Citation Nr: 21028310 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 13-15 602 DATE: May 11, 2021 ORDER The claim of entitlement to service connection for chronic laryngitis, also claimed as pharyngitis (hereafter, laryngitis), is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran had laryngitis or any related disability, other than her already service-connected gastroesophageal reflux disease (GERD), at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for laryngitis, separate from service-connected GERD, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from February 1982 to February 1992 in the United States Air Force and had additional reserve service. She received the Southwest Asia (SWA) Service Medal with three Bronze Stars, among other notable commendations. This matter comes before the Board of Veterans' Appeals (Board) from a September 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board video conference hearing before the undersigned in June 2017. A written transcript of that hearing has been prepared and is associated with the evidence of record. The Board remanded this matter in August 2018 and September 2020 for additional development. The Board concludes that there has been substantial compliance with its prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). 1. The claim of entitlement to service connection for chronic laryngitis, also claimed as pharyngitis. The Veteran contends that she has chronic laryngitis related to her active service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). When the preponderance of the evidence weighs against the claims of the Veteran, the claim will be denied on its merits, and when the preponderance of the evidence weighs for the claims of the Veteran, the claim will be granted on its merits. In those cases, the benefit of the doubt doctrine is inapplicable. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). In its prior remands, the Board directed the RO to obtain medical opinions on the nature and etiology of the Veteran's claimed laryngitis condition. These opinions were to address the Veteran's multiple in-service complaints of a chronic sore throat and hoarseness, and to consider whether the Veteran's condition could be secondarily related to or aggravated by her service-connected GERD. Given the Veteran's service in SWA, the RO was also able to obtain a medical opinion as to whether the claimed condition was related to the Veteran's exposure to environmental hazards associated with service in SWA, and whether the Veteran's collective symptoms of throat pain, hoarseness, and recurrent loss of voice resulted in functional impairment at any time during or approximate to the pendency of the claim. The Veteran is already in receipt of service connection for GERD. Thus, the question for the Board is whether the Veteran has a separate disability that is related to service or a service-connected disability. Having fully considered the evidence of record, the Board finds the preponderance of the competent, credible, and probative evidence weighs against a finding that she has such a separate disability for service connection purposes. Following the Board's September 2020 remand, the Veteran received an in-person VA examination in February 2021, which included consideration of Gulf War conditions as well as conditions of the larynx and pharynx. The examiner's evaluation reports include lay statements from the Veteran about the approximate in-service date of onset of her symptoms and the course of her condition since then. The Veteran described her symptoms to include chronic hoarseness and sore throat, laryngeal spasms resulting in shortness of breath six to seven times per year, and a dry itchy throat with chronic cough. Upon examination and record review, the examiner assessed the Veteran with GERD, noting that the condition involved other pertinent physical findings due to larynx or pharynx conditions, however, the examiner did not diagnose the Veteran with chronic laryngitis or chronic pharyngitis and found no historical diagnosis of those conditions in her medical records. The examiner opined that the Veteran's symptoms of "chronic hoarseness, sore throat, dysphagia, dry cough are all consistent with the service connected condition of GERD," citing medical research that GERD "occurs when the amount of gastric juice that refluxes into the esophagus exceeds the normal limit, causing symptoms with or without associated esophageal mucosalinjury." The examiner noted that GERD symptoms can include dysphagia, hoarseness, sore throat, coughing, and wheezing. The examiner concluded that the Veteran's current symptoms are the result of her service-connected condition, GERD. In the examiner's separate Gulf War disability benefits questionnaire, she opined that the standard Gulf War disability patterns were not applicable to the Veteran's claimed chronic laryngitis condition, noting that the Veteran's objective physical examination was normal, that there were no historical diagnoses of a chronic condition, and that the Veteran's reported symptoms did not form the pathology for a diagnosable condition outside of the condition of GERD. The Board finds the examiner's opinion probative, because is it based on a thorough review of available medical and lay history and provides explanations with clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Further, the examiner's reports accurately outline the medical evidence contained in the Veteran's service medical records. While these records detail episodes of laryngitis and pharyngitis, the Veteran was not diagnosed during service with chronic conditions. Instead, her records consistently describe esophageal distress, including symptoms related to epigastric burning and other symptoms relating to her extensive medical history of GERD. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. § 1131. In the absence of proof of a current diagnosis of chronic laryngitis or pharyngitis separate from GERD, service connection cannot be established. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board acknowledges the definition of "disability" in 38 U.S.C. § 1110 (and by implication 38 U.S.C. § 1131) includes any condition that results in functional impairment of earning capacity. See e.g.m Martinez-Bodon v. Wilkie, No. 18-3721 (Fed. Cir. 2020); Wait v. Wilkie, 33 Vet. App. 8, 16 (2020). Here, however, while the Board acknowledges the Veteran's report of chronic hoarseness, sore throat, dysphagia, and dry cough, the evidence does not reflect that the Veteran has symptomology of a disability other than her service-connected GERD that results in any functional impairment. See February 2021 VA examinations. For the above reasons, the preponderance of the evidence is against the claim and service connection for laryngitis is denied. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Hart, 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.