Citation Nr: 21020834 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 19-08 615 DATE: April 8, 2021 ORDER Entitlement to service connection for a gastrointestinal disorder, to include acid reflux, is DENIED. FINDING OF FACT The weight of the evidence is against a finding that the Veteran’s currently diagnosed gastrointestinal reflux disease (GERD) either began during, or was otherwise caused by, his service in the United States Army. CONCLUSION OF LAW The criteria for service connection for a gastrointestinal disorder, to include acid reflux, have not been met. 38 U.S.C. §§ 1110, 1111, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.310 (2020).   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the United States Army from April 1964 to April 1967. The certificate of release from active duty (DD214) reflects that the Veteran received the Vietnam Service Medal. Entitlement to service connection for a gastrointestinal disorder, to include acid reflux, is denied. In February 2016, the Veteran submitted a VA Form 21-526b. Thereby, the Veteran initiated a claim for service connection for a gastrointestinal disorder, to include acid reflux. To substantiate a claim for service connection, there must be evidence of a current disability; evidence of incurrence or aggravation of a disease or injury in service; and evidence of a nexus between the current disability and the disease or injury in service. See Shedden v. Principi, 381 F.3d 1153, 1166-1167 (Fed. Cir. 2004). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303 (a). VA regulations provide that certain diseases associated with exposure to herbicide agents may be presumed to have been incurred in service even if there is no evidence of the disease in service, provided the requirements of 38 C.F.R. § 3.307 (a)(6) are met. 38 C.F.R. § 3.309 (e). A Veteran who, during active service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a). If a Veteran was exposed to an herbicide agent during active service, the following diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied: AL amyloidosis; chloracne or other acneform disease consistent with chloracne; Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes); Hodgkin’s disease; all chronic B cell leukemias; multiple myeloma; non-Hodgkin's lymphoma; Parkinson’s disease; early-onset peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx or trachea); soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma); and ischemic heart disease, (including, but not limited to, acute, subacute, and old myocardial infarction); atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal’s angina), shall be service-connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied. 38 C.F.R. § 3.309 (e). The diseases listed at 38 C.F.R. § 3.309 (e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and early-onset peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year after the last date on which the Veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii). Where the evidence does not warrant presumptive service connection, the United States Court of Appeals for the Federal Circuit has determined that an appellant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). In October 2015, the Veteran’s service treatment records (STRs) were associated with the claims file. After review, the Board observes that an impression for non-specific gastroenteritis was noted in July 1964. In September and October 1965, a military provider noted the presence of diarrhea and other gastrointestinal symptoms. During the February 1967 clinical evaluation, which is at the Veteran’s separation from service, the military examiner reported a normal gastrointestinal system. In October 2019, the Board addressed the Veteran’s claim for service connection for a gastrointestinal disorder. The Board noted that the Veteran had a current diagnosis for acid reflux and gastroesophageal reflux disease (GERD), and the July 1964 service treatment records (STRs) reported gastrointestinal problems. The Board found that evidence of record was insufficient to decide the claim. The Board directed the agency of original jurisdiction (AOJ) to arrange a VA examination for the Veteran that addressed the nature and etiology of the claimed gastrointestinal disability, to include acid reflux. In January 2020, the Veteran underwent a VA examination that addressed the nature and etiology of esophageal conditions. The VA examiner noted a diagnosis for gastroesophageal reflux disease (GERD). At that time, the Veteran reported an onset of upper gastrointestinal issues with previous alcohol abuse. The VA examiner noted that the STRs revealed that the Veteran was seen once for non-specific gastroenteritis, and three times for diarrhea, during service in the United States Army. The VA examiner relayed that the episodes reported in the STRS were compatible with self-limited non-specific gastroenteritis. The examiner noted the episodes were treated symptomatically and resolved. The VA examiner noted that the Veteran’s separation examination was silent for gastrointestinal issues. The VA examiner opined that the Veteran’s current GERD was less likely than not (less than 50 percent probability) incurred in, or caused by, an in-service injury, event or illness. The VA examiner supplied the following rationale: “GI problems documented in STRs were compatible with episodes of acute gastroenteritis, which is a separate and distinct clinical entity from the currently diagnosed GI condition of acid reflux. These episodes, in STRs, resolved with time and symptomatic care and w/o residuals. The separation exam is silent for issues compatible with the current (diagnosed) GI condition of GERD.” The VA examiner addressed the article submitted by the Veteran, “Gastrointestinal problems in modern wars: Clinical features and possible mechanisms.” The VA examiner opined that, “this article does not (scientifically) allow for supporting a nexus between this Veteran’s active (Vietnam) service and the diagnosed condition of GERD.” The VA examiner noted that the Veteran reported a prior history of alcohol abuse as a contributing factor to the current acid reflux. The VA examiner noted that the Veteran’s treatment records indicated that the onset of acid reflux / heartburn occurred several decades after the Veteran’s military service. After review of “Veterans and Agent Orange: Update 11” (2018), the VA examiner relayed that the Committee had not found an association between herbicide agent exposure and gastrointestinal / digestive diseases. On numerous occasions during the claim period, the Veteran’s treatment records have been associated with the claims file, to include those generated at the Captain James Lovell Federal Health Center and Daytona Beach Outpatient Clinic. After deliberate review, the Board notes that the records do not contain a notation that would support a finding that the Veteran’s currently endured GERD was incurred during active duty service. Moreover, the Board notes that the first notation in the claims file that indicates gastrointestinal problems was generated in 2012, which is many decades after the Veteran’s active duty service. The Board observes that the Veteran is currently diagnosed with GERD. Additionally, the Veteran was treated for gastrointestinal issues while on active duty in the United States Army. Consequently, the first and second requisite elements for direct service connection have been substantiated. See Shedden, 381 F.3d at 1166-1167. However, the Board finds that the preponderance of the evidence does not support a nexus between the Veteran’s in-service gastrointestinal issues and the currently endured GERD. Consequently, the final requisite element for direct service connection has not been substantiated. See id. Ultimately, the Board finds that the preponderance of the evidence stands counter to the Veteran’s claim for service connection for a gastrointestinal disorder, to include acid reflux. Since the preponderance of the evidence is against this claim, the provisions of 38 U.S.C. § 5107(b), regarding reasonable doubt, are not applicable. The Veteran’s claim for service connection for a gastrointestinal disorder, to include acid reflux, must be denied, because the preponderance of the evidence weighs against his claim. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board RLBJ, 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.