Citation Nr: 21028355 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 11-28 493 DATE: May 11, 2021 ORDER An increased 30 percent rating for gastroesophageal reflux disease (GERD) with gastritis is granted. VETERAN'S CONTENTIONS The Veteran contends that he is entitled to a rating in excess of 10 percent for his GERD with gastritis disability. The Veteran specifically contends that following his right orchiectomy in service, he began having gastrointestinal issues. See September 2010 Notice of Disagreement and September 2020 report of VA Examination. The Veteran reported that he experiences severe heartburn, gas, bloating, diarrhea, recurrent epigastric distress, substernal pain, shoulder pain, reflux, regurgitation, sleep disturbance, and pyrosis. See VA Examinations dated June 2009, August 2018, and September 2020. The Veteran also explained that he experiences exacerbation of the reflux due to dietary changes based on his deployments for his job. See May 2017 Private Medical Treatment Record. Further, the Veteran stated that since 2009, he has experienced heartburn and wakes up at night coughing with acid in his throat. See September 2020 report of VA Examination. FINDING OF FACT For the entire claim period, the Veteran's GERD with gastritis has been manifested by persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, and substernal and shoulder pain. These signs and symptoms are productive of considerable impairment of health. CONCLUSION OF LAW The criteria for an increased disability rating of 30 percent for GERD are met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.400, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.113, 4.114, Diagnostic Code 7307-7346. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1989 to May 2009. This matter comes before the Board of Veteran's Appeal (Board) on appeal from an August 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board has previously remanded this claim in April 2014, June 2018, and July 2020 for further development, including new VA examinations. The case has now returned to the Board for adjudication. An increased 30 percent rating for the Veteran's GERD with gastritis is granted. The Veteran's GERD with gastritis is currently rated as 10 percent disabling under 38 C.F.R. § 4.114, Diagnostic Codes 7307-7346. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. See 38 C.F.R. § 4.27. Here, the Veteran's GERD is not a condition listed in the rating schedule, and as such, is rated by analogy under either DC 7307, which pertains to gastritis, or 7346, which pertains to hiatal hernia. Under Diagnostic Code 7346, a 60 percent rating is assigned for symptoms of pain, vomiting, material weight loss, and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. Comparatively, a 30 percent rating is assigned for persistently recurrent epigastric distress with dysphagia (difficulty swallowing), pyrosis (heartburn), and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. Finally, a 10 percent rating is assigned for two or more of the symptoms listed in the criteria for a 30 percent rating but with less severity. As indicated above in the Conclusions of Law section, the Board finds that the Veteran's GERD warrants a 30 percent rating under DC 7346, but no higher. To this extent, the Veteran's claim is granted. In support of this determination, the Board first notes that the Veteran was provided five VA examinations during the claim period which were relevant to this issue on appeal. The Veteran reported that following the right orchiectomy in service, he began to experience gastrointestinal tract problems. See September 2010 Notice of Disagreement. The Veteran has been diagnosed with GERD, eosinophilic esophagitis (EoE), Crohn's disease associated with mesentery adenopathy with lymphoid aggregates with ileitis, and schistosomiasis. See March 2019 VA Examination. Additionally, the Veteran's GERD has been characterized predominantly by heartburn, regurgitation, epigastric pain, sleep disturbance, nausea, and stomach and shoulder pain. See VA Examinations dated June 2009, January 2018, and September 2020. The Veteran stated that he continued to be symptomatic, experiencing frequent bouts of heartburn, stomach irritation, epigastric pain, and reflux of acid to throat and mouth. See VA Examinations dated January 2018 and March 2019. The September 2020 examiner noted that the Veteran's treatment plan included Prilosec and Zantac, but that he now used Pepcid due to the side effects from the other GERD medications. See VA Examinations dated June 2009, March 2019, and September 2020. Relatedly, the Veteran's private treatment records and VA examinations show that the Veteran's GERD has been productive of considerable impairment of his health throughout the period on appeal. Specifically, the June 2009 examiner noted that the Veteran's symptoms included severe heartburn, gas, and bloating. See June 2009 VA Examination. In addition to these symptoms, the Veteran's private treatment records show that he has been treating the Veteran for regurgitation, chest pain, abdominal pain, and acid reflux. See June 2018 Private Medical Correspondence and August 2016 Private Medical Treatment Record. Further, the VA examiners opined that the Veteran's GERD continued to be symptomatic including persistently recurrent epigastric distress, dysphagia, pyrosis, reflux, regurgitation, pain substernal, sleep disturbance, nausea, vomiting, and pain in the stomach and shoulder area. See VA Examinations dated August 2018 and September 2020. Moreover, the Veteran reported that his GERD symptoms has caused him to leave work one to times per year due to heartburn. See March 2019 VA Examination. Therefore, the Board finds that the Veteran's GERD has caused a considerable impairment in his health. The Veteran's GERD, however, is not productive of severe impairment of health. Although the Veteran has argued that VA has failed to compensate him for the breadth of his gastrointestinal signs and symptoms, the preponderance of the evidence supports a finding that the signs and symptoms not accounted for by the 30 percent rating under DC 7346 are unrelated to his service-connected disability. In this regard, the Board acknowledges that the Veteran has been diagnosed with multiple gastrointestinal disabilities but finds that March 2019 and September 2020 examiners have distinguished the Veteran's gastrointestinal disabilities and the signs and symptoms attributable to each disability. Specifically, the March 2019 VA examiner distinguished the signs and symptoms associated with the Veteran's GERD from those associated with his Crohn's disease and related mesentery adenopathy with lymphoid aggregates with ileitis, and schistosomiasis. However, the March 2019 examiner opined that the Veteran's GERD symptoms and eosinophilic esophagitis (EoE) symptoms are indistinguishable. The March 2019 examiner opined that the Veteran's GERD and EoE disabilities produced the following symptoms: dysphagia, bloating, regurgitation, chest, and abdominal pain. Additionally, the August 2018 and September 2020 examiners found that the Veteran's epigastric pain was attributable to his GERD disability. Contrastingly, the March 2019 examiner explained that Crohn's disease is a disorder of the lower gastrointestinal tract and that the symptoms are diarrhea, fecal urgency, and occasional incontinence. Therefore, this examiner opined that the Veteran's diarrhea was attributable to the Veteran's Crohn's disease ileitis with lymphoid aggregates and mesentery adenopathy, and not his service-connected GERD. Further, the September 2020 VA examiner explained that the Veteran's GERD disability has not aggravated or caused the Veteran's other gastrointestinal disabilities. Specifically, the September 2020 examiner explained that GERD involves the structure of the esophagus, while the other conditions involve the lower intestines. The examiner explained that the Veteran's schistosomiasis was caused by a parasite, not GERD, and found that this condition has resolved. Additionally, this examiner explained that Crohn's disease is a disease that inflames the small and large intestines, whereas GERD involves the esophagus. This examiner also explained that ileitis is caused by Crohn's disease and that lymphoid aggregates is a benign self-limiting inflammation. Further, the examiner explained that mesentery adenopathy is also a benign self-limiting disorder that affects the mesenteric lymph nodes and that peer review articles do not contain persuasive evidence that GERD causes or aggravates this condition. In light of the above, the Board finds that the signs and symptoms attributable to the other various disorders discussed above are not relevant in assigning the appropriate disability rating for the Veteran's GERD with gastritis disability. In addressing whether the Veteran's GERD is productive of severe impairment of health, the Board observes that the Veteran's private treatment records and VA records show that the Veteran's GERD was not productive of material weight loss and hematemesis or melena with moderate anemia, or other symptom combinations productive of severe impairment of health. Accordingly, the Board finds that a higher 60 percent rating is not warranted. Turning next to Diagnostic Code 7306, the Board finds that a rating higher than 30 percent is also not warranted under this diagnostic code. Diagnostic Code 7306 provides for a higher 40 percent rating with intercurrent episodes of abdominal pain at least once a month partially or completely relieved by ulcer therapy, with mild and transient symptoms of vomiting or melena. Here, the Veteran has not been diagnosed with an ulcer related to his service-connected condition, and clinical records are absent evidence of reported vomiting or melena, and neither has the Veteran complained of such. For these reasons, Diagnostic Code 7306 cannot serve as a basis for a rating higher than 30 percent. In sum, the Board finds that an increased initial 30 percent rating pursuant to 38 C.F.R. § 4.114, Diagnostic Code 7307-7346 is warranted, but no higher. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.Foster, 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.