Citation Nr: 21011740 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 09-45 337 DATE: March 2, 2021 ORDERED Entitlement to service connection for chronic gastritis, claimed as right upper quadrant abdominal pain, is granted. REMANDED Entitlement to service connection for residuals of a left clavicle fracture, including left clavicle and left shoulder disabilities, is remanded. Entitlement to service connection for a left knee condition is remanded. Entitlement to service connection for a sinus condition is remanded. FINDING OF FACT The Veteran’s chronic gastritis had its onset during his active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for right upper quadrant abdominal pain have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1977 to February 1999. He received the Air Force Training Ribbon; Small Arms Expert Marksmanship Ribbon; Air Force Longevity Service Award with one oak leaf cluster; Air Force Overseas (Long Tour) Ribbon; Air Force Good Conduct Medal with two oak leaf clusters; Air Force Outstanding Unit Award; and, Air Force Commendation Medal. In October 2018, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. Service Connection for Right Upper Quadrant Pain Direct service connection generally requires credible and competent evidence showing: (1) the existence 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. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). The evidence shows that the Veteran has a current disability. Specifically, the Veteran has been diagnosed with chronic gastritis. See July 2017 Private Treatment Records, p. 8; June 2012 VA Examination, pp. 25, 65. Accordingly, the Board finds that the first element of service connection is established. See Holton, 557 F.3d at 1366. The Board finds that the evidence also supports a finding of an in-service injury or event. The Veteran had an episode of gastritis during his active duty service and numerous complaints of right upper quadrant abdominal pain. See June 2007 STR, pp. 13, 15, 62, 71, 87, 95. The Board finds that there is sufficient evidence to establish the occurrence of an in-service injury. Accordingly, the second element of service connection is established. See Holton, 557 F.3d at 1366. With regard to nexus, the evidence is at least in equipoise. The June 2012 examiner opined that it was at least as likely as not that the Veteran’s disability was incurred in or caused by his active duty service. See June 2012 VA Examination, p. 65. In arriving at this conclusion, the examiner considered the Veteran’s in-service and post-service abdominal complaints and noted that these complaints are all consistent with chronic gastritis. The Board finds the June 2012 opinion to be adequate and based on the evidence of record; therefore, it is probative. As there is no opinion to the contrary, the evidence regarding nexus is at least in equipoise. When the evidence for and against a claim is in relative equipoise, the Board has an obligation to resolve all reasonable doubt in favor of the claimant. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In resolving all reasonable doubt in the Veteran’s favor, the Board finds that the third element of service connection is established. See Holton, 557 F.3d at 1366. Thus, service connection for chronic gastritis is warranted. REASONS FOR REMAND Service Connection for Residuals of a Left Clavicle Fracture The Veteran underwent a VA examination in June 2012 for his residuals of a left clavicle fracture. The examiner noted the Veteran’s reports of gradually worsening pain since the 1981 injury but offered a negative nexus opinion based on a lack of documented complaints. See June 2012 VA Examination, pp. 45, 69. Moreover, the Veteran testified at the October 2018 hearing that he has had continuous symptoms from his separation from service to the present and he has not had any other left shoulder injuries. See October 2018 Hearing Transcript, pp. 20, 22. On remand, the Agency of Original Jurisdiction should obtain a new opinion that considers the Veteran’s reports of gradually worsening pain as well as the Veteran’s post-service history. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Service Connection for a Left Knee Condition The June 2012 examiner also offered a negative nexus opinion for the Veteran’s left knee condition. See July 2017 CAPRI, p. 1. In support of the opinion, the examiner indicated that the Veteran only had a November 1988 knee injury and that he did not have any other left knee complaints. However, the Veteran testified that he experienced continuous left knee symptoms from the time of his separation to 2006 when he was first treated post-service. See October 2018 Hearing Transcript, p. 32. Accordingly, on remand the AOJ should obtain a new opinion that considers the Veteran’s reports of continuous symptoms from service to 2006. Service Connection for a Sinus Condition The Veteran underwent an examination in June 2012 for his sinus condition as well. See July 2017 CAPRI, pp. 1-2. The examiner indicated that the Veteran no longer had a diagnosis of chronic sinusitis but did not offer a nexus opinion on his non-allergic rhinitis. Accordingly, a nexus opinion is needed that addresses whether the Veteran’s non-allergic rhinitis is etiologically related to his active duty service. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to ascertain the nature and etiology of the Veteran’s residuals of a left clavicle fracture, including a left shoulder condition. Any indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion, and the examination report should include a discussion of the Veteran’s documented medical history and assertions. The examiner should offer comments, an opinion and a supporting rationale that address whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s residuals of a left clavicle fracture was incurred in, aggravated by, or is otherwise etiologically related to the Veteran’s active duty service. In providing this response, the examiner must consider the Veteran’s reports of continuous and worsening left shoulder symptoms since his service. See October 2018 Hearing Transcript, pp. 20, 22. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. 2. Schedule the Veteran for an examination to ascertain the nature and etiology of the Veteran’s left knee condition, including left knee strain and buckling. Any indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion, and the examination report should include a discussion of the Veteran’s documented medical history and assertions. The examiner should offer comments, an opinion and a supporting rationale that address whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s left knee condition was incurred in, aggravated by, or is otherwise etiologically related to the Veteran’s active duty service. In providing this response, the examiner must consider the Veteran’s reports of continuous left knee symptoms since his service. See October 2018 Hearing Transcript, p. 32. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. 3. Schedule the Veteran for an examination to ascertain the nature and etiology of the Veteran’s sinus condition, including non-allergic rhinitis. Any indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion, and the examination report should include a discussion of the Veteran’s documented medical history and assertions. (Continued on the next page)   The examiner should offer comments, an opinion and a supporting rationale that address whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s current sinus condition, including non-allergic rhinitis, was incurred in, aggravated by, or is otherwise etiologically related to the Veteran’s active duty service. In providing this response, the examiner must consider the Veteran’s reports of continuous sinus symptoms since his service and the in-service sinus trauma from exposure to pressure and temperature. See October 2018 Hearing Transcript, p. 16; January 2021 VA Treatment Records, p. 7. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W.V. Walker, 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.