Citation Nr: 21029479 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 17-37 961 DATE: May 13, 2021 ORDER Service connection for dumping syndrome with hypoglycemia is granted. FINDING OF FACT The competent evidence of record reflects that the Veteran's dumping syndrome with hypoglycemia is proximately due to his service-connected post-operative peptic ulcers. CONCLUSION OF LAW The criteria for entitlement to service connection for dumping syndrome with hypoglycemia have been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1967 to August 1969. In May 2021, a Board hearing was held before the undersigned Veterans law Judge. Entitlement to service connection for dumping syndrome with hypoglycemia. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a). Service connection also may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). There are three requirements to establish service connection: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Secondary service connection is warranted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Briefly, the threshold legal requirements for a successful secondary service connection claim are: (1) evidence of a current disability for which secondary service connection is sought; (2) a disability for which service connection has been established; and (3) competent evidence of a nexus between the two. Although all of the evidence must be reviewed, only the most salient evidence must be discussed. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). Persuasive or unpersuasive evidence must be identified, however, and reasons must be provided for rejecting favorable evidence. Gabrielson v. Brown, 7 Vet. App. 36 (1994), Wilson v. Derwinski, 2 Vet. App. 614 (1992); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Both medical and lay or non-medical evidence may be discounted in light of its inherent characteristics and relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). When there is an approximate balance of positive and negative evidence, the claimant must be afforded the benefit of the doubt. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 49. The Veteran seeks entitlement to service connection for a disability manifested by hypoglycemia that he asserts is secondary to his service-connected post-operative peptic ulcer. See March 2019 Statement. In September and November 2017, the Veteran's VA and private physicians indicated he had severe hypoglycemia and the physicians explained that hypoglycemia was secondary to dumping syndrome because the Veteran was able to maintain euglycemia overnight. As such, the Board finds that the Veteran has a current diagnosis for dumping syndrome with hypoglycemic manifestations. The Veteran's VA and private physicians also indicated that the Veteran's dumping syndrome/hypoglycemia was associated with his service-connected post-operative peptic ulcer. Chiefly, they indicated that the Veteran had a Billroth II procedure (gastrectomy) for the purpose of his treating his stomach ulcers and that such surgery caused the Veteran's dumping syndrome. See September and November 2017 Treatment Provider Statements. The Veteran's VA treatment records also indicate that a gastrectomy is one of the procedures the Veteran underwent for his service-connected ulcer. As such, there is sufficient evidence to establish an etiological link between the Veteran's dumping syndrome with hypoglycemia and his service-connected post-operative peptic ulcers. The Board acknowledges the January 2014 VA medical opinion that suggests the Veteran's hypoglycemia is likely from insulin/glucose mismatch with low glycogen storage breakdown and gluconeogenesis from the cirrhosis of the liver. The examiner indicated that the Veteran's hypoglycemia was a suspected isolated incident from cirrhotic liver. The examiner, however, did not consider or discuss the Veteran's treatment reports that his hypoglycemia occurred every three months for the last four or five years. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). As such, the Board finds that the January 2014 VA medical opinion is entitled to little to no probative value and is outweighed by the more probative November and September 2017 statements from the Veteran's VA and private physicians. (Continued on the next page) Based on the foregoing evidence, the Board finds that entitlement to service connection for dumping syndrome with hypoglycemia to include as secondary to service-connected post-operative peptic ulcers is warranted. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Metzner, Paul 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.