Citation Nr: 21020755 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 16-14 992 DATE: April 8, 2021 ORDER Service connection for coronary artery disease is denied. Service connection for hypertension is denied. Service connection for gastroesophageal reflux disease (GERD) is denied. FINDINGS OF FACTS 1. The weight of the competent evidence of record is against finding that the Veteran’s coronary artery disease began during his military service, was caused by service, had onset within a year of service, or was caused or aggravated by his service-connected asthma or asthma medication. 2. The weight of the evidence of record does not show that the Veteran’s hypertension had onset in service, had onset within a year of service, is otherwise caused by service, or caused or aggravated by his service-connected asthma or asthma medication. 3. The weight of the evidence of record does not show that the Veteran’s GERD had onset in service, is otherwise caused by service, or caused or aggravated by his service-connected asthma or asthma medication. CONCLUSIONS OF LAW 1. The criteria for service connection for coronary artery disease have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.309, 3.310. 2. The criteria for service connection for a hypertension have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.309, 3.310. 3. The criteria for service connection for GERD have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1977 to December 1988. This matter is on appeal from a June 2014 rating decision and was previously remanded by the Board in September 2018. Service Connection Generally, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during military service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence showing (1) current disability; (2) in-service incurrence in or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010); 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303 (a). Additionally, service connection may be granted on a secondary basis for a condition that is not directly caused by the Veteran’s service. 38 C.F.R. § 3.310. In order to prevail under a theory of secondary service connection, the evidence must demonstrate an etiological relationship between (1) a service-connected disability or disabilities, and (2) the condition said to be proximately due to the service-connected disability or disabilities. Buckley v. West, 12 Vet. App. 76, 84 (1998). In addition, secondary service connection may also be found in certain instances when a service-connected disability aggravates another condition. See Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310 (b). Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic disease or illness manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303 (b). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). Certain “chronic diseases” may be presumed to have been incurred during service if manifested to a compensable degree within one year of separation from active military service; however, if the evidence of the record is insufficient to establish a disease was chronic in service, and/or manifested within the specified time period, then there must be a continuity of disease symptoms shown after discharge in order to warrant service connection. 38 C.F.R. § 3.303 (b). Coronary Artery Disease The Veteran is currently seeking service connection for a coronary artery disease, directly caused by his service, as well as secondary to his asthma, including medication for asthma. First, the Veteran asserts that the stressful environment on board the USS Kitty Hawk led to the development of his current coronary artery disease. However, service treatment records were silent for any complaints or diagnosis suggestive of a heart condition. Rather, he had an extensive history of treatment for a respiratory condition, ultimately identified as bronchospasm, respiratory failure, and asthma. Imaging studies of his chest taken in August 1987 revealed a normal cardiac and mediastinal silhouette. Treatment records dating December 1987 aboard the USS Kitty Hawk reported a medical history of lung disease, asthma, chronic obstructive pulmonary disease, persistent cough, shortness of breath, history of fainting, high blood pressure, heat exhaustion, ruptured ear drum, and fear of enclosed spaces. No cardiac problems were noted. His report of medical examination in March 1988 showed no clinical abnormalities regarding his heart. His accompanying report of medical history showed that he denied palpitations, pounding heart, or heart trouble. Post service treatment records show signs of a cardiac condition several years after service. In April 2013, his cardiovascular assessment showed bradycardiac/hypotensive episode. Later that same month, the Veteran reported chest pains due to bradycardia. February 2014 VA notes showed slight calcification in the coronary arteries. His cardiac chambers were normal in size. The pulmonary artery dilated. His thoracic aorta is ectatic and torturous with small plaques in the arch. In December 2014, a VA physician found no evidence of significant reversible perfusion abnormalities to suggest inducible coronary insufficiency. Old infarct in the proximal to distal inferoseptal wall and associated with mild inferior wall. The Veteran was afforded a VA examination in October 2015. The VA examiner opined that it is less likely than not that the Veteran’s current coronary artery disease is caused by or related to his service-connected asthma, including medication to treat asthma. Instead, the examiner found that the main causative risk factors for coronary artery disease are age and hereditary. Asthma, nor medication for asthma, was a significant cause for coronary artery disease. In his April 2016 VA Form 9, the Veteran indicated that he does not have a ‘heart-healthy lifestyle to help prevent coronary artery disease, high cholesterol, and high blood pressure.’ It is his belief that his history of asthma along with his asthma medication have precipitated his current disabilities, specifically his coronary artery disease, as he does not have a family history of coronary artery disease. Subsequently, in an April 2016 Statement of Representative in Appealed Case (Appellate Brief), the Veteran’s representative submitted a medical article from the American Institute of Stress, finding a relationship between stress and heart disease. It stated that the incidence of heart attacks and sudden deaths have been shown to increase significantly following the acute stress of natural diaster like hurricanes, earthquakes, and tsunamis, and as a consequence of any severe stressor that evokes ‘fight or flight’ responses. Coronary heart disease is also much more common in individuals subjected to chronic stress. Recent research has focused on how to identify and prevent this growing problem, particularly with respect to job stress. Furthermore, another medical article from Medscape asserted that asthma is an independent predictor or coronary artery disease. When the matter came to the Board in September 2018, it was remanded for a medical opinion addendum. The new opinion was to address the findings identified in the April 2016 Appellate Brief, to adequately determine the etiology of Veteran’s coronary artery disease, especially since he does not have a family history of the disease, and to address the question of direct service connection. A new medical opinion was obtained in July 2019. The examining physician noted that the Veteran was diagnosed with coronary artery disease with old myocardial infarction status post coronary stents. His service treatment records did not suggest evidence of onset of symptoms during his active duty service. His report of medical history in March 1988 and in June 1990 indicated ‘no’ to section on heart trouble. Therefore, it is less likely than not that his current heart condition incurred during active duty. Second, the examining physician opined that the Veteran’s current coronary artery disease and old myocardial infarction status post coronary stents, is less likely than not proximately due to or the result of the asthma, to include medication used for asthma. In his rationale, the examiner explained that the two conditions have differing pathophysiology that is unrelated. The Veteran’s service treatment records indicate that the Veteran has been prescribed Theophylline and Proventil to treat his asthma. Neither of these medications commonly cause coronary artery disease with myocardial infarction and stent placement as a side effect. The development of coronary artery disease and myocardial infarction is multifactorial and can involve age, genetics, lack of physical activity, being overweight, hypertension, and diabetes. Regarding baseline severity, the physician noted that the Veteran did in fact developed two vessel coronary artery disease with a myocardial infarction in February 2014. However, the remainder of the record does not suggest worsening or aggravation beyond the natural progression of the disease. Since his heart attack episode in 2013, he did not have any other myocardial infarction that required further invasive treatment. Therefore, it is merely speculation to state that such medications cause the Veteran’s heart condition. In addressing the Veteran’s medical articles, the examining physician noted that the referenced study of two matched cohorts indicated a 1.2 folds increased risk of coronary artery disease in those with asthma. While this study showed a mild increased risk from asthma for coronary heart disease, it did not show a definitive link of asthma as the sole risk factor for coronary heart disease. Even with this study’s result, it is speculative to single out asthma as the primary cause of his coronary artery disease when more important contributors, previously mentioned, have a larger role in the pathology of coronary artery disease. In reviewing the record, the Board finds that service connection for coronary artery disease is not warranted. First, the evidence of record does not support service connection on a direct basis. While the Veteran has asserted that his current heart condition developed as a result of stress while serving aboard the USS Kitty Hawk, his service treatment records did not document any complaints or symptoms indicative of a heart problem. The Veteran asserts that he experienced chronic stress manifested by high blood pressure during service, which is suggestive of a heart condition. However, his high blood pressure reading was an isolated occurrence and did not progress into a chronic condition. During a March 1988 examination (9 months prior to the Veteran’s separation from service), the Veteran’s heart was clinically evaluated as normal and no heart issues were noted. The Veteran himself has indicated on his reports of medical history that he did not experience any heart problems such as palpitations or pounding. In fact, the Veteran did not develop signs of a heart condition until several years after service. While not dispositive, the passage of time between service and post-service symptomatology is an appropriate factor for consideration. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Moreover, upon evaluation of the claims file, the July 2019 VA examiner opined that that it is less likely than not that the Veteran’s heart condition had onset in service. In his rationale, the examining physician could not find evidence indicative of a heart condition during service. The Veteran had submitted an article by the American Institute of Stress in attempts to link his current heart condition with his military service. The Board observes that medical treatise evidence can, in some instances, constitute competent medical evidence. Wallin v. West, 11 Vet. App. 509, 514 (1998). But medical evidence that is speculative, general, or inconclusive in nature cannot, however, support a claim. See Obert v. Brown, 5 Vet. App. 30, 33 (1993). This general information does not pertain to the particular symptoms of this disease for this specific Veteran. Thus, the Board assigns the articles little probative weight, which is outweighed by the medical opinion of record. The Board also finds that the Veteran’s claim does not prevail under the secondary theory of entitlement. He has claimed that his service-connected asthma as well as his asthma medication caused or aggravated his coronary artery disease. However, the record does not support this contention. The July 2019 medical opinion specifically found that the Veteran’s asthma is a distinct and separate medical condition from his coronary artery disease. Due to the differing pathophysiologies, it is unlikely that the Veteran’s asthma caused the development of his current heart condition. Additionally, the medications, namely Theophylline and Proventil, are not known to cause or aggravate coronary artery disease. The July 2019 examining physician did not find evidence of coronary artery disease worsening beyond its natural progression due to asthma or asthma medication. Rather, the physician indicated that the development of coronary artery disease and myocardial infarction is multifactorial and can involve age, genetics, lack of physical activity, being overweight, hypertension, and diabetes. While the Board notes that the Veteran’s medical records does not show a family history or genetic predisposition of a coronary heart disease, the Veteran may remain at risk due to other factors. By his own admission in his VA Form 9, the Veteran stated that he does not have a ‘heart-healthy lifestyle to help prevent coronary artery disease.” Thus, taken in totality, the Board finds that it is less likely than not that the Veteran’s coronary artery disease is caused or aggravated by his asthma or asthma medications. To the extent that the Veteran believes that such a relationship exists, he is only competent to provide testimony concerning factual matters of which he has first-hand-knowledge and experiences through his senses. Barr v. Nicholson, 21 Vet. App. 303 (2007). However, as to the etiology of his heart condition is a medical determine outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Thus, although the Board has carefully considered the lay contentions of record suggesting that the Veteran’s heart condition is related to his service, the Board ultimately affords the objective medical evidence of record, which weighs against finding such a connection, with greater probative weight than the lay opinion. While service connection may be granted for diseases such as atherosclerotic heart disease (including myocardial infarction) under 38 C.F.R. § 3.309 (a), the disease must have manifested within one year after separation from service. In this case, there is no evidence of complaints of a heart condition within the year following separation from active duty service. Thus, service connection for a coronary artery disease is also not warranted on the basis of presumptive service connection. Overall, the medical evidence does not support a positive nexus between the Veteran’s current coronary artery disease and his military service, nor does it support a nexus between his coronary artery disease and his asthma, including his asthma medication. Hypertension It is the Veteran’s contention that he developed hypertension as a result of his military service, including secondary to his service-connected asthma and asthma medication. Service treatment records did not reflect a diagnosis or treatment for chronic high blood pressure. It is noted that the Veteran had an elevated diastolic blood pressure of 130/90 in March 1987. However, subsequent treatment records suggest that the mild elevation was an isolated incident, rather than evidence of a chronic condition. In his 1988 report of medical history, the Veteran specifically denied having problems with his blood pressure. His accompanying medical examination also reported no clinical abnormalities indicative of hypertension. Post service treatment records show that he was ultimately diagnosed with hypertension several years after service in 2006. To address the etiology of his hypertension, the Veteran was afforded a VA examination in October 2015. The VA examiner opined that it is less likely than not that the Veteran’s current hypertension is caused by or related to his service-connected asthma, including medication to treat asthma. The main causative risk factors for coronary artery disease are age and hereditary. Asthma, nor medication for asthma, was not significant cause for hypertension. In support of his claim, the Veteran’s representative asserts in an April 2016 Appellate Brief, similar to coronary artery disease, that chronic stress and asthma have adversely affected his blood pressure. When the matter returned to the Board in September 2018, the Board found that the October 2015 VA medical opinion was inadequate as the question of aggravation was not addressed. Furthermore, as it was unclear whether the VA examiner determined if the Veteran’s hypertension was a result of his age and heredity. Therefore, the matter was remanded for a new medical opinion. A new medical opinion was obtained in July 2019, in which the examining physician found against a nexus between the Veteran’s hypertension and his military service. In his rationale, the examiner indicated that the Veteran’s service treatment records did not show evidence of a diagnosis or treatment during active service except for a clinical note dating March 1987. It showed a mildly elevated diastolic blood pressure of 130/90. However, there was no evidence of repeated elevated blood pressure measurements. His report of medical history in March 1988 showed that he indicated ‘no’ to the section on high blood pressure. The Veteran’s March 1988 Report of Medical History indicated ‘no’ to section on high blood pressure. Therefore, the March 1987 record merely reflected an isolated incidence of elevated blood pressure rather than evidence of hypertension. The Veteran was ultimately diagnosed with hypertension several years after service and was placed on anti-hypertensive after his myocardial infarction and coronary artery disease. Since the onset on his hypertension, the examiner found that his condition mainly remained the same. Therefore, this condition was less likely than not incurred during active service. Second, the examining physician found that the Veteran’s hypertension is less likely than not caused by or aggravated by the Veteran’s asthma. Hypertension and asthma are two separate conditions with differing pathophysiology, which are unrelated. It is not medically reasonable to state his hypertension is either due to or exacerbated by asthma. Risk factors for hypertension such as age, lifestyle, and family history are more likely to exacerbate hypertension. The Veteran’s service treatment records indicate asthma treatment with Theophylline and Proventil. Neither these medications commonly cause hypertension as a side effect. Therefore, it is speculative to state these medications caused hypertension. In evaluating the Veteran’s baseline severity of his hypertension, the examining physician noted that his blood pressure reading from clinic note dating September 2008 documented a reading of 165/90. There is no evidence in the remainder of his records to suggest aggravation beyond its natural progression, as subsequent readings reflected a decline in blood pressure. For example, in February 2014, this blood pressure readings were between 120s-140s/80s-90s, which highly suggests improvements of his hypertension between 2008 to 2014. As previously noted by the examining physician, the Veteran’s hypertension remained the same since its onset in 2013. Therefore, it is less likely than not that the Veteran’s hypertension is caused or aggravated by the Veteran’s asthma, including his asthma medication. In reviewing the record, the Board finds that service connection for hypertension is not warranted. The Veteran’s service treatment records do not suggest that his hypertension had onset in service. There were no complaints or treatment relating to chronic elevated blood pressure. Nine months prior to his separation, he did not exhibit any clinical abnormalities relating his cardiovascular system. In fact, he did not show signs of chronic hypertension until several years after service. The Board notes that this passage of time weighs significantly against a finding of direct service connection for hypertension. See Maxson, 230 F.3d 1330. While the Veteran believes that his hypertension is linked to his active duty, the Board notes that he is not competent to provide an etiology opinion. The question regarding the etiology of his current hypertension is an issue of causation of a medical condition, which requires a medical determination outside the realm of common knowledge of any lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, his lay statements alone are not sufficient to establish the required nexus in this case. The Board must then rely on the available and probative medical evidence, which have not found the required nexus in this case. The Board notes that in support his claim, the Veteran’s representative has asserted a possible link between hypertension and chronic stress. Unlike his assertion linking stress and heart disease, the Veteran has not submitted any accompanying medical opinion or even a medical article to support such a link between hypertension and stress. As such, the Board affords no probative value to this assertion sufficient to support the Veteran’s claim. The most probative medical evidence, which remains the July 2019 VA medical opinion, found that it is less likely that the Veteran’s current hypertension is related to his military service. Additionally, the VA physician also found that the Veteran’s hypertension is less likely related to his service-connected asthma, including medications for asthma. In reviewing the Veteran’s claims file, the physician found that the two conditions are not pathophysiology related. Furthermore, the collective medical evidence does not suggest that the Veteran’s hypertension had worsened beyond its natural condition as a result of his asthma or its medication. The Veteran has not submitted any probative medical evidence to the contrary. Finally, service connection may also be granted for chronic disabilities if such are shown to have been manifested to a compensable degree within one year after the Veteran was separated from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. For this purpose, a chronic disease is one listed at 38 C.F.R. § 3.309 (a), to include hypertension. See Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013). However, there is no evidence, nor allegation, that the Veteran’s hypertension was diagnosed either in service or within one year after service, let alone to a compensable degree. See 38 C.F.R. §§ 3.309. The earliest post-service medical evidence of hypertension is dated no earlier than 2006, which is almost 20 years after service. Without evidence supporting a diagnosis in service for one year, the claim is also not warranted under 38 C.F.R. § 3.309 (a). Accordingly, service connection for hypertension is denied. GERD The Veteran contends that he developed GERD as a result of his military service, to include secondary to his service-connected asthma and medication for asthma. Service treatment records were silent for a diagnosis of acid reflux. However, he was seen at sick bay in April 1984 for gastroenteritis. By nine months prior to his separation in 1988, his medical examination indicated that digestive system was clinically evaluated as normal with no digestive problems noted. In his accompanying report of medical history, the Veteran denied problems with his stomach or reflux. Post service treatment records showed that the Veteran began experiencing GERD in December 2014. To determine the etiology of his condition, the Veteran was afforded a VA examination in October 2015. The VA examiner concluded that the Veteran’s current GERD is less likely than not related or caused by his service-connected asthma or by the medication used to treat his asthma. GERD is a condition caused by reflux of the stomach acid into the esophagus, generally due to excess acid or a weak esophageal sphincter. Additionally, GERD is not caused by asthma medications. In his April 2016 VA Form 9, the Veteran asserted his asthma along with his asthma medication have affected his overall health, causing his acid reflux. In support of his claim, the Veteran submitted a column by Dr. Roach in The Press-Enterprise that stated, ‘Acid reflux is caused by stomach acid going backward up into the esophagus, and it can damage the esophagus as well as causing pain. Many conditions predispose toward acid reflux, often called GERD, gastroesophageal reflux disease, especially those that affect the lower esophageal sphincter, a structure of smooth muscle at the esophagus, which acts as a valve to prevent the asset from going backward. Calcium channel blockers like Verapamil relax and smooth muscle, as other medications such as Albuterol, Nitroglycerine, and Theophylline. These medications cause the lower esophageal sphincter to weaken immediately.’ As the Veteran is currently taking Omeprazole daily, it is his belief that it has been causing or aggravating his GERD. Through his representative, the Veteran asserted in an April 2016 Appellate Brief that the shipboard duty provided a stressful environment based on the finding of US Navy Research Center. According to a medical article regarding heartburn published by WebMD, stress can increase acid production and can cause heartburn. When the matter returned to the Board in September 2018, the Board found that a new medical opinion was necessary to adequately determine the etiology of the Veteran’s GERD. The new medical opinion was to address the findings published by The Press-Enterprise newspaper, which suggested that certain medications such as calcium channel blockers can reflex esophageal muscles, which may cause GERD. The new medical opinion was also to address the WebMD article, which found that stress can increase acid production, which may lead to heartburn. Furthermore, the examiner was also to address direct service connection. A new medical opinion was obtained in July 2019, in which the examining physician also found negative nexus between the Veteran’s military service and the Veteran’s GERD. The physician reasoned that his service treatment records do not support evidence of onset of symptoms during active service. His report of medical history in March 1988 and June 1990 noted that the Veteran reported ‘no’ to frequent indigestion. His March 1988 report of medical examination reported no issues with his stomach. He was ultimately diagnosed with GERD and began treatment with medications in 2005. His overall record show that his condition had remained the same since his diagnosis with symptoms such as heartburn, regurgitation, substernal burning sensation, and occasional throbbing. Therefore, it is less likely that the Veteran’s current GERD began in service. With regard to the Veteran’s claim for secondary theory of entitlement, the examining physician found that asthma does not directly cause GERD symptoms. The Veteran’s service treatment records indicated that his asthma has been treated with Theophylline and Proventil. Neither of these medications commonly cause GERD as a side effect. Therefore, it is only speculative to state that such medications cause GERD. The baseline for the Veteran’s condition is unclear since the record contains subjective complaints and the existence of symptoms alone cannot be quantified to establish a baseline. Post service treatment records did not specifically indicate the severity of his condition. Asthma does not directly cause GERD symptoms, and the Veteran’s service treatment records do not support aggravation of GERD symptoms during service. Therefore, it is less likely that the Veteran’s GERD was caused or aggravated beyond its normal progression by asthma or medication for asthma. In reviewing the record, the Board finds that service connection is not warranted for GERD. While the Veteran has consistently asserted a link between this current GERD and his military service, including his service-connected asthma and its medication, the medical evidence or record does not support his contention. To support his assertion, the Veteran submitted an article from WebMD stating that chronic stress can cause acid production and heartburn. While the article illustrates a general association between acid reflux and GERD, it does not specifically address the facts of the Veteran’s case. He has not submitted any accompanying medical opinion to interpret and apply the study to the Veteran’s circumstance. Therefore, the WebMD article remains inconclusive and have not been able to provide a probable nexus between the Veteran’s GERD and his military service. Thus, the Board must rely on the probative medical evidence of record, namely the July 2019 VA medical opinion, which found negative nexus between the Veteran’s GERD and his service. In his rationale, the examining physician found no evidence of GERD onset in service, which is also supported by the Veteran’s denial of any stomach or acid reflux problems in service. With regard to the secondary theory of entitlement, the July 2019 medical opinion also found that it is less likely that the Veteran’s GERD is caused or aggravated by the Veteran’s asthma or asthma medication. In finding so, the VA physician explained that the medical evidence did not suggest that the Veteran’s GERD had worsened beyond its natural progression due to his asthma. Moreover, there is no medical evidence or literature to show that his asthma medication adversely affected his GERD. Furthermore, the Board notes that during service, the Veteran was presented with gastroenteritis in April 1984. While GERD and gastroenteritis are separate conditions, the Board has nevertheless considered whether the Veteran presented a continuity of symptomatology that may support his claim for GERD. However, it finds that continuity has not been shown. After April 1984, the medical evidence did not document continued treatment relating to his digestive system, which suggests that the condition had resolved. There were no other complaints by the Veteran during service relating to acid reflux or GERD. In fact, the earliest documented evidence of a clinical diagnosis was not until several years after service. The Veteran has not contended otherwise. The weight of the probative evidence of record simply fails to demonstrate a medical link between the issue on appeal and the Veteran’s period of active service. Nor has the evidence suggested a link between his GERD and his service-connected asthma, including its medication. Therefore, the evidence in this case is not so evenly balanced so as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The preponderance of the evidence is against the Veteran’s claim, and as such entitlement to service connection for a disorder of GERD is denied. Tiffany Dawson Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Yeh, 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.