Citation Nr: 21022232 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 12-35 639 DATE: April 15, 2021 ORDER Entitlement to service connection for a stomach condition, claimed as secondary to service-connected knee disabilities, is denied. FINDING OF FACT The competent and probative evidence of record fails to link the Veteran’s stomach condition to his service-connected knee disabilities. CONCLUSION OF LAW The criteria for entitlement to service connection for a stomach condition, claimed as secondary to service-connected knee disabilities, have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1978 to January 1980. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a December 2015 Board hearing before a different Veterans Law Judge (VLJ). The transcript is associated with the claims file. The Veteran was provided an opportunity for another hearing in February 2021 because the VLJ who conducted the hearing in December 2015 is no longer at the Board. The Veteran was told that if the Board did not receive a response within 30 days from the date of the February 2021 letter, it would be assumed that he did not want another hearing. The Board did not receive a response from the Veteran or his representative. As such, this option is deemed waived. The Board notes that the Veteran perfected an appeal to the Board in September 2018 regarding an increased rating for service-connected left sinus tarsi syndrome and requested a Board video conference hearing. This hearing has not yet been scheduled. Thus, this issue will be addressed in a subsequent Board decision, after the Veteran has been afforded the opportunity participate in his requested hearing. Furthermore, the Veteran appealed the Board’s December 2017 decision to the Court of Appeals for Veterans Claims (CAVC). The prior denial on the claim on appeal was vacated here. Several other issues were resolved in November 2019 and October 2020 Board decisions. In this case, the Board remanded the Veteran’s claim regarding service connection for a stomach condition to the RO in November 2019 for a new VA examination and in October 2020 for an adequate VA opinion. After reviewing the evidence of record, the Board finds that the resulting VA opinion is adequate to adjudicate the issue of service connection for the Veteran’s stomach condition. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. Where a service-connected disability aggravates a nonservice-connected condition, a Veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. The Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). VA shall give the benefit of the doubt to the claimant when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran contends that he has a stomach condition due to the medications prescribed for his service-connected knee disabilities. The Veteran’s November 2010 claim specified a claim for secondary service connection, and the evidence does not otherwise raise the issue of entitlement to direct service connection. Thus, the Board will only address secondary service connection. In December 2017, the Board denied the Veteran’s service connection claim for a stomach condition based on an April 2016 VA examination. The examiner stated that Veteran’s chronic gastritis and associated gastroesophageal reflux disease (GERD) were less likely than not caused by prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for his service-connected knee disabilities. However, as noted above, the Veteran appealed this decision to CAVC as the April 2016 opinion did not address the causal role of Tramadol, a medication the Veteran was prescribed for his service-connected knee disabilities. Pursuant to the findings in the February 2019 joint motion for partial remand (JMPR), the Board remanded the issue for a VA medical opinion. In January 2020, a new VA opinion was obtained. The January 2020 report stated the Veteran’s NSAID use had stopped for several years and thus would not be responsible for the Veteran’s continuing reflux or gastritis. In addition, the report stated that the Veteran was currently prescribed hydrocodone and Tylenol, which are not usually associated with gastritis or reflux. The Board remanded the case in October 2020, as the January 2020 opinion did not address the Veteran’s use of Tramadol and its possible effects on the Veteran’s stomach condition for an earlier part of the appeal period. Pursuant to the October 2020 Board remand, an addendum opinion was obtained in December 2020 that addressed the deficiencies of the prior January 2020 opinion. The December 2020 examination report stated that the Veteran’s stomach condition was less likely than not proximately due to or caused by the medications prescribed for the Veteran’s service-connected disabilities. The examiner stated that there is no “anatomic or pathophysiological basis for the Veteran’s stomach condition” and that the Veteran was prescribed Tramadol in 2012. The examiner further stated that although Tramadol can cause mild gastrointestinal side effects, the medical profile of the medication does not show any causal relationship to chronic gastritis and associated GERD. In addition, the examiner cited studies that indicated even excess dosages than those prescribed do not show any changes in gastric pH levels. Also, the side effects of taking more than prescribed would include sedation, dry mouth, respiratory depression and constipation, with no known risk of developing chronic gastritis. The examiner also addressed the Veteran’s current medications of hydrocodone and oxycodone with acetaminophen, noting that these medications are also not known to cause chronic gastritis or associated GERD. Moreover, the December 2020 addressed aggravation by stating that the weight of medical evidence does not support any aggravation of the stomach condition beyond its natural progression due to the medications prescribed for service-connected knee disabilities, including Tramadol. The examiner indicated that the side effect profiles of the Veteran’s medications, including Tramadol, oxycodone, and hydrocodone with acetaminophen, have not been shown by medical research findings to aggravate the stomach condition. As such, a nexus based on causation or aggravation beyond natural progression was not found. See 38 C.F.R. § 3.310. The Board finds that the Veteran’s lay statements are outweighed by the persuasive rationale provided in the December 2020 opinion. To the extent that the Veteran has been shown to be competent to opine on symptoms and matters of personal observation, respectively, the Board finds that the opinion of the VA examiner is of greater probative weight than the lay statements of record, and the Veteran is not shown to have the training or credentials to provide a competent medical opinion on the etiology of his stomach condition, as that requires medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The December 2020 examiner has training, knowledge, and expertise upon which he relied to reach the above determinations, and the opinion reflects a comprehensive, accurate, and reasoned review of the entire evidentiary record. Thus, the examiner’s opinion outweighs the lay statements of record. Ultimately, the preponderance of evidence is against a finding that the Veteran’s stomach condition (chronic gastritis and associated GERD) is related to his active service on a secondary service connection basis. The Board finds that the December 2020 VA opinion is the most probative evidence with respect to the claim, given the examiner’s training and credentials and the claims file review incorporated. As such, the benefit-of-the-doubt doctrine does not apply in this case, and service connection for a stomach condition as secondary to service-connected knee disabilities must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ariasaif, 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.