Citation Nr: 21012838 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 14-29 464 DATE: March 5, 2021 ORDER Entitlement to an initial rating in excess of 10 percent for acid peptic reflux disease is denied. FINDING OF FACT The Veteran’s acid peptic reflux disease has been manifested by infrequent episodes of epigastric distress with pyrosis and regurgitation. It has not been manifested by persistently recurrent epigastric distress. CONCLUSION OF LAW The criteria for entitlement to an initial rating in excess of 10 percent for acid peptic reflux disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7399-7346. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1971 to November 1976. He appeals a December 2013 rating decision granting entitlement to service connection for acid peptic reflux disease with a noncompensable initial rating. During the appeal period, the Veteran was granted an increased initial rating of 10 percent for the entire period on appeal in a July 2014 rating decision. As this does not represent a full grant of benefits sought on appeal, the issue of entitlement to an increased rating for acid peptic reflux disease is still on appeal. Increased Rating Disability ratings are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Veteran’s entire history is reviewed when making disability evaluations. See generally, Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection is required. See Fenderson v. West, 12 Vet. App. 199, 125-26 (1999). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Further, “[w]here there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned.” 38 C.F.R. § 4.7. 1. Entitlement to an initial rating in excess of 10 percent for acid peptic reflux disease. The Veteran asserts that he is entitled to a 30 percent initial rating for his acid peptic reflux disease. After review of the evidence, the Board finds that an initial rating in excess of 10 percent is not warranted. The Veteran is currently rated at 10 percent for his acid peptic reflux disease under 38 C.F.R. § 4.114, Diagnostic Code 7399-7346, for the entire period on appeal. Acid peptic reflux disease is not among the listed conditions in the Rating Schedule. When an unlisted condition is encountered, it is permissible to rate the condition under a closely related disease or injury in which not only similar functions are affected, but also the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. Acid peptic reflux disease is most closely analogous to a hiatal hernia (Diagnostic Code 7346) in terms of symptomatology and resulting disability picture. Under Diagnostic Code 7346, a 60 percent rating requires symptoms of pain, vomiting, material weight loss and hematemesis (vomiting blood) or melena (black stool) with moderate anemia; or other symptom combinations productive of severe impairment of health. A 30 percent rating requires persistently recurrent epigastric distress with dysphagia (difficulty swallowing), pyrosis (heartburn), and regurgitation accompanied by substernal, arm, or shoulder pain, which is productive of considerable impairment of health. A 10 percent disability rating is warranted when two or more of the symptoms required for a 30 percent rating are present at a lesser severity than is required for a 30 percent rating. 38 C.F.R. § 4.114. The Veteran was afforded a VA examination in July 2017. He reports pain and states that he must watch his diet. The examiner noted infrequent episodes of epigastric distress with pyrosis, reflux with associated sleep disturbance, regurgitation, and pain. The Veteran reported a symptom frequency of 4 or more times per year with a duration of 1 to 9 days. At a subsequent VA examination in March 2019, the examiner again found that the Veteran suffered from infrequent episodes of epigastric distress with pyrosis, nausea, and vomiting. Notably, the examiner pointed out that the Veteran has a very recent GI history secondary to alcohol abuse (Cirrhosis with esophageal varices) which required surgical banding in October 2017. Since having the varices banded, he has very few symptoms of gastrointestinal reflux disease. The Veteran now reported a symptom frequency of 2 times per year lasting a single day. Based on the medical evidence of record, the Board finds that the symptoms of the Veteran’s acid peptic reflux disease do not reach the level required for a 30 percent rating. Specifically, at no time during the appeal does the evidence reflect symptoms commensurate with persistently recurrent epigastric distress. In fact, the evidence indicates that the Veteran’s condition has slightly improved. Accordingly, the Board finds that an initial rating in excess of 10 percent for acid peptic reflux disease is not warranted and the claim is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Daniel Ballinger, Associate Counsel