Citation Nr: 22059893 Decision Date: 10/25/22 Archive Date: 10/25/22 DOCKET NO. 17-23 254 DATE: October 25, 2022 REMANDED Service connection for gastroesophageal reflux disease (GERD) is granted. FINDING OF FACT The Veteran had service in Southwest Asia, and the etiology of his GERD is inconclusive. CONCLUSION OF LAW The criteria for service connection for GERD are met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the U.S. Army from June 1987 to June 1991, as well as additional reserve service. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision. It was previously remanded for additional development in April 2019, August 2021, and June 2022. Service connection for GERD Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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. The Veteran had active service in Southwest Asia. Service connection may be granted on a presumptive basis if a veteran exhibits objective indications of qualifying chronic disability, including resulting from undiagnosed illness, that became manifest either during active service in the Southwest Asia theater of operations, or to a degree of 10 percent or more not later than December 31, 2021, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 C.F.R. § 3.317. In claims based on qualifying chronic disability, unlike those for "direct service connection," there is no requirement that there be competent evidence of a nexus between the claimed illness and service. A "qualifying chronic disability" for VA purposes is a chronic disability resulting from (A) an undiagnosed illness, or (B) a medically unexplained chronic multi symptom illness (MUCMI) that is defined by a cluster of signs or symptoms. An illness is a MUCMI where either the etiology or pathophysiology of the illness is inconclusive. The determination of whether an illness is medically unexplained is particular to the claimant in each case. A MUCMI determination is to be based on a claimant's unique symptoms and the evidence of record. The generic information in a medical journal or treatise that certain factors could cause a medical condition does not, as a general matter, establish nexus absent additional evidence that those factors did cause a veteran's condition. Stewart v. Wilkie, 30 Vet. App. 383 (2018). The Board finds that service connection for GERD as a MUCMI is warranted. First, as documented in a February 2016 VA examination, the Veteran's GERD was manifested by symptoms of pyrosis, regurgitation, and substernal pain. The presence of these symptoms corresponds to at least a 10 percent rating under 38 C.F.R. § 4.114, DC 7346. Therefore, the condition has manifested to a compensable degree within the specified time period. Regarding pathophysiology, a February 2016 VA examiner explained that GERD is a digestive disorder of the lower esophageal sphincter (LES). It occurs when the LES is weak or relaxes inappropriately, allowing stomach contents to flow upward through the esophagus. Regarding etiology, a July 2022 VA examiner explained that GERD could occur due to factors such as obesity, hiatal hernia, diet, and medications. The examiner cited to a February 2016 upper GI series which diagnosed a hiatal hernia; March 2016 VA treatment records which noted foods that aggravate the Veteran's symptoms; a February 2017 record which showed the Veteran had increased reflux after stopping Levothyroxine (a thyroid medication); and a November 2019 record which showed increased reflux alongside the Veteran's report of taking Motrin every night on an empty stomach. In a November 2015 statement, the Veteran reported struggling with GERD during service. The July 2022 VA examiner indicated that this statement was not consistent with the other evidence of record. Specifically, reserve service treatment records from June 1992, August 1996, August 1999, September 2003, and August 2005 all show the Veteran denied a history of any indigestion, stomach trouble, and/or heartburn. Both VA examiners concluded that the Veteran's GERD was not associated with his service in Southwest Asia, and collectively, this evidence seemingly indicates that the pathophysiology and etiology of the Veteran's GERD are known, and therefore GERD is not a MUCMI as defined above. However, as noted in the April 2019 and August 2021 Board remands, service treatment records from the Veteran's period of active service in the U.S. Army from 1987 to 1991 are not contained in the claims file. In concluding that the Veteran's statements regarding the onset of his GERD were not supported by the record, the July 2022 VA examiner did not have the benefit of reviewing his active duty records. Indeed, in all of the responses to the last remand, the VA examiner cited explicit records from after 1991, after the Veteran's separation from service. Consequently, the Board cannot find that such opinion with regards to the etiology of the Veteran's claimed GERD, to especially include consideration of his inservice complaints and condition to be adequate; and therefore, of little probative value. This is particularly significant because the Veteran was awarded the Combat Infantryman's Badge, and therefore has documented service in combat. Under 38 U.S.C. § 1154(b), VA shall accept lay evidence as proof of incurrence of a disease or injury for veterans who engaged in combat, notwithstanding the fact that there is no official record of such incurrence. Service connection for such injury or disease may only be rebutted by clear and convincing evidence to the contrary. In that regard, given the Veteran's assertion of GERD symptoms during active service and the absence of any treatment records from that period, the Board finds that GERD symptoms were present at that time as a MUCMI. To date, no VA examiner has addressed that factor in assessing the etiology of the Veteran's GERD, and therefore no negative nexus opinion is adequate. See Stewart, supra (a MUCMI determination is to be based on a claimant's unique symptoms and the evidence of record). Without an adequate opinion, the etiology of the Veteran's GERD remains inconclusive, and therefore, resolving reasonable doubt in favor of the Veteran, service connection is warranted. Zi-Heng Zhu Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shamil Patel, 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.