GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Summary

The Veteran, who served from July 2014 to July 2019, appeals the denial of service connection for GERD, lumbar spine muscle strain, and right hip muscle strain. The Veteran sought secondary service connection for these conditions, claiming they were related to his service-connected depressive disorder and right knee disability, respectively. The Veteran submitted private medical opinions from August 2021, which provided clinical diagnoses for GERD, lumbar spine muscle strain, and right hip muscle strain. These opinions also established the necessary nexus for secondary service connection. The private examiner concluded that the GERD was at least as likely as not related to the emotional stress and sleep disturbance associated with the Veteran's depressive disorder, citing relevant medical literature. For the back and hip strains, the examiner noted the altered gait caused by the service-connected right knee disability and cited medical literature supporting the hastened development of discomfort in the lower back and hip due to biomechanical changes. The Board found these private medical opinions adequate, as they were based on the Veteran's medical history, described the conditions, and provided explanatory rationales. With no contradictory medical opinions of record, the Board granted service connection for GERD secondary to depressive disorder, and for lumbar spine and right hip muscle strains secondary to the right knee disability.

Rationale

Private medical opinion found GERD related to emotional stress and sleep disturbance from depressive disorder.; Opinion was adequate, based on medical history and literature.; No contradictory medical opinions of record.

Full Decision Text

Citation Nr: A25010928
Decision Date: 02/06/25	Archive Date: 02/06/25

DOCKET NO. 230823-374313
DATE: February 6, 2025

ORDER

Service connection for gastroesophageal reflux disease (GERD), as secondary to the Veteran's service-connected depressive disorder, is granted.

Service connection for lumbar spine muscle strain, as secondary to the Veteran's service-connected right knee disability, is granted.

Service connection for a right hip muscle strain, as secondary to the Veteran's service-connected right knee disability, is granted.

FINDINGS OF FACT

1. The Veteran's GERD is related to his service-connected depressive disorder.  

2. The Veteran's lumbar spine muscle strain is related to his service-connected right knee disability.

3. The Veteran's right hip muscle strain is related to his service-connected right knee disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for GERD, as secondary to the Veteran's service-connected depressive disorder, are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.  

2. The criteria for service connection for lumbar spine muscle strain, as secondary to the Veteran's service-connected right knee disability, are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for service connection for a right hip muscle strain, as secondary to the Veteran's service-connected right knee disability, are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 2014 to July 2019.  This matter comes before the Board of Veterans' Appeals on appeal from a September 2022 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).  

A June 2022 rating decision denied the Veteran's claims for service connection for GERD, back and right hip disabilities.  The Veteran submitted a VA Form 20-0996 Request for Higher-Level Review (HLR) in July 2022.  In the September 2022 rating decision on appeal, the RO continued the denials.  The Veteran thereafter submitted a VA Form 10182 (Notice of Disagreement) and selected the Direct Review docket.  Based upon the selection of the Direct Review option, the Board may only consider the evidence of record as of June 14, 2022-the date of the rating decision adjudicated by the HLR rating decision on appeal.  See 38 C.F.R. § 20.301. 

Service Connection for GERD, Back and Right Hip Disabilities.

Generally, service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury incurred in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  Establishing service connection requires evidence of a current disability, an in-service incurrence, disease or injury and a causal relationship between the current disability and the in-service incurrence, disease or injury.  Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). 

Service connection may also be granted where a disability is proximately due to or aggravated by an already service-connected disability.  38 C.F.R. § 3.310.  To establish secondary service connection for a disability there must be (1) a current disability (for which secondary service connection is sought); (2) an existing service-connected disability, and (3) evidence that the current disability for which service connection is sought was either (a) caused or (b) aggravated by the service-connected disability.  38 C.F.R. § 3.310.  See Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).  

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  To deny a claim on its merits, the evidence must preponderate against
 service connection is sought was either (a) caused or (b) aggravated by the service-connected disability.  38 C.F.R. § 3.310.  See Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).  

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996).  

Here, in support of the claims for service connection for GERD, back and right hip disabilities, the Veteran has submitted August 2021 private medical opinions relating those conditions to service-connected disabilities.  The private medical examiner concluded that the Veteran had clinical diagnoses of GERD, lumbar spine muscle strain and right hip muscle strain.  The Veteran is thus able to satisfy the first element for secondary service connection.  The record reflects that the Veteran is service connected for depressive disorder and a right knee disability, satisfying the second element for secondary service connection.  

With respect to the nexus element, the private medical examiner reviewed the relevant records, considered the Veteran's lay reports and offered positive nexus opinions relating the Veteran's GERD to his service-connected depressive disorder and relating the back and right hip disabilities to his service-connected right knee disability.  The private examiner noted that the connection between stress and GERD was supported by relevant medical literature and concluded that it was at least as likely as not that the Veteran's GERD was related to the emotional stress and sleep disturbance the Veteran experienced as part of his depressive disorder.  The examiner also explained that the Veteran's right knee disability caused him to walk and stand unevenly and resulted in an altered gait.  The private examiner noted that medical literature supported a finding that biomechanical changes can hasten the development and progression of discomfort in the lower back and hip strain and relied on relevant medical studies in support of the opinions that the Veteran's back and right hip conditions were secondary to his service-connected right knee disability.  

The Board finds the opinions of the private medical examiner adequate for adjudicative purposes as they were based on consideration of the Veteran's medical history, described the Veteran's conditions and included explanatory rationales based on relevant medical literature.  See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).  Notably, there are no contradictory medical opinions of record.  As the record supports findings that the Veteran's GERD is related to his service-connected depressive disorder and that his lumbar spine muscle strain and right hip strain are related to his service-connected right knee disability, service connection on a secondary basis is warranted and the claims are granted.  38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.  

 

 

S.C. KREMBS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Snyder, M.

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.