Citation Nr: 21040401 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 19-06 970 DATE: July 3, 2021 ORDER Service connection for residuals of a duodenal ulcer, to include gastroesophageal reflux disease (GERD), esophagitis, and Helicobacter pylori (H. pylori) infection is denied. FINDING OF FACT Currently shown gastrointestinal diseases, including GERD, esophagitis, and H. pylori infection were not initially manifested during service and are not related in any way to the ulcer for which the Veteran was treated during service; no other connection to service is shown. CONCLUSION OF LAW The criteria for service connection for residuals of a duodenal ulcer, to include GERD, esophagitis, and H. pylori infection have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1961 to September 1965, with subsequent Reserve service. This matter comes before the Board of Veterans' Appeals (Board) from a November 2017 decision by the Agency of Original Jurisdiction (AOJ). It was before the Board in May 2019 and again in September 2020, when it was remanded for further evidentiary development. The development requested on remand has been fully accomplished, and the matter has been returned to the Board for further appellate review. The Veteran was treated for a duodenal ulcer during service, to include a hospital stay. Testing showed that the ulcer was entirely healed when he was discharged from the hospital. His gastrointestinal system was deemed to have been normal upon clinical examination at discharge from service. Recent medical records reflect diagnoses of GERD, esophagitis, and a history of esophageal stricture and H. pylori infection. He is seeking service connection for his current gastrointestinal complaints on the basis that they had their inception during or are otherwise related to the ulcer in service. He specifically asserts that the ulcer caused erosion of his esophageal sphincter. Generally, service connection may be granted for any disability resulting from injury suffered or disease contracted in line of duty, or for aggravation in service of a pre-existing injury or disease. 38 U.S.C. §§ 1110, 1131. Service connection may be established by demonstrating that the disability was first manifested during service and has continued since service to the present time or by showing that a disability which pre-existed service was aggravated during service. Service connection may be granted for any disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303. Disability which is proximately due to or the result of a service-connected disease or injury also shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310. In the attempt to corroborate the Veteran's assertion that his inservice ulcer led to his current gastrointestinal disabilities, the VA obtained three informed medical opinions regarding whether a relationship could be established. All three medical reviewers concluded that the ulcer in service was unrelated to the later gastrointestinal disabilities. Because the first two opinions were deemed inadequate for various reasons which were previously explained in the Board remands, a third opinion was obtained in November 2020. This opinion is better-explained and fully informed. We hold that it resolves the inadequacies of the other two and is fully adequate. The medical reviewer read through the Veteran's medical records, interviewed the Veteran over the telephone, and performed a review of relevant medical literature. In the written opinion, the reviewer summarized the course of the Veteran's ulcer disease and treatment during service. The reviewer emphasized that the ulcer was fully healed after treatment and that the Veteran has had no recurrence of ulcer disease since 1965. The reviewer explained that there is no support in medical literature for a causative relationship between ulcers and GERD, or other gastric disease. Similarly, H. pylori does not cause GERD. The Veteran's currently diagnosed esophagitis is a direct result of his GERD, rather than the ulcer or H. pylori. The reviewer noted that in addition to GERD and esophagitis, the Veteran had had an esophageal stricture which was treated in 1995, approximately twenty-five years prior to the date of the opinion, and twenty-two years before the Veteran filed the claim leading to this appeal. The reviewer specifically commented upon the Veteran's contention that his physician had told him his ulcer causes an erosion of a flap in his stomach, causing GERD and esophagitis. According to the medical opinion, this theory of entitlement is not supported by medical literature. The reviewer also noted that the available medical records do not include an explanation like this from the Veteran's treating physician. In sum, the preponderance of the evidence is against the Veteran's claim for service connection. GERD and gastritis, which are his current disabilities, are not shown to have been caused by, aggravated by, or related to the ulcer he had in service. No other relationship to service is shown. The law, as interpreted by the United States Court of Appeals for Veterans Claims (Court) does not preclude service connection for a transitory disability, or even for a no-longer-existing disability. The service connection requirement that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves. McClain v. Nicholson, 21 Vet. App. 319 (2007). In this case, however, the Veteran is not shown to have had ulcer, H. pylori, or esophageal stricture during the appeal period, from 2017 to the present. Therefore, service connection for these disabilities is not supported under law. The Veteran's representative notes that various medications can cause gastrointestinal symptoms. However, review of the Veteran's claims file reveals that his only service-connected disabilities are hearing loss and tinnitus. Since he does not take medication for either of these disabilities, a theory of secondary service connection is inappropriate in this case. The preponderance of the evidence is against the Veteran's claim. The evidence shows the Veteran has no residuals of the ulcer in service, as it was fully healed upon his discharge from the hospital and his subsequent discharge from service. Service connection for a gastrointestinal disability to include GERD, esophagitis, and H. pylori infection is denied. (Continued on the next page) Continued on next page T. V. CASEY Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Heather J. Harter, 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.