GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Summary

The Veteran, who served in the U.S. Army from June 1982 to December 1989, appeals the denial of service connection for GERD, erectile dysfunction (ED), and migraine headaches. The Veteran claims these conditions are secondary to his already service-connected disabilities: intervertebral disc syndrome (IVDS), major depressive disorder with anxious distress (MDD), bilateral lower extremity sciatic radiculopathy, bilateral lower extremity femoral radiculopathy, tinnitus, and obstructive sleep apnea (OSA). The Board reviewed evidence submitted by the Veteran, including lay statements and a comprehensive medical opinion from Dr. G, which linked the claimed conditions to the service-connected disabilities through physiological explanations and peer-reviewed studies. The Board found Dr. G's opinion highly probative due to its thoroughness and scientific basis. In contrast, the Board found the VA examiner's negative opinions inadequate, as they failed to consider the Veteran's lay testimony and the specific physiological interplay of his conditions. The Board determined that the evidence was at least evenly balanced regarding causation for GERD, ED, and migraines, and resolved this doubt in the Veteran's favor. Consequently, service connection for GERD, ED, and migraine headaches, secondary to the identified service-connected disabilities, was granted.

Rationale

Evidence is at least evenly balanced regarding causation.; Benefit of the doubt resolved in Veteran's favor.; Dr. G's opinion found highly probative.

Full Decision Text

Citation Nr: A26017683
Decision Date: 02/26/26	Archive Date: 02/26/26

DOCKET NO. 250725-567618
DATE: February 26, 2026

ORDER

Entitlement to service connection for gastroesophageal reflux disease (GERD), secondary to service-connected intervertebral disc syndrome (IVDS) and major depressive disorder with anxious distress (MDD), on a causation basis, is granted.

Entitlement to service connection for erectile dysfunction (ED), secondary to service-connected IVDS, bilateral lower extremity sciatic radiculopathy, bilateral lower extremity femoral radiculopathy, and MDD, on a causation basis, is granted.

Entitlement to service connection for migraine headaches, secondary to service-connected tinnitus, IVDS, obstructive sleep apnea (OSA) and MDD, on a causation basis, is granted.

FINDINGS OF FACT

1. The evidence is at least evenly balanced as to whether the Veteran's GERD was caused in part by his service-connected IVDS and MDD.

2. The evidence is at least evenly balanced as to whether the Veteran's ED was caused in part by his service-connected IVDS, bilateral lower extremity sciatic radiculopathy, bilateral lower extremity femoral radiculopathy, and MDD.

3. The evidence is at least evenly balanced as to whether the Veteran's migraine headaches were caused in part by his service-connected IVDS, OSA, and MDD.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for GERD, secondary to service-connected IVDS and MDD, on a causation basis, have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for entitlement to service connection for ED, secondary to service-connected IVDS, bilateral lower extremity sciatic radiculopathy, bilateral lower extremity femoral radiculopathy, and MDD, on a causation basis, have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for entitlement to service connection for migraine headaches, secondary to service-connected tinnitus, IVDS, and OSA, on a causation basis, have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active duty service in the United States Army from June 1982 to December 1989.

These matters come before the Board of Veterans' Appeals (VA) from a July 2024 rating decision, indicated as being a mandated, special review, of the Department of Veterans Affairs (VA).  In the rating decision, the Agency of Original Jurisdiction (AOJ) denied the above claims.

In his July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), the Veteran elected the Evidence docket.  

As the Veteran selected the Evidence docket, the Board may only consider the evidence of record at the time of the AOJ rating decision on appeal, as well as any evidence submitted by the Veteran or 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 wishes to have VA consider any evidence that was not considered, he may at any time file a supplemental claim with the AOJ after receiving this decision and the additional evidence will be considered in connection with the supplemental claim.  38 U.S.C. §§ 5104C(a)(1)(B), (b); 5108; 38 C.F.R. §§ 3.2501, 20.1105(a).  If filed within one year, this supplemental claim will preserve the date of the claim denied herein as the effective date of the grant of the benefit or benefits sought.  38 U.S.C. § 5104C(a
300, 20.303, 20.801.  If the Veteran wishes to have VA consider any evidence that was not considered, he may at any time file a supplemental claim with the AOJ after receiving this decision and the additional evidence will be considered in connection with the supplemental claim.  38 U.S.C. §§ 5104C(a)(1)(B), (b); 5108; 38 C.F.R. §§ 3.2501, 20.1105(a).  If filed within one year, this supplemental claim will preserve the date of the claim denied herein as the effective date of the grant of the benefit or benefits sought.  38 U.S.C. § 5104C(a)(2)(B); 38 C.F.R. § 3.2500(h)(1).

Service Connection

The Veteran contends that his GERD, ED, and migraine headaches were caused by service-connected disabilities (as delineated in the above order).

Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a).  Courts have held that both direct and secondary service connection may be established under a broad, "but for" causation standard, warranting the grant of secondary service connection if one or more service-connected diseases or injuries are one of the causes of the current disability, even if there are other causes.  Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) ("but-for causation is broad, undisputedly broader than proximate cause"); Adams v. Collins, 38 Vet. App. 273, 286 (2025) ("Before the Federal Circuit's decision in Spicer, secondary service connection was considered a product of regulation, rather than statute (quoting Frost v. Shulkin, 29 Vet. App. 131, 137 (2017) ("Secondary service connection for VA benefit purposes is not addressed in any statute")); Gajeski v. Collins, No. 24-4992, 2025 U.S. App. Vet. Claims LEXIS 942, *10-11 ("A veteran is entitled to compensation for a 'disability resulting from personal injury suffered or disease contracted' in or related to service. 38 U.S.C. § 1110. And 'the causation standard of § 1110 is simply standard but-for causation.' Spicer v. McDonough, 61 F. 4th 1360, 1364 (Fed. Cir. 2023). But-for causation is a broad standard that 'is not limited to a single cause and effect but rather contemplates multi-causal links.'  Id. This means that establishing one factor as a but-for cause does not necessarily eliminate all other factors as but-for causes.  See Bostock v. Clayton Cnty., Ga., 590 U.S. 644, 656 (2020) (explaining that, in the context of Title VII, but-for causation means that a defendant cannot avoid liability 'just by citing some other[non-discriminatory] factor that contributed to its challenged employment decision'"); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain).  

Upon a November 2019 VA headaches report, a clinician provided a diagnosis of migraine headaches.  Upon a battery of VA examination reports in May 2022, a clinician provided diagnoses of GERD and ED.  Consequently, the current disability requirement for each of these three disabilities has been met.  

The Veteran contends that his GERD, ED, and migraine headaches are related to the Veteran's service-connected disabilities.  The evidence of record has also raised whether these three disabilities are due to the synergistic effect of all of the Veteran's toxic exposures.  For the reasons discussed below, the Board finds that service connection for the three disabilities of GERD, ED, and migraine headaches, secondary to the above-articulated service-connected disabilities, on a causation basis, is warranted.

In lay statements, the Veteran has reported that his discernable symptoms of GERD began after he was prescribed 800 milligrams of ibuprofen to control the pain of his service-connected IVDS.  These GERD symptoms have been on-going.  As to ED, the Veteran reports that his symptoms began after he was prescribed duloxetine to treat his service
-connected disabilities.  The evidence of record has also raised whether these three disabilities are due to the synergistic effect of all of the Veteran's toxic exposures.  For the reasons discussed below, the Board finds that service connection for the three disabilities of GERD, ED, and migraine headaches, secondary to the above-articulated service-connected disabilities, on a causation basis, is warranted.

In lay statements, the Veteran has reported that his discernable symptoms of GERD began after he was prescribed 800 milligrams of ibuprofen to control the pain of his service-connected IVDS.  These GERD symptoms have been on-going.  As to ED, the Veteran reports that his symptoms began after he was prescribed duloxetine to treat his service-connected MDD, bilateral lower extremity sciatic radiculopathy, and bilateral lower extremity femoral radiculopathy.  In this regard, the Court has indicated that veterans are competent to describe the nature and degree of erectile dysfunction.  See Jackson v. McDonough, No. 21-5894, 2023 U.S. App. Vet. Claims LEXIS 654, *11-12 (Apr. 2023) (mem dec) (Allen, J.) ("Lay testimony is competent... to establish the presence of observable symptomology and may provide sufficient support for a claim of service connection.  The Board doesn't explain why appellant's testimony that he has erectile dysfunction is, or isn't, a symptom capable of lay observation, as opposed to a medical diagnosis. As appellant points out, erectile dysfunction is defined as impotence, something that seems observable to a lay person such as appellant.  To be sure, erectile dysfunction is also a medical term. But that does not mean that it can't also be a description of a physical condition a lay person observes") (internal quotations and citations omitted).  See also Bethea, 2 Vet. App. 252, 254 .  And, as to migraine headaches, the Veteran reports that they have been on-going, coinciding with the "irritability" produced by his other service-connected disabilities.  Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007) (a veteran is competent to testify regarding observations); Buchanan v. Nicholson, 451 F. 3d 1331, 1337 (holding lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent, regardless of the lack of contemporaneous medical evidence).   The Veterans lay accounts are credible and competent as to the onset and discernable symptoms of these three disabilities.

In July 2025 (during the permissible evidence window) VA received an extensive medical opinion from Dr. G.  This medical professional indicated that he performed a comprehensive review of the Veteran's medical history, extensive compendium of medical records and the contents of the entire claims file.  Dr. G rendered positive etiological opinions as to secondary causation for GERD, ED, and migraine headaches, which require elucidation.  As to GERD and ED, Dr. G reasoned, based on lay, medical, and peer-reviewed studies (involving cross sections of the population) the NSAIDs (like ibuprofen) and MDD have been found to have causal relationships with these disabilities.  As noted above, the Additionally, neurological literature reflects an etiological correlation between "nerve impingement" (here, bilateral lower extremity sciatic radiculopathy and bilateral lower extremity femoral radiculopathy) and ED.  As to the Veteran's on-going migraine headaches, Dr. G reasoned, through reference again to peer-reviewed scientific studies, that spine pain (IVDS), tinnitus, and sleep apnea (here, OSA) contribute to the acquisition of migraine headaches.  In addition to a holistic assessment of the Veteran's medical history and treatment since service, Dr. G delved into the somatic implications of these causative associations through an extensive discussion of human physiology and the connexity between the nervous, digestive, musculoskeletal, and endocrine systems.  After this extensive analysis Dr. G rendered positive etiological opinions as to secondary causation for GERD, ED, and migraine headaches, with precise identification of the service-connected disabilities (as articulated above) that have been significant factors of the causation of these three claimed disabilities.  The Board assigns considerable probative weight to Dr. G's extensive report because of its expansiveness, references to scientific studies, physiological discussion, and it holistic assessment of the Veteran's psycho-medical history.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning); Acevedo v. Shinseki
.  After this extensive analysis Dr. G rendered positive etiological opinions as to secondary causation for GERD, ED, and migraine headaches, with precise identification of the service-connected disabilities (as articulated above) that have been significant factors of the causation of these three claimed disabilities.  The Board assigns considerable probative weight to Dr. G's extensive report because of its expansiveness, references to scientific studies, physiological discussion, and it holistic assessment of the Veteran's psycho-medical history.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record).

The Veteran's representative summarized Dr. G's extensive report with great specificity, emphasizing the secondary associations and the inadequacy of the VA examinations performed in association with these three service connection claims.  The representative also argued that Dr. G's etiological opinions are of great probative weight and suffice to establish service connection, without resort to remanding for VA addenda.  For reasons discussed below, the Board concurs with the representative on this point.  Importantly, the representative did not discuss toxic exposure and the causation of either GERD, ED, or migraines headaches.

In May 2022, a clinician rendered negative etiological opinions as to secondary causation and TERA exposure for GERD, ED, and migraine headaches.  As a rationale to support these negative opinions, the clinician (generically) emphasized that the literature fails to disclose an association between GERD, ED, and migraine headaches and the Veteran's service-connected disabilities.  Moreover, the clinician opined that these disabilities were not caused by the synchronistic effect of the Veteran's toxic exposures.  The clinician neither included consideration of the lay evidence of record nor evaluated the intricate physiological interplay between the  nervous, digestive, musculoskeletal, and endocrine systems.  For these reasons, the Board finds that these negative etiological opinions are of little, if any, probative weight.  Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (a medical opinion that relies on the absence of general medical literature supporting nexus without discussing the specific facts of the case is inadequate).

The Board could remand these service connection claims for yet more opinions.  However, considering Dr. G's highly probative and exacting opinions as to secondary causation, remanding now could be considered as a prohibited attempt to obtain additional evidence for the sole purpose of denying this Veteran's claims, which is impermissible.  38 C.F.R. § 3.304(c) ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination"); Andrews v. McDonough, 34 Vet. App. 216, 225 (2021) ("Remand is inappropriate where the predominant purpose is not to allow the Board to make a fully informed decision unencumbered by error but to allow VA to obtain more evidence so that it can properly deny the claim").  

Considering the above, the evidence suffices to decide these service connection claims, as it is at least evenly balanced as to whether the Veteran's service-connected IVDS, MDD, bilateral lower extremity sciatic radiculopathy, bilateral lower extremity femoral radiculopathy, tinnitus, and OSA were causes of the Veteran's GERD, ED, and migraine headaches.  As the reasonable doubt created by this relative equipoise in the evidence of record must be resolved in the Veteran's favor, entitlement to service connection for these three disabilities is warranted.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

 

Jonathan Hager

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	B.J. Komins, 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.