Citation Nr: 21074320 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 17-50 717 DATE: December 14, 2021 ORDER Service connection for gastroesophageal reflux disease (GERD) is denied. REMANDED The claim for service connection for traumatic brain injury (TBI) is remanded. The claim for service connection for headaches is remanded. The claim for service connection for tinnitus is remanded. The claim for service connection for a bilateral knee disability is remanded. The claim for service connection for a back disability is remanded. The claim for service connection for a left shoulder disability is remanded. The claim for service connection for a heart disability, including hypertension, is remanded. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran's GERD was incurred in or caused by service. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for GERD have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. § 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1983 to September 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In his September 2017 substantive appeal, the Veteran requested a hearing before the Board. However, in a February 2021 written statement, the Veteran's attorney indicated that the Veteran wished to withdraw his request for a hearing. Service Connection Service connection may be established 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. Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). 1. Entitlement to service connection for GERD Upon review of the record, the Board finds that the preponderance of the evidence is against a finding that GERD was incurred in or caused by service. Although the Veteran has asserted that he was diagnosed with GERD during service, his assertion is not consistent with the evidence of record. See See Caluza v. Brown, 7 Vet. App. 498, 511 (1995). Service treatment records show no diagnosis of or treatment for GERD during service despite records showing treatment for other gastrointestinal symptoms. See AZ v. Shinseki, 731 F.3d 1303, 1311 (Fed. Cir. 2013). In May 1988, the Veteran reported symptoms of mid-epigastric pain, fever, chills, diarrhea, and abdominal pain, and the assessment was gastroenteritis. Two days later, he reported feeling much better, and the assessment was resolved gastroenteritis. Post-service treatment records likewise do not show a diagnosis of or treatment for GERD. The Veteran underwent a VA examination in July 2017, during which he reported having heartburn during service and being diagnosed with GERD around 1985. He reported current symptoms of dysphagia, pyrosis, and esophageal reflux. The examiner diagnosed the Veteran with GERD and opined that it was less likely than not incurred in or caused by service. In support of this, the examiner explained that the Veteran's in-service mid-epigastric pain was due to acute gastroenteritis, which does not result in GERD. To the extent that the Veteran believes that his current GERD is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In this regard, the diagnosis and etiology of GERD are not matters capable of lay observation and require medical expertise to determine. Thus, the Veteran's opinion regarding the etiology of his current GERD is not competent medical evidence. As there is no competent evidence of record linking the Veteran's GERD to service, service connection for GERD is denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim, the doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). REASONS FOR REMAND 1. Entitlement to service connection for TBI is remanded. The Veteran asserts that he sustained an in-service TBI during a parachuting accident near Pope Air Force Base while stationed at Fort Bragg. In a May 2016 written statement, the Veteran indicated that in December 1988, he was knocked unconscious during a parachute landing at Sicily Drop Zone and was diagnosed with a concussion. He stated that he was evaluated by a physician the following morning, and he was placed on physical profile of no duty for 72 hours. The record shows that the Veteran attended airborne school and received a parachutist badge during service. However, service treatment records show no evidence of an in-service parachuting accident or a head injury during service. As the Veteran asserts that he was placed on physical profile for 72 hours, the Board finds that a remand is necessary in order to request the Veteran's service personnel records. Additionally, clinical records from Fort Bragg and Pope Air Force Base from December 1988 should also be requested. 2. Entitlement to service connection for headaches is remanded. The Veteran asserts that he has headaches which were caused by the claimed in-service TBI. Accordingly, the claim for service connection for headaches is remanded for contemporaneous adjudication. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that two issues are inextricably intertwined when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issues has been rendered). 3. Entitlement to service connection for tinnitus is remanded. During a January 2015 VA audiological examination conducted pursuant to the Veteran's service connection claim for tinnitus, he reported a history of an in-service head injury with concussion while stationed at Fort Bragg. As it appears that the Veteran may be claiming tinnitus secondary to the alleged TBI, that claim is also remanded for contemporaneous adjudication. See id. 4. Entitlement to service connection for a bilateral knee disability is remanded. 5. Entitlement to service connection for a back disability is remanded. 6. Entitlement to service connection for a left shoulder disability is remanded. The Veteran underwent VA knee, back, and shoulder examinations in July 2017, and the examiner opined that it was less likely than not that a current knee, back, or left shoulder disability was incurred in or caused by service. In support of this, the examiner explained that there was no evidence of a knee, back, or left shoulder condition in the Veteran's service treatment records. However, the Veteran has not asserted that he sustained a specific injury to his knees, back, or left shoulder during service. Rather, he claims that current knee, back, and left shoulder disabilities were generally caused by wear and tear from in-service parachute jumps and/or carrying a ruck sack and heavy equipment. Accordingly, the Board finds that a remand is necessary in order to obtain supplemental opinions that address the Veteran's contentions. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 7. Entitlement to service connection for a heart disability, including hypertension, is remanded. Where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and certain chronic diseases, including cardiovascular-renal disease, becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. The term cardiovascular-renal disease "applies to combination involvement of the type of arteriosclerosis, nephritis, and organic heart disease, and since hypertension is an early symptom long preceding the development of those diseases in their more obvious forms, a disabling hypertension within the 1-year period will be given the same benefit of service connection as any of the chronic diseases listed." 38 C.F.R. § 3.309(a). For purposes of VA compensation, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. Id. Service treatment records do not show a diagnosis of hypertension or a heart condition during service. However, the Veteran's blood pressure was 126/100 in April 1987 and 130/90 in February 1990. Post-service treatment records show that in October 2013, the Veteran was diagnosed with a hypertensive emergency, bradycardia, and high-grade AV block, and he subsequently had a pacemaker implanted. Accordingly, the Board finds that the Veteran should be provided with a VA examination pursuant to his claim for service connection for a heart disability. See McLendon v. Nicholson, 20 Vet. App. 79, 84 (2006). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file the Veteran's complete service personnel file. 2. Request through official sources a search for clinical and/or hospital records regarding the Veteran's reported treatment for a head injury in December 1988 at Fort Bragg and/or Pope Air Force Base. All attempts to secure this evidence must be documented in the claims file. If the requested records do not exist or are not available, the Veteran should be notified of such. 3. Provide the claims file to an appropriate clinician to obtain a supplemental opinion pursuant to the Veteran's claim for service connection for a bilateral knee disability. After review of the claims file, the clinician should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that a current bilateral knee disability was caused by wear and tear from in-service parachute jumps and/or carrying a ruck sack and heavy equipment. A complete rationale must be provided. 4. Provide the claims file to an appropriate clinician to obtain a supplemental opinion pursuant to the Veteran's claim for service connection for a back disability. After review of the claims file, the clinician should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that a current back disability was caused by wear and tear from in-service parachute jumps and/or carrying a ruck sack and heavy equipment. A complete rationale must be provided. 5. Provide the claims file to an appropriate clinician to obtain a supplemental opinion pursuant to the Veteran's claim for service connection for a left shoulder disability. After review of the claims file, the clinician should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that a current left shoulder disability was caused by wear and tear from in-service parachute jumps and/or carrying a ruck sack and heavy equipment. A complete rationale must be provided. 6. Schedule the Veteran for a VA examination pursuant to his claim for service connection for a heart disability. After review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that a current heart disability (including, but not limited to bradycardia and AV block) was incurred in or caused by service or manifested within one year following service. A complete rationale must be provided. The examiner's opinion should reflect consideration of service treatment records showing diastolic blood pressure readings of 90 mm. or greater on at least two occasions. 7. If the claims remain denied, issue a supplemental statement of the case. K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Banister, 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.