Citation Nr: 21021834 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 16-14 974 DATE: April 14, 2021 ORDER Entitlement to service connection for a gastrointestinal disorder, to include as secondary to herbicide exposure and contaminated water exposure, is denied. FINDING OF FACT The preponderance of the evidence is against findings that het Veteran has a gastrointestinal disorder due to an event, injury, or disease in service. CONCLUSION OF LAW The criteria for service connection for a gastrointestinal disorder are not met. 38 U.S.C. § 1131; 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from February 1969 to September 1970. In December 2018, a Board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran’s claims file. Entitlement to service connection for a gastrointestinal disorder, to include as secondary to herbicide exposure and contaminated water exposure Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed.Cir.1996) (table); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303. Service connection may be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents, even though there is no record of such disease during service, if they manifest to a compensable degree any time after service, in a veteran who had active military, naval, or air service for at least 90 days, during the period beginning on January 9, 1962, and ending on May 7, 1975, in the Republic of Vietnam, including the waters offshore, and other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e), 3.313. This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309. The evidence confirms that the Veteran served in Vietnam. Accordingly, exposure to herbicides in service is conceded. However, VA determined that the presumption is not warranted for any condition other than those for which VA has found a positive association between the condition and such exposure. Nevertheless, the Veteran can still receive service connection for a disability on a direct basis if the service connection elements are otherwise met. The Veteran contends that his gastrointestinal disorder began during service and is related to herbicide exposure, or to exposure to contaminated water while stationed at Camp Pendleton. GERD has not been presumptively associated with exposure to herbicide agents. The Board concludes that the preponderance of the evidence is against finding that the Veteran suffers from GERD directly related to his military service—to include as due to herbicide exposure or as due to exposure to contaminated water. The Veteran has a diagnosis of gastroesophageal reflux disorder and mild diffuse gastritis (“GERD”). STRs do not contain any reports or complaints related to his gastrointestinal system. On discharge in 1970, he marked no to frequent indigestion, stomach, liver, or intestinal trouble. In September 2013 the Veteran underwent an esophagogastroduodenoscopy, with the impression being mild diffuse gastritis, and multiple gastric polyps were removed. In September 2013, the Veteran underwent a VA examination. He was diagnosed with GERD and mild diffuse gastritis. The Veteran reported that upon returning from Vietnam he had the onset of frequent heartburn and being diagnosed with GERD. He reported current symptoms of frequent heartburn for which he takes omeprazole. The examiner did not render an opinion. In an October 2013 statement, the Veteran asserted that he believes due to exposure to herbicides while in Vietnam, he developed gastrointestinal problems. At the Board hearing, he asserted his belief that he was exposed to contaminated water at either Camp Pendleton, California, or contaminated water in barreled water that was provided while stationed in Vietnam. A VA opinion was rendered in November 2019. The examiner concluded the GERD is less likely than not due to service, to include herbicide exposure. Rationale included that current literature does not support an association with any gastrointestinal condition and exposure to herbicides. The examiner referenced the NAS finding that there is insufficient or inconclusive evidence of an association with any gastrointestinal diagnosis and herbicide exposure. Further, the examiner explained there is no indication of a gastrointestinal condition during service, or within one year of separation. A memorandum was issued in August 2020, documenting that the Veteran served in Vietnam, and that he was stationed at Camp Pendleton. The EPA confirmed that disposal practices contaminated the groundwater and soil at Camp Pendleton. In August 2020, the Veteran underwent another examination. The Veteran reported developing pyrosis prompting an EGD and colonoscopy in 2013, which revealed the presence of mild gastritis, gastric polyps, and sigmoid polyps. The examiner concluded the Veteran’s GERD, mild gastritis, gastric polyps, and sigmoid poylps were less likely than not incurred during service. The examiner noted that review of the records revealed no objective evidence of any chronic esophageal, stomach or intestinal symptoms or pathology during service. His separation examination specifically noted no to frequent indigestion, stomach, liver, or intestinal trouble. The examiner further found that initial documentation of the presence of GI pathology came over 40 years post-discharge. The examiner opined the Veteran’s GERD and mild gastritis are less likely than not due to exposure to contaminated water at Camp Pendleton and/or in water barrels in the Republic of Vietnam, and/or exposure to herbicides in Vietnam during service. The examiner noted that GERD is due to relaxation of the gastroesophageal junction/sphincter, allowing stomach contents and acid to reflux into the esophagus. The examiner noted that the etiology of gastritis is not specified, but there is no pathophysiologic mechanism by which remote exposure could impact the onset of GERD 40+ years later. The examiner found that any condition due to said exposures would almost certainly manifest at the time of such exposures and not remotely. There was no evidence of a gastroesophageal condition in service or at separation. Therefore, the examiner concluded it is less likely than not that the Veteran’s GERD and mild gastritis were due to or incurred in the above-noted exposures. Although the Veteran believes his GERD is due to his time in service, to include herbicide exposure and contaminated water exposure, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examiners’ opinions. When read together, the 2019 and 2020 opinions establish the Veteran does not suffer from GERD with mild gastritis, due to service, to include herbicide or contaminated water exposure. The 2020 examiner explained the Veteran’s there is no pathophysiologic mechanism by which remote exposure to herbicides or contaminated water could impact the onset of GERD 40+ years later. In so concluding, the examiners provided a detailed rationale—including consideration of the medical evidence and lay reports. The Board notes the Veteran reported in September 2013, that upon returning from Vietnam he had the onset of frequent heartburn and being diagnosed with GERD, but this assertion is not corroborated by the contemporaneous medical evidence of record, and is controverted by the probative VA opinions. The first indication of a gastrointestinal condition was not until 2013, over 40 years post-discharge. Had the Veteran experienced gastrointestinal discomfort during service, it would be likely he would have reported his discomfort either during service or shortly thereafter, not over 40 years later. Consequently, the Board does not afford the Veteran’s lay statements of continuity of symptoms probative value. The Board appreciates the Veteran’s sincere belief that his GERD with mild gastritis is due to in-service exposures, but absent a competent opinion linking the GERD to service, service connection must be denied. Moreover, the examiners’ opinions are probative, because they are based on an accurate medical history and provide explanations that contain clear conclusions and supporting data. Unfortunately, there is no competent opinion to the contrary. (Continued on the next page)   The most probative evidence of record does not show that the Veteran suffers from GERD with mild gastritis due to service. Therefore, the claim must be denied. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Skiouris, 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.