Citation Nr: 21022903 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 17-31 191 DATE: April 19, 2021 ORDER Entitlement to service connection for gastroesophageal reflux disease (GERD) is granted. FINDING OF FACT The Veteran’s GERD is etiologically related to service. CONCLUSION OF LAW The criteria for service connection for GERD have been met. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1988 to December 1991, with service in Southwest Asia from November 1990 to March 1991. This matter comes to the Board of Veterans’ Appeals (Board) from a March 2015 rating decision which, in pertinent part, denied service connection for irritable bowel syndrome (IBS). In September 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In December 2019, the Board remanded the claim of service connection for a gastrointestinal disability, to include IBS, GERD, and as due to an undiagnosed illness, for a new VA examination. A February 2021 rating decision granted service connection for IBS. A February 2021 supplemental statement of the case (SSOC) identified the issues on appeal as service connection for GERD as due to an undiagnosed illness and entitlement to a total disability rating based on individual unemployability (TDIU). As a preliminary matter, the Board notes that an August 2004 rating decision previously denied a claim of service connection for GERD. While the Veteran’s current claim was initially filed for IBS in October 2014, the Board’s December 2019 remand framed the claim as a gastrointestinal disability because the Veteran’s diagnoses were not clear. The January 2020 VA examiner clarified that the Veteran has separate diagnoses of IBS and GERD. While the February 2021 SSOC did not discuss whether new and material evidence had been submitted to reopen the previously denied claim, the Board notes that the January 2020 VA examiner provided a nexus opinion. Thus, new and material evidence has been presented, and the Board is proceeding with adjudication on the merits. The Board also notes that a claim for a TDIU is not properly on appeal. A TDIU claim was inferred as part of an increased rating claim for posttraumatic stress disorder (PTSD) because the Veteran reported that he stopped working in July 2019 due to anxiety attacks and depression. A July 2020 rating decision denied a TDIU, and the February 2021 SSOC referenced this rating decision. The July 2020 rating decision is not before the Board, and the claim of service connection for GERD would not include a TDIU claim. The Board finally notes that the Veteran’s representative has not been provided an opportunity to submit an informal hearing presentation. However, as the claim for a TDIU is not before the Board and this decision represents a full grant of the benefit on appeal, there is no prejudice to the Veteran in the absence of an informal hearing presentation. Entitlement to service connection for GERD is granted. Service connection may be granted for a disability related to active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, a veteran must establish: (1) evidence of a current disability; (2) in-service incurrence or aggravation of an injury; and (3) a causal relationship between the current disability and the injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A December 1987 entrance examination identified no abnormalities or defects with the mouth and throat. A March 1991 service treatment record noted the Veteran was prescribed a gastrointestinal cocktail after reporting nausea with pain to the abdomen. An October 1991 separation examination identified no abnormalities or defects with the mouth and throat. At a June 1994 VA examination for PTSD, the Veteran reported that there was a good deal of smoke in the air while stationed in Southwest Asia and that it was pretty dark the last month or so. In a July 2003 letter, a private gastroenterologist stated the Veteran had been a patient since 1991 and had a diagnosis of GERD with hypersensitive esophagus. In a June 2017 buddy statement, a fellow solider stated the Veteran frequently complained of stomach pain and nausea even to the point of vomiting and sought treatment for these symptoms during service in Southwest Asia. At the September 2019 hearing, the Veteran reported experiencing stomach issues during service in Southwest Asia. He reported going to the field hospital on two occasions and was given a gastrointestinal cocktail. He reported that the field hospital did not keep any medical records. He reported environmental exposures during service in Southwest Asia, to include burning feces and oil well fires. At a January 2020 VA examination for an esophageal disability, the examiner reviewed the Veteran’s electronic folder and performed an in-person examination. The examiner diagnosed the Veteran with GERD and stated that it was a diagnosable chronic multisymptom illness with a partially explained etiology. The examiner stated that the available medical records detailed reports of the Veteran seeking treatment in Southwest Asia for GERD symptoms after consistent exposure to burn pits smoke and fumes and that the timing of onset of symptoms suggested a correlation between the environmental exposure and the development of gastrointestinal symptoms. The examiner opined that the Veteran’s esophageal disability was as likely as not due to the esophageal disability reported during the time of service and that the current GERD disability was as likely as not due to exposure to burn pits smoke and fumes during the time of service. As a preliminary matter, the Board finds that the Veteran was in sound condition when he entered service based on the December 1987 examination identifying no abnormalities or defects with the mouth and throat. The Board notes that the Veteran’s GERD is not subject to service connection for certain disabilities occurring in Persian Gulf veterans because this disability has been diagnosed and has a partially explained etiology. See 38 C.F.R. § 3.317(a)(2)(ii); see also Atencio v. O’Rourke, 30 Vet. App. 74, 87 (2018) (excluding GERD as a functional gastrointestinal disorder). Turning to the issue of direct service connection, the Board finds that the competent and credible evidence shows a current disability and an in-service incurrence. The January 2020 VA examiner diagnosed the Veteran with GERD. The evidence of record, to include the June 1994 VA examination, supports the Veteran’s testimony of environmental exposures during service in Southwest Asia, to include oil well fires. The evidence of record, to include the March 1991 service treatment record and the buddy statement, also supports the Veteran’s testimony of seeking treatment for stomach problems during service in Southwest Asia. While the March 1991 service treatment record shows that some medical records were kept at the field hospital, the Board finds that the Veteran’s testimony of a second visit is credible. The Board assigns probative weight to the January 2020 VA examiner’s opinion that the Veteran’s GERD is related to service. The Board notes that the examiner reviewed the Veteran’s claim file. Based on this review, the examiner opined that the available medical records showed that it was more likely than not that the Veteran’s current GERD was related to the symptoms reported during service and were due to environmental exposures during service in Southwest Asia. While the Veteran’s GERD is not a chronic condition subjective to presumptive service connection under 38 C.F.R. § 3.309, the Board notes that the examiner’s nexus opinion is consistent with the July 2003 letter noting treatment for GERD contemporaneously at the end of service. The Board further notes that there is no negative nexus opinion. (Continued on the next page.)   Because the credible and competent evidence supports the Veteran’s claim, the Board finds that service connection for GERD is warranted. Accordingly, the Veteran’s claim is granted. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ormson, 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.