Citation Nr: 21031963 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 16-24 744 DATE: May 25, 2021 ORDER Entitlement to service for a gastrointestinal disorder (variously classified), to include as secondary to medication prescribed for the Veteran's service-connected disabilities, is granted. FINDING OF FACT Resolving all reasonable doubt in his favor, the Veteran's gastrointestinal disorder is aggravated by medication prescribed for his service-connected disabilities. CONCLUSION OF LAW The criteria for service connection for a gastrointestinal disorder, as secondary to medications prescribed for service-connected disabilities, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from July 1968 to June 1972. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The issue was previously remanded by the Board in February 2019, October 2019, and October 2020. The appellant is the Veteran's spouse, who is the fiduciary/payee. Entitlement to service for a gastrointestinal disorder (variously diagnosed), to include as secondary to medication prescribed for the Veteran's service-connected disabilities. The Veteran seeks entitlement to service connection for a gastrointestinal disorder. He asserts that his gastrointestinal disorder began during service, or alternatively, is aggravated by medication prescribed for his service-connected migraines. 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). Service connection may be granted for a disability that is proximately due to, the result of, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that is proximately due to or is aggravated beyond its natural progress by service or a service-connected disability. The Veteran was afforded a VA examination in July 2019 whereby the examiner indicated a diagnosis of GERD. The Board acknowledges that the examiner opined that the Veteran's current gastrointestinal disorder was less likely than not incurred in or otherwise related to his active service. In its October 2019 remand, the Board found that an addendum opinion was necessary addressing the Veteran's contention that he had chronic gastritis in service and was relieved by over-the-counter antacids. Therefore, a February 2020 VA examiner reviewed the evidence of record and noted diagnoses of gastritis and a history of GERD. He opined that the Veteran's gastrointestinal disorder is less likely than not related to service. The examiner stated that although the Veteran's service treatment records (STRs) indicated a diagnosis of gastritis with nausea and vomiting in November 1968, it was acute in nature and unrelated to the Veteran's current gastrointestinal disorder. In its October 2020 remand, the Board requested an opinion that addresses whether the gastrointestinal condition is secondary to medication the Veteran takes for his service-connected migraine headaches, given that an April 2011 VA treatment record notes that the Veteran's severe burning sensation in the stomach was mostly associated with intake of his migraine medication. Therefore, the Veteran was afforded a VA examination in March 2021 whereby the examiner opined that the Veteran's current gastrointestinal disorder was less likely than not incurred in or related to military service. However, in providing his rationale, the examiner noted that the Veteran is prescribed Fiorinal for his service-connected migraines and complained that he experiences burning in his stomach associated with taking that medication. He stated that because Fiorinal contains Acetylsalicylic Acid (ASA), it can cause a burning sensation in the stomach. Further, the examiner indicated that the current severity of the Veteran's gastrointestinal disorder is greater than the baseline at the time of his separation from service. Therefore, he opined that the Veteran's gastrointestinal disorder is at least as likely as not aggravated beyond its natural progression by a service-connected disability. It was also indicated that some of the pathology might be related to another drug for other pathology, but the Board will resolve reasonable doubt in this matter in the Veteran's favor. Upon review of the record therefore, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current gastrointestinal disorder is secondary to his prescribed migraine medication. The Board finds no adequate basis to reject the evidence of record that is favorable to the Veteran, based on a lack of credibility or probative value. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997); Evans v. West, 12 Vet. App. 22, 26 (1998). Accordingly, resolving all reasonable doubt in the Veteran's favor, the Board finds that the evidence indicates that the Veteran's gastrointestinal disorder is aggravated beyond its natural progression by medication prescribed for his service-connected disabilities, specifically Fiorinal prescribed for migraines. As such, the Board finds that service connection is warranted, and the Veteran's claim is granted. MICHAEL D. LYON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Sneeringer, 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.