Citation Nr: 22016288 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 07-08 812 DATE: March 21, 2022 ORDER Service connection for a chest/esophageal disability, diagnosed as gastroesophageal reflux disease (GERD), is granted. FINDING OF FACT The Veteran was treated for gastrointestinal symptoms during service and has presented competent and credible testimony of continuous gastrointestinal symptoms from service to the present time CONCLUSION OF LAW Revolving all reasonable doubt on behalf of the Veteran, the criteria for service connection for GERD have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1976 until September 1980. This claim comes to the Board of Veterans' Appeals (Board) on appeal from a February 2005 Department of Veterans Affairs (VA) regional office (RO) rating decision. This appeal was remanded by the Board in November 2013, October 2014, and July 2017 for additional development. The Veteran testified before the undersigned in October 2021; a transcript is associated with the claims file. The Board recognizes that the Veteran recently appointed Disabled American Veterans as her representative service organization and they did not yet file an informal hearing presentation on her behalf. Nevertheless, as discussed below, the Board finds that the evidence is in relative equipoise as to whether it is at least as likely as not that the Veteran's GERD onset in service; as such, issuing this decision before such is filed will not be prejudicial to the Veteran. Service Connection Service connection will be granted for disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection requires competent evidence showing (1) current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be awarded on secondary basis for a disability which is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Entitlement to service connection for a chest/esophageal disability, to include GERD The Veteran contends that she is entitled to service connection for a chest or esophageal disability, to include GERD. She generally claims that her GERD started in service and continued thereafter unto the present. Her November 1977 service treatment records reflect treatment for "throat swelling causing difficulty in swallowing," and "nausea and vomiting . . . also difficulty swallowing." Her December 1978 service treatment records reflect treatment for a "red irritated" throat. In sworn testimony before the undersigned, the Veteran stated that she has been having GERD symptoms since service. Specifically, she testified that her symptoms in service included "having problems with the eating" and that she would "choke on my food." The post-service evidence shows a diagnosis of GERD in September 1999. July 2004 VA treatment records also show treatment for chest pain with diarrhea, nausea, and vomiting. April 2004 private treatment notes indicate that the Veteran has been seeking treatment for hiatal hernia and diarrhea "which may be worsened by stress/anxiety." June 2006 VA treatment notes state that her chest pain "could be from the stress she's having at this time." The Veteran participated in April 2014, October 2015, August 2017, and June 2019 VA examinations for this disability. As discussed by the prior October 2014 Board remand, the April 2014 VA examination failed to discuss the Veteran's claimed disability manifested by chest pain. As such, this examination is inadequate and will be afforded no probative weight. As discussed by the July 2017 Board remand, while the Veteran reported difficulty swallowing and choking, the October 2015 VA examiner stated that the Veteran's GERD and hiatal hernia did not cause chest pain and onset after service in 2005. The July 2017 Board decision found this examination to be inadequate as it failed to directly answer whether or not the Veteran's GERD or hiatal hernia is related to service. As such, it is afforded no probative weight. An August 2017 VA examination was obtained. Therein, the examiner opined that the Veteran's GERD and hiatal hernia is less likely than not related to service. The examiner reasoned only that the Veteran's service treatment records are "null" for any symptomatology or chronicity of symptoms during service. A June 2019 VA examination was also obtained. Therein, the VA examiner opined that the Veteran's GERD and hiatal hernia was diagnosed in 2005 and that she did not have complaints of these disabilities in service. The VA examiner added that her "longstanding methamphetamine dependance" played some role in the development of these disabilities. However, the Board finds that these examinations are based on an incorrect factual premise. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). A stated above, the Veteran's November 1977 and December 1978 service treatment records reflect complaints of "throat swelling causing difficulty in swallowing," and "nausea and vomiting... also difficulty swallowing." Additionally, the post-service medical evidence establishes that the Veteran's GERD was first diagnosed in September 1999, not 2005. Furthermore, the August 2017 VA examiner did not have the benefit of considering the Veteran's October 2021 testimony regarding the onset of these symptoms in service and chronicity thereafter. Miller v. Wilkie, 32 Vet. App. 249 (2020). The Board finds the Veteran's statements, which were made under oath, to be credible and notes that the Veteran is competent to relate continuity of symptoms of GERD, to include "throat swelling causing difficulty in swallowing," and "nausea and vomiting... also difficulty swallowing," from service to the present time. In other words, the weight of the evidence supports a finding that the symptoms providing a basis for her current GERD diagnosis started in service. Further supporting service connection is the relationship between the Veteran's hiatal hernia and her service-connected psychiatric disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see April 2004 Private Treatment Notes (indicating that the Veteran has been seeking treatment for hiatal hernia and diarrhea "which may be worsened by stress/anxiety."), and June 2006 VA Treatment Notes (stating that her chest pain "could be from the stress she's having"). As such, and after resolving all reasonable doubt in favor of the Veteran, the Board finds that service connection for GERD is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. As the Board grants the claim, no further discussion is necessary. The nature and extent of this disability is not before the Board at this time. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Finelli, 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.