Citation Nr: 21040931 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 19-18 145 DATE: July 7, 2021 ORDER A compensable rating for esophageal spasm is denied. FINDING OF FACT The Veteran's esophageal spasm disability does not require dilatation and does not represent a stricture. CONCLUSION OF LAW The criteria for entitlement to a compensable rating for esophageal spasms have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.114, Diagnostic Codes (DCs) 7203, 7204. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 1964 to February 1968. In September 2020, the Board remanded the appeal for additional development. The case has now been returned to the Board for further appellate action. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The Veteran contends that his service-connected esophageal spasm disability warrants a compensable rating. He is currently in receipt of a noncompensable rating for an esophageal condition. The esophageal condition is rated pursuant to 38 C.F.R. § 4.114, Diagnostic Code 7204, which provides that a spasm of the esophagus is to be rated as an esophageal stricture under Diagnostic Code 7203 if the condition is not amenable to dilation. Pursuant to Diagnostic Code 7203, a 30 percent rating is assigned for moderate impairment. For severe impairment, permitting liquids only, a 50 percent rating is assigned. When the stricture permits passage of liquids only with marked impairment of general health, an 80 percent rating is assigned. 38 C.F.R. § 4.114, Diagnostic Codes 7203, 7304. Upon review of the record, the Board does not find that a compensable rating is warranted for the esophageal condition. The severity of the esophageal condition was evaluated in September 2018, the results of which were recorded in a Disability Benefit Questionnaire (DBQ). During that examination the Veteran reported additional spams over the years, going to the emergency room to have food pushed down, and having scope to dilate ring, the last one was in the early 2000's. The Veteran indicated that he had additional spasm episodes, with the most recent the previous week after eating and had a spasm and tried to vomit food up. He noted that he started to go to the emergency room after many hours of the food being stuck but then he drank some water and was able to dislodge the food. Further, the Veteran reported having to take small bites and frequent sips. He indicated experiencing episodes about 5 times per year and took Protonix and TUMS. The examiner diagnosed the Veteran with spasm of the esophagus. His symptoms included dysphagia and substernal pain. The examiner noted the severity of the condition to be mild and noted no dilation since the early 2000's. An October 2018 DBQ received from the Veteran reported a history of reflux, dyspepsia, Schatzki's ring requiring dilation, surgical intervention. The Veteran indicated daily treatment with Protonix. His symptoms consisted of persistently recurrent epigastric distress, dysphagia, pyrosis, reflux, sleep disturbance caused by esophageal reflux, anemia, nausea, periodic vomiting. His persistently recurrent epigastric distress and sleep disturbance caused by esophageal reflux were noted to occur 4 or more times per year and to last 1-9 days each time that they occurred. His dysphagia was noted to occur 3 times per year and to last 1-9 days each time that it occurred, and the Veteran refrained from eating certain cuts of meat. His pyrosis and reflux were noted to occur 4 or more times per year and to last 10 days or more each time that they occurred. His nausea was noted to be mild and to occur 3 times per year and to last less than 1 day each that it occurred, and his vomiting was noted to be periodic. His anemia was noted as 13.9/40 hemoglobin/ hematocrit. The clinician diagnosed the Veteran with GERD, hiatal hernia, esophageal diverticulum, Schatzki's ring, elevated bilirubin and elevated LFT. The clinician noted the severity of the condition to be mild and that it "ha[d] been repaired." On an August 2020 private treatment record, the Veteran denied any pain or difficulty swallowing, any food getting stuck or any dysphagia. An April 2021 DBQ documents that the Veteran had a diagnosis of GERD and esophageal spasm. The examiner noted that GERD was a separate diagnosis and it was not a progression of esophageal spams. The examiner indicated that the Veteran's last endoscopy was performed in the early 2000's for dilation of Schatzki's ring. Further, the examiner noted the Veteran's last VA DBQ in September 2018 and his esophageal spasm was unchanged. He reported that the Veteran was asymptomatic on daily Famotidine and if he forgot to take it, usually once every 4-6 weeks, he would have a spasm that causes vomiting and the spasm will resolve after 1 hour. The examiner noted signs and symptoms of vomiting. Symptoms occurred 4 or more times per year, lasting less than 1 day each time. He denied pain, nausea, dysphagia, heartburn, or weight loss. The examiner indicated that the Veteran had mild episodes of esophageal spams described as episode of spasm every 4-6 weeks with subsequent vomiting and his last dilation of Schatzki's ring was in the early 2000's. In an April 2021 statement from the Veteran, he stated that he took the Famotidine medication when he woke up, therefore it would be extremely unlike that he would miss a dose. He noted that he experienced the occasional spasms despite the fact that he regularly took the medication. Based on the evidence above, the Board finds that the evidence of record does not meet the criteria for a compensable rating for the Veteran's esophageal spasms. The evidence fails to demonstrate moderate stricture of the esophagus. The September 2018 VA examiner, October 2018 private clinician, and April 2021 VA examiner noted the existence of esophageal spams, with the severity of condition noted to be mild. While the evidence of record indicates that the Veteran's condition caused dilatation of Schatzki's ring as indicated in an upper endoscopy in the early 2000's, that same procedure also demonstrated that the Veteran's condition was amenable to dilation. Under these conditions, the Board finds that the Veteran's condition most closely resembles the criteria rated for spasm of the esophagus that is amenable to dilation. 38 C.F.R. § 4.114, Diagnostic Code 7204. Where the condition is amenable to dilation, a compensable rating for the degree of stricture is not appropriate. Id.; 38 C.F.R. § 4.31. Further, while the September 2018 VA examiner indicated that the Veteran had dysphagia and the October 2018 private clinician stated that the Veteran's dysphagia had resulted in him refraining from eating certain cuts of meat, there is no evidence that the Veteran's dysphagia manifests as an inability to swallow solid food or pills such that he can only consume liquids. VA medical records indicate that while the Veteran continues to be monitored for symptoms of an esophageal condition he has never been evaluated as having an esophageal stricture that is not amenable to dilation. The Board has considered the Veteran's lay statements that his service-connected disability is worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify specific levels of disability of her service-connected disability according to the appropriate diagnostic codes. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. Accordingly, the preponderance of the evidence is against a finding that a compensable rating is warranted for the esophageal condition, and, as such, the claim seeking a compensable rating is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). ROBERT N. SCARDUZIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Grzeczkowicz 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.