical opinion also lacks an adequate rationale. Based on the foregoing reasons, the Board finds that the October 2020 VA examiner's medical opinions for the Veteran's gastrointestinal, bilateral knee, and lumbar spine disabilities are inadequate. As such, a remand is warranted to obtain a new VA examination to determine the etiology of the Veteran's disabilities. With regards to the Veteran's diabetes mellitus, the Veteran asserts that it is etiologically related to his gastrointestinal disabilities. As the Board is remanding the Veteran's gastrointestinal disability and a decision on the remanded issue could significantly impact a decision on the issue of his diabetes mellitus, the issues are inextricably intertwined. Thus, a remand of the claims for his diabetes mellitus is required. The matters are REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records related to the Veteran's gastrointestinal disability, not to include GERD, right and left knee disability, and lumbar spine disability and associate them with the claims file. 2. After, schedule the Veteran for an examination for his gastrointestinal disability, not to include GERD, left and right knee disability, and lumbar spine disability. The claims file, including a copy of this remand, should be made available to the examiner, who should review it in conjunction with the prior examination and should note that review in the report. The VA examiner is requested to provide an opinion to the following questions: a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's gastrointestinal disability, not to include GERD, is related to an in-service injury, event, or illness, to include his in-service treatment for an acute gastroenteritis, bloody stool, and diarrhea? b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's left and right knee disabilities is related to an in-service injury, event, or illness, to include his in-service treatment for knee pain January 2001 and March 2004? c.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's lumbar spine disability is related to an in-service injury, event, or illness, to include his in-service treatment low back pain January 2001, June 2002, and November 2004? The examiner should consider the Veteran's lay statements in providing a medical opinion. Moreover, the examiner is reminded that a complete and detailed rationale should be provided for every opinion requested by the examiner. 3. After, readjudicate the claims. If the benefit sought on appeal remains denied, furnish the Veteran with a supplemental statement of the case (SSOC) and provide him with an appropriate opportunity to respond. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Xiong, 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.