GASTRIC OR DUODENAL ULCER DISEASE

Summary

The Veteran, a Marine Corps Veteran who served from September 2007 to October 2008, appeals the denial of service connection for a stomach disorder, claiming it was aggravated by service. The Board reviewed the Veteran's claim, noting prior remands for additional development. Service treatment records indicated a congenital abnormality (gastroschisis) with no complications noted at enlistment, but a surgical scar. Post-service records showed a history of abdominal pain and intermittent stomachaches, consistent with the Veteran's lay statements and testimony that his condition worsened after deployment to Iraq. The Board found that the Veteran's stomach disorder clearly and unmistakably preexisted service. The primary issue was whether this preexisting condition was aggravated by service, triggering the presumption of aggravation under 38 U.S.C. § 1153. While a VA examiner opined in August 2025 that military service did not aggravate the condition beyond its natural progression, citing a lack of specific medical literature, the Board found this opinion insufficient to rebut the presumption with clear and unmistakable evidence. The Board noted the examiner's acknowledgment of limited research on strenuous activity's impact on gastroschisis patients. Given the lack of clear and unmistakable evidence to rebut the presumption of aggravation, and resolving all reasonable doubt in the Veteran's favor, the Board granted service connection for the stomach disorder.

Rationale

Preexisting condition noted on enlistment; Aggravated by service beyond natural progression; VA failed to provide clear and unmistakable evidence to rebut presumption of aggravation

Full Decision Text

Citation Nr: 25013080
Decision Date: 10/20/25	Archive Date: 10/20/25

DOCKET NO. 20-09 803
DATE: October 20, 2025

ORDER

Entitlement to service connection for a stomach disorder is granted.

FINDING OF FACT

Resolving all reasonable doubt in favor of the Veteran, the persuasive evidence of record is in favor of a finding that the Veteran's stomach disorder preexisted service and underwent an increase in severity during service beyond the natural progression of the disease.

CONCLUSION OF LAW

The criteria for entitlement to service connection for a stomach disorder have been met. 38 U.S.C. §§ 1110, 1132, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the Marine Corps from September 2007 to October 2008. 

This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO).

In January 2022, the Veteran testified before the undersigned Acting Veterans Law Judge via a virtual hearing. A transcript of the hearing is of record.

In May 2024 and April 2025, the Board remanded the Veteran's claim for additional development. The Board now finds that there was substantial compliance with its April 2025 remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998).

SERVICE CONNECTION

Generally, to prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a).

Cases in which the condition is noted on entrance to service are governed by the presumption of aggravation contained in 38 U.S.C. § 1153. This statute provides that a preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless clear and unmistakable evidence shows that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306.

Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. §§ 3.304, 3.306(b). A preexisting disease or injury will be presumed to have been aggravated by service only if the evidence shows that the underlying disability underwent an increase in severity; the occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. See Davis v. Principi, 276 F.3d 1341, 1345; 38 C.F.R. § 3.306(a). When a disability is not "noted" at entrance to service, VA must show by clear and unmistakable evidence that the disability preexisted service, and if so, whether it clearly and unmistakably was not aggravated during service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b).

Stomach Disorder

The Veteran seeks service connection for his preexisting stomach disorder, as aggravated by military service. 

As an initial matter, the Board notes that the record includes several VA medical opinions, dated May 2018, February 2020, June 2024, and December 2024, that have been deemed inadequate for adjudicative purposes. Thus, the Board will omit discussion of these inadequate opinions in the adjudication of the claim. 

Service treatment records reveal a January 2006 enlistment report of medical history that reported the Veteran was born with a small part of his intestine on the outside, but no complications since; and further reported an identifying abdomen surgical scar in the enlistment medical examination. A July 2006 record reveals the Veteran had a cold about a week ago and has had diarrhea lately.

Post-service medical treatment records reflect a history of gastroschisis status post repair as an infant, with
 opinions, dated May 2018, February 2020, June 2024, and December 2024, that have been deemed inadequate for adjudicative purposes. Thus, the Board will omit discussion of these inadequate opinions in the adjudication of the claim. 

Service treatment records reveal a January 2006 enlistment report of medical history that reported the Veteran was born with a small part of his intestine on the outside, but no complications since; and further reported an identifying abdomen surgical scar in the enlistment medical examination. A July 2006 record reveals the Veteran had a cold about a week ago and has had diarrhea lately.

Post-service medical treatment records reflect a history of gastroschisis status post repair as an infant, with treatment for abdominal pain and reported history of intermittent stomachaches that always resolve. 

Lay statements of record reflect the Veteran's assertions that he was born with gastroschisis, and after his deployment to Iraq, his stomach issues worsened and were aggravated, eventually resulting in a hospitalization for stomach issues. 

During a Board hearing, the Veteran testified that he was born with a hole in his belly and part of his intestine was sticking out, which was repaired immediately, so prior to service he had no stomach issues. However, his stomach issues began when he first went to bootcamp, described as small stomachaches, that progressed to constant pain while on deployment. These issues continued ever since and resulted in hospitalization twice for blockages in small intestines. 

VA examinations of record reveal that the Veteran has been diagnosed with intestinal obstruction and surgical repair of congenital gastroschisis. As a result of the congenital diagnosis and in-service notation of an intestinal problem at birth, the Board remanded the Veteran's claim twice to determine whether the Veteran's claimed stomach disorder clearly and unmistakably preexisted service and was aggravated by such service, and if not, whether the claimed condition was related to military service. All examiners opined that the Veteran's claimed stomach disorder clearly and unmistakably existed prior to service, along with the Veteran asserting to its preexisting nature throughout the appeal period. The Board therefore finds that while a gastrointestinal disorder other than the congenital abnormality with no complications was noted on entrance to service, an actual gastrointestinal disorder was not noted on entrance to service.  However, the evidence does clearly and unmistakably show that the Veteran had a gastrointestinal disorder which preexisted his military service.  

The primary question at issue is then whether that preexisting stomach disorder was aggravated by such service, thus, attaching consideration of the presumption of aggravation in this claim. See Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). The presumption may only be rebutted by clear and unmistakable evidence showing that it was not in fact aggravated.

The Board finds that the medical evidence fails to provide clear and unmistakable evidence that his stomach disorder was not aggravated by his service.

The most probative medical opinion was obtained in August 2025, from a nurse practitioner who reviewed the claims file. She opined that the Veteran's claimed stomach disorder, which clearly and unmistakably existed prior to service, was not aggravated beyond its natural progression by military service. She rationalized that there is no evidence in the medical literature that military service specifically aggravates the natural progression of surgically repaired congenital gastroschisis. Long-term outcomes for individuals with repaired gastroschisis are generally favorable, with most patients achieving gastrointestinal function and quality of life comparable to healthy controls, particularly in cases of simple gastroschisis without major postoperative complications, although a subset of patients could experience increased gastrointestinal symptoms or require additional abdominal surgery later in life. She wrote that while strenuous physical activity or abdominal trauma, such as might occur during military service, could theoretically pose risks in any individual with a history of abdominal surgery, there was no data directly linking military service to worsened outcomes or disease progression in this population. Data directly addressing the impact of military service or similar physical demands on long-term outcomes in gastroschisis patients are lacking, and further research may be needed to clarify this specific risk. Current consensus was that, in the absence of significant complications or complex disease, most individuals with repaired gastroschisis can expect outcomes similar to the general population. As it related to the diagnosed intestinal obstruction, the examiner added that intestinal obstruction is a clinical syndrome characterized by the interruption of the normal flow of intestinal contents due to a mechanical or, less commonly, functional cause. The most common etiologies were intra-abdominal adhesions, malignancy, and herniation. Clinical features included nausea, vomiting, colicky abdominal pain, abdominal distension, and cessation of flatus and stool passage. 

The VA examiner also discussed the Veteran's contention that the "Meals Ready-to-East" (MRE) had worsened his stomach condition, but he found no evidence supporting this
 of significant complications or complex disease, most individuals with repaired gastroschisis can expect outcomes similar to the general population. As it related to the diagnosed intestinal obstruction, the examiner added that intestinal obstruction is a clinical syndrome characterized by the interruption of the normal flow of intestinal contents due to a mechanical or, less commonly, functional cause. The most common etiologies were intra-abdominal adhesions, malignancy, and herniation. Clinical features included nausea, vomiting, colicky abdominal pain, abdominal distension, and cessation of flatus and stool passage. 

The VA examiner also discussed the Veteran's contention that the "Meals Ready-to-East" (MRE) had worsened his stomach condition, but he found no evidence supporting this assertion.  She wrote that studies of MREs in military populations have shown that while some individuals experience changes in bowel habits, including constipation or diarrhea, the majority do not develop clinically significant gastrointestinal complications.  She wrote that there was no evidence that MREs aggravated or accelerated the natural progression of surgically repaired congenital gastroschisis to cause intestinal obstruction, and there were no studies that directly linked MREs to intestinal obstruction in this context, though further research would be needed to clarify any specific dietary risks.

The Board finds that VA has not shown clear and unmistakable evidence that the Veteran's preexisting stomach disorder was not aggravated by service. The Board emphasizes that nothing short of clear and unmistakable evidence can rebut the presumption of aggravation. In this case, the Veteran's service treatment records reveal a complaint of gastrointestinal issues, with post-service records showing abdominal pain and stomachaches. This is aligned with the Veteran's consistent lay statements that his disorder was aggravated by service and has continued ever since. While the Board acknowledges the August 2025 VA examiner provided a lengthy and substantive opinion to weigh against the Veteran's claim, the Board notes that this evidence must be weighed against the entire record, with the opinion, alone, is not found to provide evidence that the condition clearly and unmistakably was not aggravated, and it is therefore not sufficient to rebut the presumption of aggravation based on the clear and unmistakable standard.  The VA examiner herself even acknowledged that there was a lack of research on the impact of strenuous physical demands on the long-term outcomes in gastroschisis patients, which further supports finding that her conclusions are not based on clear and unmistakable evidence. Consequently, VA has not established by clear and unmistakable evidence that the Veteran's preexisting stomach disorder was not permanently worsened beyond the natural progress by his military service.

Therefore, based on the above, the Board finds that the persuasive evidence of record is in favor of the Veteran's claim, or at the very least, is in relative equipoise, that a stomach disorder was aggravated by service in the absence of clear and unmistakable evidence sufficient to rebut that presumption. Thus, resolving all reasonable doubt in favor of the Veteran, the Board finds that service connection for the Veteran's stomach disorder is warranted, and the claim is granted. See 38 U.S.C. § 5107(b).

 

Mary E. Rude

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Carter, 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.