Citation Nr: 21013993 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 16-05 607 DATE: March 11, 2021 ORDER Entitlement to service connection for gastroesophageal reflux disease (GERD) is granted. FINDING OF FACT Resolving reasonable doubt in favor of the Veteran, her GERD incurred in service. CONCLUSION OF LAW The criteria for entitlement to service connection for gastroesophageal reflux disease (GERD) have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1984 to December 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge; a transcript of the hearing has been associated with the record. Additionally, while the Veteran submitted a private nexus opinion following issuance of the November 2015 statement of the case, waiver of Agency of Original Jurisdiction (AOJ) consideration is not necessary as the appeal was perfected after February 2, 2013. The Veteran also submitted a waiver of AOJ consideration of additional evidence in November 2019. Entitlement to service connection for GERD Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: ‘(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’ the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran asserts that her GERD incurred during active military service. Specifically, she contends that GERD manifested during service as chest pains but was not properly diagnosed until after service. Medical treatment records from Guam Naval Hospital show treatment for GERD. In addition, private treatment records document that the Veteran underwent an Upper GI endoscopy due to heartburn, established esophageal reflux and failure to respond to medical treatment. Accordingly, the first element required for service connection is met. In regard to the second element of service connection, the Veteran’s service treatment records (STRs) document that she complained of chest pain and was diagnosed with atypical chest pain in August 1991. During her separation examination in August 1992, the Veteran reported experiencing chest pain and pressure and the examiner noted that she experienced erratic symptoms at first and then sudden onset. The examiner reported that the Veteran was taken to the Emergency Room, an EKG was performed, the Veteran was prescribed Motrin, and no further symptoms were noted since 1991. As such, the question in this case is whether a causal relationship or nexus exists between the Veteran’s GERD and her in-service manifestations of chest pain. The Board finds that service connection is warranted. In November 2019, the Veteran submitted a nexus opinion from her private examiner. The examiner noted that prior to becoming her patient in 2009, the Veteran complained of chest pains on numerous occasions. Additionally, the examiner noted that after ruling out heart problems as the cause of the Veteran’s distress, she was diagnosed with GERD. Upon returning from Guam, the Veteran was still having discomfort, including occasional chest pains due to GERD, and the examiner referred her to Dr. T.T. for additional testing. The examiner reported that Dr. T.T. performed a procedure which enabled him to take photographic evidence of the damage sustained over the years to the Veteran’s upper GI tract due to GERD and found a gaping hole where the esophageal sphincter should have been. As the examiner found that the damage sustained to the Veteran’s esophageal sphincter would have taken decades to erode to that extent, she concluded that there is a better than 50 percent chance that the Veteran’s GERD existed during her active military service from 1984 to 1992. As the November 2019 private examiner relied on the time frame of the Veteran’s military service, documented history of complaints of chest pain, and the extent of the Veteran’s current condition when providing her opinion, the Board finds the medical opinion highly probative. There is also no medical opinion to the contrary. Accordingly, based on all the evidence and resolving all reasonable doubt in favor of the Veteran, service connection for GERD is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. B. Smith, 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.