Citation Nr: 22018669 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 18-02 092 DATE: March 30, 2022 ORDER Entitlement to service connection for a stomach condition is denied. FINDING OF FACT The evidence of record persuasively weighs against finding that a stomach condition is related to the Veteran's active service. CONCLUSION OF LAW The criteria for service connection for stomach condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1968 to September 1971, to include service in the Republic of Vietnam. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is associated with the claims file. The claim was previously remanded by the Board in June 2021. There was substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Service Connection 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). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. VA is responsible for determining whether the evidence supports the claim, with the veteran prevailing, or whether the evidence weighs persuasively against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). 1. Entitlement to service connection for a stomach condition The Veteran asserts that he is entitled to service connection for a stomach condition, specifically residuals of a gastrectomy and ulcer. At the August 2020 Board hearing, and in a statement submitted in May 2018, the Veteran explained that he was treated for severe stomach problems while in service in 1969, and that his symptoms persisted after service discharge in 1971. He stated that in the 1990s, he underwent emergency surgery due to a bleeding duodenal ulcer. The Veteran further explained that after surgery, he was treated for helicobacter pylori (H. pylori), and cited research articles that indicate H. pylori infections rates were high in Vietnam. The Board concludes that, while the Veteran has a current diagnosis of status post Billroth 1 surgery for duodenal ulcer, and evidence shows that he was treated for stomach problems during service, the evidence of record persuasively weighs against finding that the Veteran's diagnosis of a stomach condition began during service or is otherwise related to an in-service injury, event, or disease. Service treatment records show that the Veteran reported experiencing frequent indigestion on his July 1968 for his service entrance report of medical history report. In November 1969, the Veteran was treated for stomach trouble caused by anorexia due to situational depression. He was again seen for stomach trouble in April 1970, and his symptoms included diarrhea, loss of appetite, and cramps. It appears that both instances of in-service stomach problems were resolved, as the Veteran's service separation report of medical examination from June 1971 makes no mention of any stomach condition. Further, the Veteran included a signed statement on the June 1971 report that he is in good health. Post-service medical records document that the Veteran has a history of ulcers. Private treatment notes from April 2018 included a discussion of the Veteran's medical history related to his stomach concerns. The private physician noted that the Veteran developed stomach pains while in service, that in 1989 he was started on Tagamet, and required surgery in 1990. The private physician also stated that the Veteran believes he contracted H. Pylori while in Vietnam. Notably, the private physician was treating the Veteran for a head lesion, not a gastrointestinal condition, and even stated that the Veteran has been asymptomatic for gastrointestinal bleeding since his surgery in 1990. A medical nexus opinion linking any current stomach condition to his active service was not provided by the private physician. The Board notes that the medical records referenced by the private physician documenting the Veteran's treatment in 1989 and 1990 are not available for review. In August 2017, the Veteran was afforded a VA examination and was noted to have a diagnosis of status post gastrectomy and vagotomy Billroth I. The Veteran reported that he had stomach problems when in service, and had additional stomach related health events in 1988 and 1992, when he underwent surgery for an ulcer. Although the VA examiner provided a nexus opinion, the Board determined in the June 2021 remand that the opinion was inadequate. Therefore, the Veteran was afforded a new VA examination in September 2021. The Veteran stated that he continued to have stomach problems after service and after the ulcer surgery, but the VA examiner noted that except for the Veteran's reported history, there were no medical records from immediately after service that were available for review. The VA examiner also specifically noted that there were no records for review regarding the Veteran's reports of H. Pylori infection and treatment. Additionally, the Veteran stated that he smoked one pack of cigarettes per day from the age of 15 to 25. The VA examiner provided a medical nexus opinion in December 2021. He opined that the Veteran's status post Billroth I surgery for duodenal ulcer is less likely than not related to his military service. In support of the opinion, the VA examiner acknowledged the Veteran's in-service treatment for stomach problems, but noted that his separation examination was normal. He stated that there was no evidence of permanent residual or chronic disability shown in the service treatment records or evidence immediately after service. The VA examiner also determined that based on updated medical literature, the Veteran's smoking history of consuming one pack of cigarettes per day for a decade is an independent risk factor for duodenal/gastric ulcer disease. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes his duodenal ulcer is related to in-service treatment for stomach problems. He also believes that his H. pylori infection following surgery in the 1990s is related to his time in Vietnam. However, the Veteran in this case is not competent to provide a nexus opinion that connects his ulcer or H. pylori infection to service in Vietnam. The issues are medically complex and require medical training to make such a determination. These findings are outside the competence of the Veteran because the record does not show that he has the necessary medical training or credentials to make an assessment regarding the etiology of the claimed conditions. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Further, although the Veteran's report of an H. pylori infection was discussed and acknowledged by a private physician in April 2018, and the VA examiner in September 2021, neither physician specifically linked the infection to his active service in Vietnam or his ulcer. Consequently, the Board gives more probative weight to the December 2021 VA medical opinion, as it based on a review of the Veteran's records, considers his lay statements regarding his medical history, and is supported by sufficient rationale. Accordingly, the claim of entitlement to service connection for a stomach condition is denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the evidence weighs persuasively against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Miller, 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.