Citation Nr: 21076914 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 17-56 190A DATE: December 28, 2021 ORDER Entitlement to service connection for a gastrointestinal disability, to include gastroesophageal reflux disease (GERD) is denied. FINDING OF FACT The Veteran's gastrointestinal disability is not shown to be due to, or etiologically related to, any event, disease, or injury incurred in service. CONCLUSION OF LAW The criteria for entitlement to service connection for a gastrointestinal disability, to include GERD, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1992 to March 1997. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran attended a hearing before the undersigned Veterans Law Judge in February 2020. A transcript of the hearing is of record. This matter was previously remanded by the Board in March 2020 and April 2021. Entitlement to service connection for a gastrointestinal disability, to include GERD The Veteran claims entitlement to service connection for a gastrointestinal disability, to include GERD. 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). The Veteran testified at the February 2020 Board hearing that he received treatment for gastrointestinal symptoms immediately after service from a private doctor and that his private doctor recommended "home remedies" to address his symptoms. The Veteran had an examination for his claimed gastrointestinal disability in December 2020. The examiner noted that the Veteran's gastrointestinal and GERD conditions are separate and provided separate etiological opinions. The examiner opined that it was less likely than not that the Veteran's GERD condition was incurred in or caused by service. The examiner stated that the earliest diagnosis of GERD was in June 2019, which is more than 20 years after separation from service. The examiner also opined that it was less likely than not that the Veteran's gastrointestinal condition was incurred in or caused by service. The examiner noted that the Veteran was evaluated for abdominal pain in July 1995, and no diagnosis of constipation or diarrhea was warranted. The Veteran reported diarrhea in January 1997 and was treated, with no subsequent treatments for diarrhea noted during military service. The examiner concluded that the episode of diarrhea was acute, and the condition was resolved. Additionally, the examiner noted that the Veteran was evaluated for constipation in July 1996. There were no subsequent reported symptoms of constipation noted during military service and the examiner concluded that the constipation noted in July 1996 was acute and therefore resolved. The examiner acknowledged the Veteran's May 2019 diagnosis of gastroenteritis but noted that the Veteran denied diarrhea in May 2020. The examiner concluded that the claimed diarrhea is an acute only condition not requiring a chronic diagnosis or treatment of chronicity. In an April 2021 statement, the Veteran's fiancé stated that Veteran's acid reflux, heartburn, stomach cramps, and gas have gotten worse over the last 24 months. In an April 2021 statement, the Veteran stated that he has been treating his GERD symptoms for several years with over-the-counter medications. The Veteran further stated that he was treated for constipation, acid reflux, and heart burn during service and had no idea what GERD was at that time. An additional medical opinion regarding the etiology of the Veteran's claimed gastrointestinal disability was obtained in June 2021. The examiner opined that it was less likely than not that the Veteran's claimed gastrointestinal disability, to include GERD, was incurred in or caused by his active service. The examiner noted that the Veteran had diagnoses of acute gastroenteritis, resolved, and acute constipation resolved. The examiner noted that the Veteran reported G.I. issues with an onset of 1993, but 1995 is documented. The examiner noted that the Veteran had no current symptoms and did not have an active diagnosis. However, the examiner conceded that the Veteran had multiple visits for either constipation or diarrhea while in service with various etiologies proffered, with at least one examiner suspecting a psychosomatic connection. The examiner stated that the Veteran's history is consistent with IBS, constipation dominant, on initial presentation but diarrhea appears to have become more prevalent. The examiner concluded that it is at least likely as not that the Veteran had episodic IBS while in service. However, the examiner indicated that it is likely that a referral or evidence of a continued condition would have been noted if present, but there is no evidence of a chronic condition after service. The examiner stated that although the Veteran claims continuity since service, becoming progressively worse, there is no medical evidence to support the claim. Specifically, the examiner indicated that some of the Veteran's medications were prescription-only during his time of service and would have required continuing care if present. Specifically, regarding GERD, the examiner noted that the Veteran reported onset in 1997, but there is no evidence of GERD, and that there is no mention of frequent indigestion or reflux symptoms in service. The examiner indicated that although both are considered gastrointestinal, the conditions of IBS and GERD are readily discernible as separate entities. Furthermore, the examiner stated that the Veteran did not seek care for GERD until late 2018 or 2019. Therefore, the examiner concluded that it is more likely than not that the Veteran's GERD had its onset in or around 2018/2019 and that it is less likely than not related to service, including the episodic IBS discussed above. Additionally, the examiner noted that there is no evidence of a continuing condition, and that although an absence of records itself is not disqualifying from potential service connection, it is pertinent. The examiner noted that it is highly unlikely an individual could have gone a span of approximately 20 years without seeking care for condition such as this, especially claiming increased severity. The Board finds that the preponderance of evidence is against the claim for service connection for a gastrointestinal disability, to include GERD. The Board finds the June 2021 examiner's opinion to be highly probative because it provided an adequate rationale based on the pertinent evidence of record. The examiner noted that the Veteran's in-service treatment for gastrointestinal issues were limited and acute, specifically noting the lack of documented treatment for the conditions. The examiner acknowledged that the absence of records itself is not disqualifying from potential service connection but noted that it is pertinent that there is no documented care for the condition, especially after considering that some of the Veteran's medications were prescription-only during his time of service and would have required continuing care if present. Furthermore, the Board notes that there is no medical evidence of record that directly contradicts the June 2021 examiner's opinion. The Board has considered the Veteran's lay statements in support of his claim. While the Veteran contends that his gastrointestinal condition is related to his active service, the Veteran's statements are not supported by the evidence of record. While the Veteran is competent to describe observable symptoms of a gastrointestinal condition, he is not competent to opine as to the etiology of the disorder, as he has not been shown to possess the requisite training or credentials needed to render a competent opinion as to medical diagnosis or causation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428 (2011). Therefore, any opinion by the Veteran regarding the etiology of his gastrointestinal condition is not competent evidence. As a result, the Board finds the June 2021 examiner's opinion to be more probative regarding causation. Accordingly, as the preponderance of the evidence is against the claim of entitlement to service connection for a gastrointestinal condition, to include to include GERD, the claim must be and is denied. 38 U.S.C. § 5107b; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David M. Sebstead, 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.