Citation Nr: 21073728 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 07-35 231 DATE: December 10, 2021 ORDER Entitlement to service connection for a gastrointestinal condition, to include gastroesophageal reflux disease (GERD) is granted. FINDING OF FACT The Veteran's GERD is proximately due to or aggravated beyond its natural progression by the service-connected disabilities, including alcohol abuse and medication used to control the symptoms of service-connected disabilities. CONCLUSION OF LAW The criteria for entitlement to service connection for a gastrointestinal condition, to include gastroesophageal reflux disease (GERD) have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from June 1985 to September 1985, December 1990 to April 1991, and from October 2004 to December 2005. This matter came before the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2018, the Board remanded the claim for additional development and in July 2018, the Board denied the claim of entitlement to service connection for GERD. The Veteran timely appealed the Board's July 2018 decision to the United States Court of Appeals for Veterans Claims (CAVC). In a May 2019 order CAVC granted a Joint Motion for Remand (JMR), vacating and remanding the July 2018 Board's decision. Subsequently, the Board remanded the matter in October 2019 and September 2020 for further development. After completing the development, the RO issued a supplemental statement of the case in September 2021, denying entitlement to service connection for a gastrointestinal condition, to include gastroesophageal reflux disease (GERD), and returned the matter to the Board for appellate consideration. The Board notes that while the Veteran was previously represented by a private attorney, the attorney withdrew representation in a letter received in May 2021. The attorney provided a copy of the letter to the Veteran, and the Veteran has not objected to the attorney's withdrawal of representation. As the private attorney withdrew and the Veteran has not appointed a new attorney, agent, or representative, he is currently unrepresented. Entitlement to service connection for a gastrointestinal condition, to include gastroesophageal reflux disease (GERD). The Veteran is seeking service connection for GERD. In February 2016, the Veteran filed the claim of entitlement to service connection for acid reflux and GERD as secondary to the service-connected disabilities. In the June 2016 notice of disagreement, the Veteran's representative specifically asserted that the Veteran's GERD is caused or aggravated by medication, which the Veteran takes to treat his service-connected disabilities. Additionally, in its January 2018 decision, the Board determined that the issue of whether the Veteran's GERD is a qualifying chronic disability (functional gastrointestinal disorder) associated with his service in Southwest Asia is raised by the record, as he is a Persian Gulf War Veteran. Also, the Board notes that the Veteran has already been granted service connection for post-traumatic stress disorder (PTSD) and major depressive disorder with alcohol abuse, which means alcohol dependence has been etiologically linked to the service-connected PTSD and major depressive disorder and is considered service-connected for purposes of consideration of secondary service connection for any disability caused or aggravated by the alcohol abuse. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 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). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. Secondary service connection requires: (1) a service-connected disability; (2) a nonservice-connected disability; and (3) evidence that the nonservice-connected disability is either (a) proximately due to or the result of the service-connected disability or (b) aggravated (increased in severity) by the service-connected disability and not due to the natural progress of the nonservice-connected disability. Id. In determining whether service connection is warranted for a disability, VA must determine 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, 53-54 (1990); 38 C.F.R. § 3.102. Thus, the question for the Board is whether the Veteran has a gastrointestinal condition that began during service or is at least as likely as not related to an in-service injury, event, or disease; or alternatively proximately due to or aggravated beyond its natural progression by the service-connected disabilities, including alcohol abuse and medication used to control the symptoms the service-connected disabilities. The existence of GERD is not in question because in the September 2021 disability benefit questionnaire ("DBQ"), the VA examiner noted the diagnosis of GERD. The examiner also noted symptoms of infrequent episodes of epigastric distress, reflux, substernal pain, and sleep disturbance caused by esophageal reflux. However, the examiner noted that the Veteran never had upper endoscopy, therefore, he has never been diagnosed with a functional gastrointestinal disorder. As far as in-service treatment or diagnosis of a gastrointestinal condition is concerned, the Veteran was not diagnosed with any gastrointestinal condition during his service. Regarding a direct relationship between the diagnosed GERD and the Veteran's military service, a VA medical opinion was obtained in September 2021. The examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As a rationale, the examiner stated that the Veteran had not filled his meloxicam (for back pain) and his pantoprazole (for GERD) since September 2019, and he denied ever having an upper endoscopy/EGD; therefore, he has never been diagnosed with a functional gastrointestinal disorder. The Veteran reports few episodes of GERD symptoms and he attributed to lifestyle changes, i.e., weight loss, discontinuation of alcohol, and dietary changes. Therefore, the Veteran's gastrointestinal condition is less likely than not incurred in or caused by his service. The Board finds the above September 2021 VA medical opinion adequate and concludes that the evidence of record demonstrate that the Veteran's GERD is not directly related to his military service. Hence, entitlement to service connection for GERD on a direct basis is not warranted. Regarding a relationship between the Veteran's GERD and his service-connected disabilities, during the September 2021 VA examination, the examiner opined that the claimed condition is at least as likely as not (50 percent or greater probability) proximately due to or result of the Veteran's service-connected condition. As a rationale, the examiner stated that the Veteran's documented alcohol abuse is considered a risk factor in GERD symptoms. The NSAID's (medication) for his headaches and multiple joint pains are also risk factors for GERD symptoms. The examiner further explained that he reviewed expert articles that attest to the effects of alcohol consumption and NSAID use on the acid reflux symptoms. Therefore, the Veteran's gastrointestinal condition is at least as likely as not proximately due to or the result of his service-connected disabilities. The Board finds the above September 2021 VA medical opinion adequate and probative in establishing a nexus between the Veteran's GERD and his service-connected disabilities, including alcohol abuse and medication used to control the symptoms of the service-connected disabilities. Consequently, upon review of the record and based on the above September 2021 VA medical opinion, the Board finds the evidence is in favor as to whether the Veteran's current gastrointestinal condition, including GERD is proximately due to or aggravated by his service-connected disabilities. Accordingly, entitlement to service connection for a gastrointestinal condition, to include gastroesophageal reflux disease (GERD) is granted. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Tariq, Nadeem, 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.