Citation Nr: A25035552 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 240625-450921 DATE: April 17, 2025 ORDER Entitlement to service connection for a gastrointestinal disability is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, his current gastrointestinal disability began during service and has continued since service. CONCLUSION OF LAW The criteria for entitlement to service connection for a gastrointestinal disability have been 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 June 1973 to April 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2024 Department of Veterans Affairs (VA) Regional Office rating decision. The Veteran submitted a new claim for acid reflux disease on VA Form 21-526 in June 2003. Entitlement to service connection for gastritis duodenitis/peptic ulcer disease was granted in October 2003. In March 2004, the agency of original jurisdiction (AOJ) proposed severance of service connection. In May 2004, the Veteran submitted a Notice of Disagreement (NOD) and requested a hearing; however, VA notified the Veteran in June 2004 that the NOD was not accepted because a final decision on severance had not been made yet. No hearing was scheduled. Entitlement to service connection for gastritis duodenitis/peptic ulcer disease was severed in a September 2004 rating decision. In October 2004, the AOJ sent correspondence to the Veteran stating that service connection had been severed and that the Veteran could file an appeal. There is no indication in the claims file that the Veteran filed an appeal within one year of the September 2004 severance decision. In June 2023, the Veteran filed a new claim on VA Form 21-526EZ for acid reflux. Entitlement to service connection for gastroesophageal reflux disease (GERD) was denied in an August 2023 rating decision. In December 2023, the Veteran submitted VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of entitlement to service connection for GERD and "gastritisduodenitis/peptic ulcer disease severance." In June 2024, the AOJ issued the supplemental claim decision on appeal, which denied service connection for both GERD and gastritis duodenitis/peptic ulcer disease. Because the AOJ adjudicated this claim on the merits, the Board concludes that there was an implicit finding of new and relevant evidence to warrant readjudication; therefore, the Board will proceed to address the claim on the merits. See 38?U.S.C. § 5104A; 38?C.F.R. § 3.104(c). In June 2024, the Veteran submitted VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), and selected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the June 2024 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Entitlement to service connection for a gastrointestinal disability is granted. The Veteran seeks service connection for a gastrointestinal disability, variously claimed as acid reflux disease, acid reflux, and gastritis duodenitis/peptic ulcer disease. By way of background, the Veteran's service treatment records indicate that he began to experience epigastric pain during service. A November 1976 service treatment record stated that the Veteran's symptoms were suggestive of early peptic ulcer disease. An upper GI series performed in December 1976 showed gastritis and duodenitis. Service treatment records dated through October 1977 noted ongoing epigastric pain. A February 1996 private treatment record noted a history of chronic gastroesophageal reflux over many years. An esophagogastroduodenoscopy and bronchoscopy were performed that same month. The procedure report diagnosed hiatus hernia with significant localized esophagitis. The pathology report on biopsies taken during the procedure assessed focal necrotic inflammatory debris consistent with ulceration and mild acute and chronic esophagitis with glandular mucosa. Private treatment records from December 2001 to 2003 noted ongoing gastrointestinal symptoms and a diagnosis of gastroesophageal reflux disease (GERD). The Veteran was afforded a VA examination in August 2003. The examiner noted that the Veteran experienced constant, burning stomach pain, and stated that the Veteran had been suffering from gastritis duodenitis/peptic ulcer disease since 1977. An upper GI series was performed in September 2003. The radiology report stated that it was an essentially negative series, with no evidence of reflux or hiatal hernia. As a result, the AOJ requested an addendum opinion with respect to the Veteran's diagnosis. The clinician who performed the August 2003 VA examination stated in an addendum opinion that the diagnoses of gastritis, duodenitis, and peptic ulcer disease should be deleted because there was no pathology to make a diagnosis. Service connection for gastritis duodenitis/peptic ulcer disease was granted in an October 2023 rating decision but severed in September 2004 on the basis that the Veteran's diagnosis had been withdrawn. The Veteran asserted in his May 2004 Notice of Disagreement (which was rejected as premature) and September 2004 correspondence that the imaging was negative because his ongoing acid reflux was controlled by medication. In June 2023, the Veteran submitted a service connection claim on VA Form 21-526EZ. He asserted in his claim that peptic ulcer disease was a misdiagnosis, and acid reflux was the correct diagnosis for the gastrointestinal symptoms that were ongoing since service. The Veteran was afforded a new VA examination in July 2023. The examiner provided a diagnosis of GERD and stated that available records documented the onset of upper gastrointestinal symptoms in 1976. In an August 2023 statement, the Veteran detailed that he continued to experience gastrointestinal symptoms requiring treatment with antacids after service. He further detailed that in the 1980s, he saw a physician after an episode with difficulty swallowing and was diagnosed with GERD. He stated that he continued to experience difficulty swallowing, regurgitation, pain deep in his chest, and burning bowel movements after consuming spicy food. The Veteran's wife and sister also provided statements in August 2023. The Veteran's wife stated that he avoids going to dinner with anyone other than his family due to difficulty swallowing. The Veteran's sister stated that the Veteran stayed with her for a month after separation from service, and she noticed that he took Mylanta after every meal and several Tums every day. The Veteran's brother provided a statement in March 2024, in which he stated that the Veteran has had constant issues with stomach burning and swallowing food since service. The Veteran was afforded a third VA examination in February 2024. The examiner diagnosed gastritis duodenitis/peptic ulcer disease and GERD. The examiner noted current symptoms of sharp epigastric pain, substernal pain, heartburn, dysphagia, nausea, vomiting, and sleep disturbances. The examiner stated that there was no objective evidence to support the diagnosis of a hiatal hernia. The Board now turns to the service connection analysis. Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden?v. Principi,?381 F.3d 1163, 1167?(Fed. Cir. 2004). The "present disability" service connection requirement is satisfied by the Veteran's gastrointestinal symptoms of sharp epigastric pain, substernal pain, heartburn, dysphagia, nausea, and vomiting. The Board notes that there has been disagreement among VA examiners and other medical sources about the Veteran's diagnosis; however, for VA purposes, "disability" refers to symptoms that cause functional impairment, irrespective of a veteran's diagnosis. Saunders v. Wilkie, 886 F.3d 1356, 1362 (Fed. Cir. 2018) . The "in-service incurrence" service connection requirement is satisfied by the many service treatment records that document assessment and treatment for epigastric pain. Resolving reasonable doubt in the Veteran's favor, the "nexus" service connection requirement is satisfied by the competent and credible evidence that the Veteran's gastrointestinal symptoms began during service and have continued since service. Specifically, the statements rendered by the Veteran, his wife, and his siblings; the consistency of the Veteran's reported symptoms over time; and the private treatment records documenting ongoing gastrointestinal signs and symptoms and treatment for GERD from 1996 to 2003 suffice to establish the continuity of symptoms since service. The Board acknowledges the six negative VA nexus opinions that were rendered from August 2023 to May 2024. All six are inadequate for adjudication. An August 2023 opinion found that the Veteran's disability, characterized as GERD, was less likely than not caused by his in-service toxic exposure because no medical literature supports a nexus. This opinion is inadequate for adjudication because it does not discuss the specific facts of the Veteran's case. Bailey v. O'Rourke, 30 Vet. App. 54, 60-61 (2018) (holding that a medical opinion was inadequate as a matter of law because the rationale was based solely on general articles and did not discuss any facts pertaining to Veteran's condition or individual circumstances). Another August 2023 nexus opinion found that the Veteran's gastrointestinal disability was less likely than not due to service based on the examiner's belief that the Veteran's disability onset was in 2003. This opinion is inadequate for adjudication because the examiner addressed neither the lay evidence of in-service onset nor the medical evidence documenting that the Veteran experienced gastrointestinal symptoms during service in the 1970s and from 1996 to 2003. A third nexus opinion was rendered in February 2004. The examiner opined that the Veteran's disability, characterized as GERD, was less likely than not due to service because his epigastric pain was due to peptic ulcer disease. This opinion is inadequate for adjudication because the examiner concluded without explanation that the Veteran does not have GERD and did not consider whether a nexus could be established for peptic ulcer disease. A May 2024 opinion concluded that the Veteran's disability was less likely than not due to service because no service treatment records document a gastrointestinal disability during service. This opinion is inadequate for adjudication because it is based on an inaccurate factual premise. Many service treatment records document gastrointestinal symptoms. A second May 2024 opinion concluded that the Veteran's disability, characterized as "hiatal hernia (gastritis duodenitis/peptic ulcer disease"), was less likely than not due to his in-service toxic exposure because "no medical data or research" currently "supports that hiatal hernias are caused by toxic exposure to include chemical exposures." This opinion is inadequate for adjudication because it does not address whether a gastrointestinal disability other than hiatal hernia might be caused by the Veteran's in-service toxic exposure. Finally, a third May 2024 opinion offered that the Veteran's GERD less likely than not caused gastritis. This opinion is inadequate for adjudication because it does not address the question at issue in this case: whether a gastrointestinal disability was caused by service. As all medical nexus opinions of record are inadequate for adjudication, they are accorded no probative weight. In conclusion, entitlement to service connection for a gastrointestinal disability is warranted because all three service connection requirements have been satisfied by the probative evidence of record. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Karp, B. 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.