GASTROESOPHAGEAL REFLUX DISEASE (GERD)

SHAUN S. SPERANZA · 2025 · Case ID: A25044272

GRANTED

Summary

The veteran, who served in the U.S. Army from March 1976 to October 1977, appeals the denial of service connection for several conditions claimed as secondary to his service-connected diabetes mellitus, type 2. The conditions under appeal include acid reflux/GERD, colonic diverticulitis, gallstones, diastasis of muscle, benign prostatic hyperplasia (BPH), obstructive sleep apnea (OSA), hyperlipidemia, hypertension, and thyroid disease disorder. The veteran's claims are based on the contention that insulin resistance from his diabetes led to weight gain, which in turn caused or aggravated these other conditions. The Board reviewed conflicting medical opinions. An initial VA examination in January 2020 opined that weight gain is not caused by diabetes but rather by lifestyle, and that diabetes does not cause weight gain, finding the opinion inadequate for failing to address aggravation of obesity by diabetes. Conversely, a July 2020 positive medical opinion from the veteran's treating physician, Dr. A.T., concluded that weight gain was more likely than not contributed by or the result of his insulin resistance/Type 2 diabetes, citing medical principles. This opinion was deemed highly probative. Additional positive opinions from other treating physicians supported secondary service connection for OSA, hypertension, hyperlipidemia, and the remaining conditions, linking them to obesity aggravated by diabetes. The Board found these opinions probative and supported by medical records and rationale. Consequently, service connection for all claimed conditions as secondary to diabetes mellitus, type 2, was granted.

Rationale

Service connection granted as secondary to diabetes mellitus, type 2; Aggravation of obesity by diabetes led to GERD; Supported by positive opinion from treating physician

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210715-172761

Full Decision Text

Citation Nr: A25044272
Decision Date: 05/16/25 Archive Date: 05/16/25

DOCKET NO. 210715-172761
DATE: May 16, 2025

ORDER

Service connection for acid reflux / gastroesophageal reflux disease (GERD), as secondary to service-connected diabetes mellitus, type 2, is granted.

Service connection for colonic diverticulitis, as secondary to service-connected diabetes mellitus, type 2, is granted.

Service connection for gallstones, as secondary to service-connected diabetes mellitus, type 2, is granted.

Service connection for diastasis of muscle, as secondary to service-connected diabetes mellitus, type 2, is granted.

Service connection for benign prostatic hyperplasia (BPH), as secondary to service-connected diabetes mellitus, type 2, is granted.

Service connection for obstructive sleep apnea (OSA), as secondary to service-connected diabetes mellitus, type 2, is granted.

Service connection for hyperlipidemia, as secondary to service-connected diabetes mellitus, type 2, is granted.

Service connection for hypertension, as secondary to service-connected diabetes mellitus, type 2, is granted.

Service connection for thyroid disease disorder (also claimed as autoimmune thyroid disease disorder), as secondary to service-connected diabetes mellitus, type 2, is granted.

FINDINGS OF FACT

1. The Veteran's acid reflux/GERD was caused and/or aggravated by his service-connected diabetes mellitus, type 2.

2. The Veteran's colonic diverticulitis was caused and/or aggravated by his service-connected diabetes mellitus, type 2.

3. The Veteran's gallstones were caused and/or aggravated by his service-connected diabetes mellitus, type 2.

4. The Veteran's diastasis of muscle was caused and/or aggravated by his service-connected diabetes mellitus, type 2.

5. The Veteran's prostate disability, including BPH, was caused and/or aggravated by his service-connected diabetes mellitus, type 2.

6. The Veteran's OSA was caused and/or aggravated by his service-connected diabetes mellitus, type 2.

7. The Veteran's hyperlipidemia was caused and/or aggravated by his service-connected diabetes mellitus, type 2.

8. The Veteran's hypertension was caused and/or aggravated by his service-connected diabetes mellitus, type 2.

9. The Veteran's thyroid disease disorder (also claimed as autoimmune thyroid disease disorder) was caused and/or aggravated by his service-connected diabetes mellitus, type 2.

CONCLUSIONS OF LAW

1. The criteria for service connection for acid reflux / gastroesophageal reflux disease (GERD), as secondary to service-connected diabetes mellitus, type 2, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for colonic diverticulitis, as secondary to service-connected diabetes mellitus, type 2, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for gallstones, as secondary to service-connected diabetes mellitus, type 2, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for service connection for diastasis of muscle, as secondary to service-connected diabetes mellitus, type 2, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

5. The criteria for service connection for a prostate disability, including benign prostatic hyperplasia (BPH), as secondary to service-connected diabetes mellitus, type 2, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

6. The criteria for service connection for obstructive sleep apnea, as secondary to service-connected diabetes mellitus, type 2, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

7. The criteria for service connection for hyperlipidemia, as secondary to service-connected diabetes mellitus, type 2, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

8. The criteria for service connection for hypertension
; 38 C.F.R. §§ 3.102, 3.310.

6. The criteria for service connection for obstructive sleep apnea, as secondary to service-connected diabetes mellitus, type 2, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

7. The criteria for service connection for hyperlipidemia, as secondary to service-connected diabetes mellitus, type 2, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

8. The criteria for service connection for hypertension, as secondary to service-connected diabetes mellitus, type 2, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

9. The criteria for service connection for thyroid disease disorder (also claimed as autoimmune thyroid disease disorder), as secondary to service-connected diabetes mellitus, type 2, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from March 1976 to October 1977.

A rating decision was issued under the legacy system in April 2018 and the Veteran then perfected an appeal under the legacy appeals system to the Board of Veterans' Appeals (Board). In August 2019, the Board remanded for additional development and consideration. Subsequently, the agency of original jurisdiction (AOJ) issued a supplemental statement of the case (SSOC) in June 2021. The Veteran opted the claims into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a July 2021 VA Form 10182, Decision Review Request: Board Appeal, identifying the June 2021 SSOC. Therefore, the June 2021 SSOC is the decision on appeal.

In the July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service.? 38?U.S.C. §?1131; 38?C.F.R. §?3.303(a).? As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and (3) a relationship or nexus between the current disability and any injury or disease during service.? Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

Per a 2017 VA General Counsel (G.C.) precedential opinion, obesity may be an "intermediate step" between a service-connected disability and a current disability that may be service connected on a secondary basis under 38 C.F.R. § 3.310 (a). See VAOPGCPREC 01-17 (Jan. 6, 2017), at 2-3. Service connection may be granted on a secondary basis where the claimed disability would not have occurred but for obesity caused or aggravated by a service-connected disability. Id.; 38 C.F.R. § 3.310. Walsh v. Wilkie, 32 Vet. App. 300 (2020).

1. Service connection for acid reflux / GERD.

2. Service connection for colonic diverticulitis.

3. Service connection for gallstones.

4. Service connection for diastasis of muscle.

5. Service connection for benign prostatic hyperplasia (BPH).

6. Service connection for sleep apnea syndromes.

7. Service connection for hyperlipidemia.

8. Service connection for hypertension.

9. Service connection for thyroid disease disorder (also claimed as autoimmune thyroid disease disorder).

The Veteran and his attorney contend that insulin resistance from service-connected diabetes affected his weight gain, which led to several disabilities on appeal, including acid reflux/GERD, colonic diverticulitis, gallstones, diastasis of muscle, BPH, sleep apnea, hyperlipidemia, hypertension, and thyroid disease. See Veteran's attorney's October 2021 brief; and March 2018 claim. Notably, during the pendency of the appeal, the AOJ established service connection for diabetes mellitus, type 2, as secondary to the service-connected hepatitis C. See September 2020 rating decision.

First, the Veteran has established a current disability for these claims. His VA and private treatment records show treatment for active problems of OSA, acid reflux and GERD, colonic diverticulitis, gallstones, diastasis of muscle, BPH, hyperlipidemia, hypertension, and thyroid disease (diagnosed as benign thyroid nodules).

The evidence includes conflicting medical opinions assessing these claims. Initially, a January 2020 VA diabetes examiner provided relevant medical commentary, stating in relevant part, "It is less than likely as not that the Veteran's diabetes mellitus caused [formatted for emphasis] the [V]eteran to gain weight. Being overweight or obesity has been shown to be a risk factor for developing type 2 diabetes. Weight gain is not caused [formatted for emphasis] by diabetes but rather by caloric intake and physical activity." The examiner instead generally indicated that the cause of any weight gain is attributable to lifestyle habits, such as diet and exercise, albeit in a generic manner, without citation to any particular medical findings for this Veteran.

Importantly, the examiner did not address whether the Veteran's service-connected diabetes aggravated his obesity. Thus, the May 2016 VA examiner's opinion was inadequate and entitled to limited probative value against the claim. Inadequate medical examinations include examinations that contain only data and conclusions, do not provide an etiological opinion, are not based upon a review of medical records, or provide unsupported conclusions. Nieves- Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

On the other hand, there is highly probative medical opinion evidence in support of whether the Veteran's disabilities were caused and/or aggravated by service-connected diabetes, with consideration of obesity as an intermediate step.

The Court of Appeals for Veterans Claims (CAVC) found, in Walsh v. Wilkie, 32 Vet. App. 300, 306 (2020), "In short, there is no permissible basis in the relevant regulation for concluding that obesity may be an "intermediate step" in a secondary-service-connection analysis when service-connected disability causes it, but not when service-connected disability aggravates it." CAVC noted that the 2017 G.C. opinion does not purport to prohibit inquiry into whether a service-connected disability aggravates a veteran's obesity. Walsh, 32Vet. App.at 307. CAVC held that the Board must consider aggravation of obesity by a service-connected disability under § 3.310 (b), in the context of obesity as an intermediate step, when explicitly
kie, 32 Vet. App. 300, 306 (2020), "In short, there is no permissible basis in the relevant regulation for concluding that obesity may be an "intermediate step" in a secondary-service-connection analysis when service-connected disability causes it, but not when service-connected disability aggravates it." CAVC noted that the 2017 G.C. opinion does not purport to prohibit inquiry into whether a service-connected disability aggravates a veteran's obesity. Walsh, 32Vet. App.at 307. CAVC held that the Board must consider aggravation of obesity by a service-connected disability under § 3.310 (b), in the context of obesity as an intermediate step, when explicitly raised by a veteran or reasonably raised by the record. Id.

A July 2020 positive medical opinion by the Veteran's treating physician, Dr. A.T., M.D., stated, "After reviewing this Veteran's service treatment medical records and post-[service] treatment medical records, it is my medical opinion that it is more likely that it is more likely than not that his weight gain was contributed by or the result of his Insulin Resistance / Type 2 diabetes." Dr. A.T. reasoned that resistance to insulin causes the body to produce more insulin, which leads to increased hunger, higher blood pressure, and weight gain; and that weight gain in patients with Type 2 diabetes mellitus causes glucose levels even more arduous to control. The Board finds this opinion to be highly probative, given that it indicates there was aggravation of obesity by the service-connected diabetes, based upon review of relevant medical records and consideration of the Veteran's reported history of his conditions, as well as review and clear articulation of medical principles.

In turn, a November 2018 positive medical opinion by another treating physician, Dr. H.M., MD., indicated that the Veteran's OSA was at least as likely as not secondary to his service-connected type 2 diabetes and resultant weight gain. Similarly, a November 2018 positive medical opinion by Dr. A.T. indicated that the Veteran's hypertension and hyperlipidemia were most likely caused by or the result of his severe OSA, citing relevant medical literature for such finding. Dr. A.T. additionally opined that the several other claimed conditions of GERD, diverticulitis, gallstones, thyroid nodule, diastasis of the abdominal rectus muscle, and BPH, were "most likely caused by or the result of his obesity." Again, Dr. A.T.'s July 2020 report had indicated his obesity was aggravated by his service-connected diabetes. Altogether, the private positive opinions are probative and supported by the relevant medical records, several cited medical literature articles, the Veteran's lay statements, clinical expertise, and discussion of the rationale of the opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).

For the above reasons, the probative evidence weighs in favor of the claims. Accordingly, service connection for acid reflux/GERD, colonic diverticulitis, gallstones, diastasis of muscle, BPH, sleep apnea, hyperlipidemia, hypertension, and thyroid disease, as secondary to service-connected diabetes mellitus, type 2, is warranted. 38 U.S.C. § 5107 (b).

SHAUN S. SPERANZA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Chatterjee, 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.

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