HIATUS HERNIA

Summary

The veteran, who served from August 1975 to October 2002, appeals the denial of an increased rating for his service-connected hiatal hernia and gastroesophageal reflux disease (GERD). The Board of Veterans' Appeals (Board) reviewed the evidence, including the veteran's statements, multiple VA examination reports from April 2003, January 2015, and May 2022, as well as VA and private treatment records. The veteran sought a 10 percent rating, claiming symptoms like heartburn, regurgitation, and dysphagia occurring frequently in the past, though he reported significant improvement with medication since 2005. The Board found that while service connection for hiatal hernia and GERD was established, the evidence did not consistently support symptoms productive of considerable impairment of health required for higher ratings under Diagnostic Code 7346. The Board resolved reasonable doubt in the veteran's favor, finding that his condition more nearly approximated the criteria for a 10 percent rating for the entire period of the claim. Higher ratings were denied as the evidence did not reflect persistent symptoms or considerable impairment. The Board noted that the veteran's GERD was often asymptomatic or stable, and his hiatal hernia did not functionally impact his ability to work, though some avoidance of heavy lifting was noted.

Rationale

Resolved reasonable doubt in Veteran's favor; Hiatal hernia and GERD more nearly approximate criteria for 10% rating; Symptoms did not meet criteria for higher ratings

Full Decision Text

Citation Nr: 22060781
Decision Date: 10/28/22	Archive Date: 10/28/22

DOCKET NO. 17-26 403
DATE: October 28, 2022

ORDER

An initial 10 percent rating, and no higher, for hiatal hernia and gastroesophageal reflux disease (GERD) is granted for the entire period of the claim.

FINDING OF FACT

The Board resolves reasonable doubt in the Veteran's favor by finding that for the entire period of the claim, his hiatal hernia and GERD more nearly approximate the criteria for a 10 percent rating under Diagnostic Code 7346.

CONCLUSION OF LAW

The criteria for an initial 10 percent rating for hiatal hernia and GERD are more nearly approximated for the entire period of the claim. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.114, Diagnostic Code 7346.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from August 1975 to October 2002. This matter comes before the Board of Veterans Appeals (Board) on appeal from a May 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for hiatal hernia and GERD and assigned a noncompensable rating, effective March 29, 2011.  A March 2022 Board decision granted entitlement to an effective date of November 1, 2002 for the grant of service connection for hiatal hernia and GERD and remanded the claim for an increased rating for hiatal hernia and GERD for additional development. A March 2022 rating decision implemented the Board decision granting an effective date of November 1, 2002 for the grant of service connection.

1. Entitlement to an initial compensable rating for hiatal hernia and GERD

Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent   the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 

Service connection for hiatal hernia and GERD was established in the May 2015 rating decision that is the subject of this appeal and assigned a noncompensable (zero percent) rating under 38 C.F.R. § 4.114, Diagnostic Code 7346, effective March 29, 2011. As noted above, a March 2022 Board decision granted an effective date of November 1, 2002.

Under Diagnostic Code 7346, a 10 percent rating is assigned for hiatal hernia with two or more symptoms for the 30 percent evaluation of less severity. 38 C.F.R. § 4.114, Diagnostic Code 7346.  A 30 percent rating is assigned for hiatal hernia with persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. Id.  A 60 percent rating is assigned for hiatal hernia with symptoms of pain, vomiting, material weight loss, and hematemesis    or melena with moderate anemia, or other symptom combinations productive of severe impairment of health.  Id.

The Veteran seeks a higher initial rating for his hiatal hernia and GERD. On his notice of disagreement, he indicated he was seeking a 10 percent rating.  After reviewing the record, and resolving doubt in the Veteran's favor, the Board finds that an initial 10 percent rating for hiatal hernia and GERD is warranted for the entire period of the claim. Evidence to support this determination includes the Veteran statements on appeal and April 2003, January 2015 and May 2022 VA examination reports and VA and private treatment records.  

In a March 2011 statement, the Veteran asserted that his GERD began in the early 1990's and during that time he "ate Tums like candy for many years."  In August 2015, he asserted symptoms of heartburn, regurgitated vile and inability to swallow food without it choking him that occurred three to four days per week since 1980. He stated that after he was prescribed medication in 2006, his symptoms occurred once or twice every two to three months.

An April 2003 VA examiner diagnosed GERD, hiatal hernia and complaints of dysphagia. An upper gastrointestinal (GI) procedure performed in conjunction with the examination revealed a hiatal hernia with positional gastroesophageal reflux. The Veteran reported that he sometimes has indigest
 his GERD began in the early 1990's and during that time he "ate Tums like candy for many years."  In August 2015, he asserted symptoms of heartburn, regurgitated vile and inability to swallow food without it choking him that occurred three to four days per week since 1980. He stated that after he was prescribed medication in 2006, his symptoms occurred once or twice every two to three months.

An April 2003 VA examiner diagnosed GERD, hiatal hernia and complaints of dysphagia. An upper gastrointestinal (GI) procedure performed in conjunction with the examination revealed a hiatal hernia with positional gastroesophageal reflux. The Veteran reported that he sometimes has indigestion and dysphagia with dry solids that get "hung up" in his throat and reported he currently does not take medication but previously used over-the-counter medication.  

A December 2005 private esophagogastroduodenoscopy (EGD) report indicated dysphagia and hematochezia, and impression of small hiatal hernia and erythema in the gastroesophageal junction.  A January 2006 private (EGD) report notes an impression of small hiatal hernia and erythema in the gastroesophageal junction per biopsy.

During a January 2015 VA examination, the Veteran reported trouble with reflux symptoms in the 1980's, in that he intermittently woke up with acid/bile in his throat and had difficulty tolerating certain foods and dysphagia. He reported he used over-the-counter medication throughout the day until he started prescription medication in 2005, which provided good relief of his symptoms. The examiner noted the Veteran had signs and symptoms of infrequent episodes of epigastric distress, reflux and sleep disturbance caused by esophageal reflux 4 or more times per year, lasting less than one day.

During August 2015 VA treatment, the Veteran reported he had heartburn, vomited vile and had difficulty swallowing food three to four days per week until he was prescribed Nexium in 2006, after which his symptoms occurred once or twice every two to three months. 

During the May 2022 VA examination, the examiner noted the Veteran had signs and symptoms of pyrosis and reflux due to GERD. 

The record reflects that the hiatal hernia and GERD has been treated with prescription medication since approximately 2005. See January 2015 and           May 2022 VA examination reports, and VA and private treatment records.

Thus, after resolving all reasonable doubt in the Veteran's favor, the Board finds that his hiatal hernia and GERD more nearly approximates the criteria for a 10 percent rating throughout the entire period of the claim.  

The Board finds that a rating higher than 10 percent is not warranted under Diagnostic Code 7346 at any time during the claim, as the evidence of record does not reflect complaints or symptoms, regardless of whether or not he was taking medication, of persistently recurrent epigastric distress with symptoms productive of considerable impairment of health. See 38 C.F.R. § 4.114, Diagnostic Code 7346; see also Jones v. Shinseki, 26 Vet. App. 56, 61-63    (2012). 

The January 2015 VA examiner indicated the Veteran seldom has reflux and infrequent episodes of discomfort at night aggravated by spicy foods and position; and there is no current evidence of the Veteran's GERD or hiatal hernia being the cause of any current swallowing difficulty. The May 2022 VA examiner indicated   the Veteran did not have signs or symptoms productive of considerable impairment   of health; symptoms combination productive of severe impairment of health; persistently recurrently epigastric distress; infrequent episodes of epigastric distress; dysphagia; regurgitation; substernal, arm or shoulder pain; sleep disturbance; material weight loss; nausea; vomiting; hematemesis; or melena with moderate anemia.  Both the January 2015 and May 2022 VA examiners determined that the hiatal hernia and GERD did not functionally impact the Veteran's ability to work. The May 2022 VA examiner additionally noted that, with respect to GERD, the Veteran may not be    able to eat/attend office parties because he may not be able to eat certain foods that would trigger GERD symptoms but there are no restrictions related to occupational functions or daily living; and, as to hiatal hernia, the Veteran should avoid lifting heavy weights or objects but has no restrictions on sedentary occupations or mild to moderate activities. 

VA and private treatment records throughout the period of the claim show the Veteran reported few symptoms. He denied indigestion, nausea, vomiting and/or trouble swallowing during VA treatment in January 201
 hiatal hernia and GERD did not functionally impact the Veteran's ability to work. The May 2022 VA examiner additionally noted that, with respect to GERD, the Veteran may not be    able to eat/attend office parties because he may not be able to eat certain foods that would trigger GERD symptoms but there are no restrictions related to occupational functions or daily living; and, as to hiatal hernia, the Veteran should avoid lifting heavy weights or objects but has no restrictions on sedentary occupations or mild to moderate activities. 

VA and private treatment records throughout the period of the claim show the Veteran reported few symptoms. He denied indigestion, nausea, vomiting and/or trouble swallowing during VA treatment in January 2010 and April 2022, and during private treatment in January 2010, April 2011, October 2011 and December 2016.  VA treatment records in 2013 and 2014 reflect that the Veteran consistently denied decreased appetite, dysphagia, pain on swallowing, heartburn, nausea, hematemesis, abdominal pain and diarrhea. See June 2013, January 2014, February 2014, March 2014, April 2014, May 2014, June 2014 and July 2014 VA treatment records. The Veteran denied sleeping difficulty during March 2015, October 2020, February 2021, December 2021 and March 2022 VA treatment. Private treatment records in January 2022 and March 2022 show the Veteran denied dysphagia, heartburn, acid reflux, nausea, vomiting and sleep disturbance. The Veteran's GERD was noted as asymptomatic in an April 2011 VA treatment record and   stable in February 2013 and March 2015 VA treatment records. 

Because the evidence does not reflect persistently occurring epigastric distress with symptoms productive of considerable impairment of health, a rating in excess of   10 percent is not warranted under Diagnostic Code 7346 at any time during the period of the claim.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

 

 

K. A. BANFIELD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. C. Birder

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.