PEPTIC ULCER DISEASE

K. CONNER · 2026 · Case ID: 26004536

GRANTED

Summary

The veteran, who served in the U.S. Army from October 1980 to May 1987 and in the U.S. Army Reserve until August 2004, appeals the initial disability rating assigned for service-connected gastroenteritis with fundic gland polyp. The veteran sought an increased rating, specifically arguing for a 20 percent rating prior to January 14, 2020, and a 20 percent rating thereafter. The Board reviewed the evidence, including VA and private treatment records, VA examinations from April 2016, January 2020, and June 2023, and the Veteran's own statements. The primary issue was determining the appropriate diagnostic code and rating for the gastroenteritis, considering its symptoms of abdominal pain, nausea, and reflux, and differentiating them from non-service-connected GERD and hiatal hernia. The Board found that the evidence supported a 20 percent rating under Diagnostic Code 7305, reflecting moderate symptoms, but did not meet the criteria for higher ratings due to lack of weight loss, incapacitating episodes, or severe manifestations. The Board acknowledged the use of Omeprazole for symptom management but found it did not warrant a higher rating. The appeal for an increased rating is granted to the extent of the 20 percent rating.

Rationale

Evidence supports 20 percent rating under DC 7305; Symptoms of intermittent abdominal pain and nausea documented; Higher ratings not warranted due to lack of weight loss or severe incapacitating episodes

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7305

Docket No.

07-34 964

Full Decision Text

Citation Nr: 26004536
Decision Date: 04/14/26 Archive Date: 04/14/26

DOCKET NO. 07-34 964
DATE: April 14, 2026

ORDER

Entitlement to an initial disability rating of 20 percent, but no higher, for service-connected gastroenteritis with fundic gland polyp is granted.

FINDING OF FACT

From the date of service connection, the Veteran's gastroenteritis with fundic gland polyp more nearly approximates moderate symptoms; there was no impairment of health manifested by weight loss or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year.

CONCLUSION OF LAW

The criteria for entitlement to an initial disability rating of 20 percent, but no higher, from July 6, 2004 for service-connected gastroenteritis with fundic gland polyp have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.31, 4.114, Diagnostic Code 7305, 7307.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the U.S. Army from October 1980 to May 1987. She was a member of the U.S. Army Reserve from May 1987 to August 2004, during which she performed periods of active duty for training and inactive duty training.

This matter originally came before the Board of Veterans' Appeals (Board) on appeal from a May 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which, inter alia, granted service connection for gastroenteritis with fundic gland polyp and assigned an initial 10 percent disability rating, effective from July 6, 2004. The Veteran disagreed with the assigned initial rating in a notice of disagreement (NOD) dated November 2016. A statement of the case (SOC) was issued in April 2018 and the Veteran perfected a timely appeal in May 2018.

The claim was remanded in a Board decision dated March 2019. In a July 2020 decision, the Board denied an initial disability rating in excess of 10 percent for gastroenteritis with fundic gland polyp. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). While that appeal was pending before the Court, the Veteran's attorney, John F. Cameron, and VA's General Counsel filed a Joint Motion for Remand (JMR), on the sole basis that the Board did not address Mr. Cameron's request for the January 2019 examiner's "curricula vitae" [sic]. In April 2021, the Court granted the motion, and vacated the Board's July 2020 decision, and remanded the matter to the Board for action consistent with the JMR.

The following month, Mr. Cameron filed an application for attorney's fees and expenses in the amount of $4,966.12, pursuant to the Equal Access to Justice Act (EAJA). VA's General Counsel indicated that the Secretary did not contest the motion for the sole purpose of avoiding further litigation and the costs related thereto. In a June 2021 order, the Court granted Mr. Cameron's application and awarded fees in the amount sought.

In Board decisions dated December 2021, May 2023, February 2024, and January 2025 the claim was remanded for further evidentiary development.

While the matter was in remand status, in a March 2024 rating decision, the RO granted a higher initial rating of 20 percent for gastroenteritis with fundic gland polyp, effective from January 14, 2020. The Veteran has not expressed satisfaction with the increased disability rating; this matter thus remains in appellate status. See AB v. Brown, 6 Vet. App. 35, 38 (1993) (when a veteran is not granted the maximum benefit allowable under the VA Schedule for Rating Disabilities, the pending appeal as to that issue is not abrogated).

In January 2025, the Veteran's claim was remanded for the sole purpose of providing Mr. Cameron with the curriculum vitae of the December 2023, February 20, 2024, and February 29, 2024 VA examiners. A review of the record shows that Mr. Cameron was provided the records in October 2025; as such, substantial compliance with the Board's Remand directives has been demonstrated. See Stegall v. West, 11 Vet. App. 268, 271 (1998
38 (1993) (when a veteran is not granted the maximum benefit allowable under the VA Schedule for Rating Disabilities, the pending appeal as to that issue is not abrogated).

In January 2025, the Veteran's claim was remanded for the sole purpose of providing Mr. Cameron with the curriculum vitae of the December 2023, February 20, 2024, and February 29, 2024 VA examiners. A review of the record shows that Mr. Cameron was provided the records in October 2025; as such, substantial compliance with the Board's Remand directives has been demonstrated. See Stegall v. West, 11 Vet. App. 268, 271 (1998). A supplemental statement of the case (SSOC) was most recently issued in October 2025. The Veteran's VA claims file has been returned to the Board for further appellate proceedings.

1. Entitlement to an initial disability rating in excess of 10 percent prior to January 14, 2020 and 20 percent thereafter for service-connected gastroenteritis with fundic gland polyp.

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. The Board determines the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. Where there is a question as to which of two ratings should be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

In general, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where a claimant appeals the initial rating assigned following an award of service connection, evidence contemporaneous with the claim for service connection and with the rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence "used to decide whether an [initial] rating on appeal was erroneous...." Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence obtained during the appeal period indicates that the degree of disability increased or decreased following the assignment of the initial rating, "staged" ratings may be assigned for separate periods of time based on facts found. Id. Here, analysis in this decision has therefore been undertaken with consideration of the possibility that different ratings may be warranted for different time periods as to the pending claim.

In all cases, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. Barr, at 308 (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. In this function, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table); see Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence").

The Board has considered all evidence of record as it bears on the issues before it. See 38 U.S.C. § 7104(a) ("Decisions of the Board shall be based on the entire record in the proceeding and upon consideration of all evidence and material of record"); 38 U.S.C. § 5107(b) ("Secretary shall consider all information and lay and medical evidence of record in a case"). Although the Board has an obligation to provide reasons and bases supporting these decisions, there is no need to discuss, in detail, the extensive evidence of record. The Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the Veteran's appeal.

The Veteran is service connected for gastroenteritis with fundic gland polyp and is assigned a 10 percent initial disability rating prior to January 14, 2020 and 20 percent thereafter. See the rating decisions dated May 2016 and March 2024. In the May 2016 rating decision, the RO rated the Veteran's gastroenteritis by analogy to gastritis under 38 C.F.R. § 4.114, Diagnostic Code (DC) 7399-7307. In the March 2024 rating decision, the RO rated the Veteran's gastroenteritis by analogy to duodenal ulcers under 38 C.F.R. § 4.114 DC 7399-7305.

Unlisted disabilities requiring analogy will be coded by the numbers of the most closely related body part and 99, while hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned, with the additional code shown after the hyphen. See 38 C.F.R. § 4.27.

Pursuant to 38 C.F.R. § 4.113, certain diseases of the digestive system, "particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia, and disturbances in nutrition." 38 C.F.R. § 4.113. Consequently, certain coexisting diseases in this area "do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 C.F.R. § 4.14." Id.

When disabilities have duplicative or overlapping symptoms, the rule against pyramiding prohibits VA from compensating the Veteran more than once for the same symptom or impairment. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); 38 C.F.R. § 4.14.

The Board notes that recently, the evaluation criteria for digestive disabilities were amended effective May 19, 2024. Schedule for Rating Disabilities: The Digestive System, 89 Fed. Reg. 19735, 19743, 19754 (Mar. 20, 2024). Because these amendments were not made retroactive, the Board can consider the pre-amended criteria for the entire period, but the amended criteria only as of May 19, 2024. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).

Prior to May 19, 2024, in accordance with 38 C.F.R. § 4.114, ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. 38 C.F.R. § 4.114 (2023). A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. Id.

From May 19, 2024, 38 C.F.R. § 4.114 instructs to not combine ratings under diagnostic codes 7301 through
19, 2024, in accordance with 38 C.F.R. § 4.114, ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. 38 C.F.R. § 4.114 (2023). A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. Id.

From May 19, 2024, 38 C.F.R. § 4.114 instructs to not combine ratings under diagnostic codes 7301 through 7329 inclusive, 7331, 7342, 7345 through 7350 inclusive, 7352, and 7355 through 7357 inclusive, with each other. 38 C.F.R. § 4.114 (2024). Instead, when more than one rating is warranted under those diagnostic codes, a single evaluation should be assigned under the diagnostic code that reflects the predominant disability picture, and should elevate it to the next higher evaluation if warranted by the severity of the overall disability.

Under DC 7305 in effect prior to May 19, 2024, a mild duodenal ulcer with recurring symptoms once or twice yearly is assigned a 10 percent rating. A 20 percent rating is assigned for a duodenal ulcer that is moderate with recurring episodes of severe symptoms two or three times a year averaging 10 days in duration, or with continuous moderate manifestations. A 40 percent rating is assigned for a moderately severe duodenal ulcer which is less than severe but with impairment of health manifested by anemia and weight loss, or with recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. A 60 percent rating is assigned for a severe duodenal ulcer with pain only partially relieved by standard ulcer therapy, periodic vomiting, recurrent hematemesis or melena, with manifestations of anemia and weight loss productive of a definite impairment of health. 38 C.F.R. § 4.114, DC 7305.

Under DC 7307 in effect prior to May 19, 2024, which evaluates hypertrophic gastritis (identified by gastroscope), a 10 percent rating is assigned for chronic hypertrophic gastritis with small nodular lesions, and symptoms. A 30 percent rating is assigned for chronic hypertrophic gastritis with multiple small eroded or ulcerated areas, and symptoms. A 60 percent rating is assigned for chronic hypertrophic gastritis with severe hemorrhages, or large ulcerated or eroded areas. 38 C.F.R. § 4.114, DC 7307.

Based on the May 19, 2024, modifications, DC 7305 was eliminated and merged into a new DC 7304 for peptic ulcer disease. Under revised DC 7307, chronic gastritis is also to be rated as peptic ulcer disease under DC 7304. Under the amended version of DC 7304, a 20 percent rating is warranted when there are "[e]pisodes of abdominal pain, nausea, or vomiting, that: last for at least three consecutive days in duration; occur three times or less in the past 12 months; and are managed by daily prescribed medication." 38 C.F.R. § 4.114, DC 7304 (2024). A 40 percent rating is warranted for episodes of abdominal pain, nausea, or vomiting, that: last for at least three consecutive days in duration; occur four or more times in the past 12 months; and are managed by daily prescribed medication. A 60 percent evaluation is warranted for continuous abdominal pain with intermittent vomiting, recurrent hematemesis (vomiting blood) or melena (tarry stools); and manifestations of anemia which require hospitalization at least once in the past 12 months. A 100 percent disability is warranted post-operative for perforation or hemorrhage, for three months. Id.

The terms "severe" and "moderately severe" are not defined in this regulation. In such situations, it is presumed that VA regulations employ words according to their ordinary dictionary readings at the time the regulations were promulgated. Moody v. Wilkie, 30 Vet. App. 329, 336 (2018). Thus, the Board will employ the Merriam-Webster dictionary (www.merriam-webster.com/dictionary/), which includes potentially relevant definitions of "severe" as "very painful or harmful" or of a "great degree." There is no standard definition for "moderately severe,"
for perforation or hemorrhage, for three months. Id.

The terms "severe" and "moderately severe" are not defined in this regulation. In such situations, it is presumed that VA regulations employ words according to their ordinary dictionary readings at the time the regulations were promulgated. Moody v. Wilkie, 30 Vet. App. 329, 336 (2018). Thus, the Board will employ the Merriam-Webster dictionary (www.merriam-webster.com/dictionary/), which includes potentially relevant definitions of "severe" as "very painful or harmful" or of a "great degree." There is no standard definition for "moderately severe," and the dictionary indicates that "moderately" means "to a moderate extent or degree."

Concerning weight loss, for purposes of evaluating conditions in § 4.114, the term "substantial weight loss" means a loss of greater than 20 percent of the individual's baseline weight, sustained for three months or longer; and the term "minor weight loss" means a weight loss of 10 to 20 percent of the individual's baseline weight, sustained for three months or longer. The term "inability to gain weight" means that there has been substantial weight loss with inability to regain it despite appropriate therapy. "Baseline weight" means the average weight for the two-year-period preceding onset of the disease. 38 C.F.R. § 4.112.

The term "incapacitating episodes" is not defined; however, under the old DC 7345, Note 2, defines an incapacitating episode as a period during which bed rest and treatment by a physician are required. 38 C.F.R. § 4.114. For comparison purposes, the Formula for Rating Intervertebral Disc Syndrome based on incapacitating episodes defines an "incapacitating episode" as a period of acute signs and symptoms that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243 Note (1).

In this matter, the Veteran was granted service connection for gastroenteritis with fundic gland polyp in a May 2016 rating decision, which assigned a 10 percent disability rating effective from July 6, 2004. As indicated above, the Veteran appealed the initial disability rating. See the NOD dated November 2016, the SOC dated April 2018, and the VA Form 9 dated May 2018. In a March 2024 rating decision, the RO increased the assigned initial rating for gastroenteritis with fundic gland polyp to 20 percent, effective from January 14, 2020. As such, the Board will herein consider whether entitlement to an initial disability rating in excess of 10 percent from July 6, 2004 to January 14, 2020 and 20 percent from January 14, 2020 is warranted for the Veteran's service-connected gastroenteritis with fundic gland polyp.

VA and private treatment records dated in September 2003, December 2003, and January 2004 indicated that the Veteran has a past history of diverticulitis, gastroesophageal reflux disease (GERD), and iron-deficient anemia. In a January 2004 medical note for a sleep disability, it lists GERD as a disability under "past history." On an "emergency physician record" from July 2004 the Veteran's chief complaint was for her sinuses but stated under gastrointestinal she experiences abdominal pain, nausea, and diarrhea. VA medical treatment records indicate the Veteran was taking Omeprazole to help treat her GERD symptoms throughout 2004.

VA treatment records dated in May 2005 noted the Veteran's report of abdominal pain with a history of diverticulosis. She endorsed nausea, but denied constipation or blood in her stool. The treatment provider indicated that the Veteran is currently taking Omeprazole. VA treatment records dated in June 2005 noted the Veteran's continuing complaint of abdominal pain, which she described as intermittent for the last several months. She reported that, in the past, she was treated for H. pylori. She denied vomiting, but admitted to nausea. The reviewing physician's impressions stated the Veteran experienced "non-specific bowel gas pattern, with scattered intestinal air... no evidence of bowel distention. No acute abdominal pathology."

VA treatment records dated in July 2005 indicated that the Veteran experienced abdominal pain with eating and felt a full/burning sensation in her chest. She reported that abdominal pain has been present for years, but she has had three bad attacks of upper abdominal pain since March. She described these attacks as really
June 2005 noted the Veteran's continuing complaint of abdominal pain, which she described as intermittent for the last several months. She reported that, in the past, she was treated for H. pylori. She denied vomiting, but admitted to nausea. The reviewing physician's impressions stated the Veteran experienced "non-specific bowel gas pattern, with scattered intestinal air... no evidence of bowel distention. No acute abdominal pathology."

An endoscopy was performed in July 2005, which revealed possible short segment Barrett's esophagus, status-post biopsy, mild gastritis status-post antral biopsy for H. pylori, status-post small bowel biopsy, small hiatal hernia, and no esophagitis.

Private treatment records dated in February 2006 noted the Veteran's complaints of chest pain over the last several days, which worsened after eating a banana. The Veteran was noted to have peptic ulcer disease. She told her treatment provider that the current pain is not like her normal reflux pain, and it is worse with taking a deep breath. See the private treatment records dated February 2006. She was prescribed Omeprazole, Carafate, and Lortab. The Veteran underwent a barium swallow test in March 2006, which indicated a diagnosis of moderate GERD.

In a January 2008 statement, the Veteran reported that, over the years, she has been diagnosed with gastroenteritis, acid reflux, and GERD.

Private treatment records dated October 2008 noted the Veteran's report of "some problems with nausea and vomiting and pain in the center of her anterior chest, which radiates into her left jaw and shoulder." In May 2009, the Veteran underwent a computerized tomography (CT) scan for upper abdominal pain, which revealed a renal cyst, a small hiatal hernia, and "mild to moderate sigmoid diverticulosis without evidence of diverticulitis."

In July 2006, the Veteran visited the Clinic for Rheumatic Diseases. Upon review of her systems, under gastrointestinal, she denied abdominal pain, bowel incontinence, constipation, or diarrhea, but reported symptoms of heartburn. An August 2006 emergency department report noted the Veteran did not list any problems with "GI/GU" (gastrointestinal/genitourinary). Medical records between 2006 and 2008 list GERD under "past medical history." However, there are no specific complaints of symptoms or treatment related to GERD or gastroenteritis. A January 2007 report indicates the Veteran complained of abdominal pain and underwent a Gastrografin. The treatment provider found "no significant abnormality."

In May 2009, the Veteran visited a VA medical center with complaints of kidney failure. A review of her systems indicates the Veteran was prescribed Omeprazole, complained of constipation, but denied nausea, dysphagia, heartburn, reflux, and other gastrointestinal symptoms. New patient information from the Birmingham VA Medical Center (VAMC) in June 2009, the Veteran reported symptoms to include heartburn, nausea, stomach pain, difficulty swallowing, change in bowel habits, and constipation. A February 2010 VAMC visit with the chief complaint of "hurting all over" discusses the Veteran's gastrointestinal symptoms and that there were "no new problems." Symptoms included heartburn, abdominal pain, constipation, and there was noted by the examiner to be "a little mild GERD." Further VAMC treatment records indicate the Veteran was taking Nexium and Omeprazole to treat her symptoms.

Treatment records from 2012 note the Veteran was experiencing more severe symptoms for her GERD. Symptoms include indigestion and heartburn but were noted to be relatively under control through medications. Primary care center records from May 2012 list GERD as a secondary complaint for her visit. It is listed as "severe" but previously controlled with Nexium and was being prescribed Prilosec. An April 2015 primary care note indicates the Veteran was being treated for symptoms of GERD. She was prescribed omeprazole and zantac and medical notes indicate the symptoms were "controlled" and "stable."

The Veteran was afforded a VA examination in April 2016 at which time the
her symptoms.

The Veteran was afforded a VA examination in April 2016 at which time the examiner diagnosed hiatal hernia. The Veteran reported, "I started having problems with that back in the 80s from taking Motrin, it progressively got worse in the 90s." She continued, "I was having heartburn and reflux a lot, but now sometimes I have bouts where the Omeprazole is not keeping it under control for about a week out of the month." She endorsed pyrosis and reflux. The examiner reported that the Veteran's hiatal hernia symptoms do not impact her ability to work.

In a separate April 2016 VA examination, the Veteran was diagnosed with gastroenteritis and fundic gland polyp. She reported that she "does not recall date of onset, however, at time of diagnosis, she was experiencing stomach pain, heartburn, and reflux, treated with Pepcid and Carafate, however, Nexium was most effective in relieving symptoms; now complains of bloating 1 to 2 weeks out of a month." The examiner indicated that the Veteran does not have incapacitating episodes. She was diagnosed with mild chronic gastritis via an upper endoscopy in March 2016. The examiner reported that the Veteran's gastroenteritis with fundic gland polyp does not impact her ability to work. Diagnostic testing was conducted. Results indicated normal mucosa in the whole mucosa, esophageal hiatal hernia, polyps (3-5mm) in the fundus and stomach body, and black pigmentation in the duodenal bulb and second part of the duodenum. A biopsy was also conducted. Results exhibited mild chronic gastritis, negative for H. pylori, and body polyp in the stomach with polypectomy.

The Veteran was afforded a VA examination in January 2020 at which time the examiner confirmed a continuing diagnosis of gastroenteritis with fundic gland polyp. The examiner noted that the Veteran "reports still having acid reflux. She also reports the feeling of being bloated in the top part of her stomach." The Veteran also endorsed a history of H. pylori and diverticulosis. She reported that her gastroenteritis condition has worsened in the last eighteen months. She indicated that she is followed by a gastrointestinal doctor, who increased her Omeprazole to twice a day. The examiner indicated that the Veteran's gastroenteritis does require continuous medication for control; specifically, Omeprazole twice per day. The examiner noted the Veteran's report of pronounced and periodic abdominal pain. The Veteran also endorsed transient nausea, occurring four or more times per year, with episodes lasting one to nine days. The Veteran reported that she does have incapacitating episodes; she "states she was placed in the hospital for diverticulitis in 2001-2003. She was placed on a liquid diet and stayed in hospital about five days. The Veteran reported that she experienced one incapacitating episode in the past year, which lasted one to nine days. The Veteran does not have hypertrophic gastritis, post-gastrectomy syndrome, vagotomy, or peritoneal adhesions. Since the examiner did not find hypertrophic gastritis, there was no basis to find the more specific rating criteria of multiple small eroded or ulcerated areas and symptoms, severe hemorrhages, or large ulcerated or eroded areas. The examiner indicated that the Veteran's gastroenteritis does impact her ability to work; namely, "Veteran has bouts of abdominal pain due to her gastroenteritis and when the pain is present, it hinders her level of activities she performs. She also has to watch what she eats to help control the gastritis." Diagnostic imaging was conducted to include an upper endoscopy. Results show normal mucosa in the whole mucosa, esophageal hiatal hernia, polyps (3-5mm) in the fundus and stomach body, black pigmentation in the duodenal bulb and second part of the duodenum. A biopsy of the stomach revealed mild chronic gastritis, negative for
areas. The examiner indicated that the Veteran's gastroenteritis does impact her ability to work; namely, "Veteran has bouts of abdominal pain due to her gastroenteritis and when the pain is present, it hinders her level of activities she performs. She also has to watch what she eats to help control the gastritis." Diagnostic imaging was conducted to include an upper endoscopy. Results show normal mucosa in the whole mucosa, esophageal hiatal hernia, polyps (3-5mm) in the fundus and stomach body, black pigmentation in the duodenal bulb and second part of the duodenum. A biopsy of the stomach revealed mild chronic gastritis, negative for H. pylori, stomach body polyp, polypectomy, and fundic gland polyp.

In a separate medical opinion, the January 2020 VA examiner explained, "[t]he Veteran is service-connected for gastroenteritis with fundic gland polyp. There is no evidence regarding a diagnosis of chronic hypertrophic gastritis supported in the claims file. There is also no evidence regarding severe hemorrhages or large ulcerated or eroded areas."

Private treatment records dated May 2020 documented the Veteran's report of generalized abdominal pain. The Veteran described the pain as sharp, worse with eating, nausea but no vomiting. She also reported diarrhea and reduced appetite for several days. The treatment provider indicated that the Veteran had possible diverticulitis and prescribed Cipro and Flagyl.

In a May 2023 remand decision, the Board directed the AOJ to obtain a medical opinion clarifying which of the Veteran's symptoms are attributable to GERD and/or hiatal hernia and which to the service-connected gastroenteritis with fundic gland polyp.

The Veteran was afforded a VA examination in June 2023 at which time the examiner diagnosed gastritis, status-post polypectomy of fundic gland polyp. The Veteran reported that her current symptoms are reflux, regurgitation, and heartburn. Her symptoms are treated with Omeprazole. The Veteran reported that the impact of her chronic gastritis ion her ability to perform occupational functioning and ordinary activities is "sometimes difficulty sleeping." The Veteran endorsed pronounced, periodic abdominal pain that is only partially relieved by standard ulcer therapy. She also reported transient nausea, occurring four or more times per year, with a duration of less than one day. She denied incapacitating episodes. The examiner reported that the Veteran's chronic gastritis does impact her ability to work due to her difficulty sleeping.

In a separate June 2023 VA esophageal examination, the examiner indicated that the Veteran has diagnoses of GERD and hiatal hernia. The symptoms of these disabilities are reflux, regurgitation, and heartburn. Her symptoms are treated with Omeprazole. The examiner noted that the Veteran's GERD and hiatal hernia do not impact her ability to work.

In a June 2023 medical opinion, the VA examiner indicated, "[t]here are no symptoms of polyp and it is not possible to differentiate the symptoms of GERD HH from gastritis."

In a February 2024 remand, the Board again sought an opinion to clarify which of the Veteran's symptoms are attributable to GERD and/or hiatal hernia and which to the service-connected gastroenteritis with fundic gland polyp.

In an April 2024 VA addendum opinion, the examiner opined,

After reviewing the Veteran's medical records, it has been determined that their recurring abdominal pain, which is only partially relieved by standard ulcer therapy, and transient nausea four times per year, can be attributed to gastroenteritis with fundic gland polyp. This condition is characterized by inflammation of the stomach and intestines, leading to symptoms such as abdominal pain, nausea, and vomiting. The presence of a fundic gland polyp, which is a small growth on the lining of the stomach, may also contribute to the Veteran's symptoms. In addition, the Veteran's reports of reflux and regurgitation can be attributed to GERD, or gastroesophageal reflux disease. This condition occurs when stomach acid and digestive juices flow back up into the esophagus, causing discomfort and other symptoms.

In a separate April 2024 VA medical opinion, the examiner further opined,

I have reviewed the conflicting medical evidence and am providing the following opinion: Gastroesophageal Reflux Disease (GERD) and hiatal hernia are two distinct medical conditions that can present similar symptoms, making it challenging to differentiate between the two. GERD is characterized by the backflow of stomach acid into the esophagus, leading to symptoms such as heartburn and regurgitation. On the other hand, hiatal hernia occurs when a portion
attributed to GERD, or gastroesophageal reflux disease. This condition occurs when stomach acid and digestive juices flow back up into the esophagus, causing discomfort and other symptoms.

In a separate April 2024 VA medical opinion, the examiner further opined,

I have reviewed the conflicting medical evidence and am providing the following opinion: Gastroesophageal Reflux Disease (GERD) and hiatal hernia are two distinct medical conditions that can present similar symptoms, making it challenging to differentiate between the two. GERD is characterized by the backflow of stomach acid into the esophagus, leading to symptoms such as heartburn and regurgitation. On the other hand, hiatal hernia occurs when a portion of the stomach pushes up through the diaphragm into the chest cavity, causing similar symptoms like heartburn and regurgitation. However, in the case of service-connected gastroenteritis with fundic gland polyp, these symptoms may be exacerbated or interconnected due to the underlying gastrointestinal issues.

After thorough review of the evidence of record, the Board finds that a 20 percent initial disability rating, but no higher, is warranted for the Veteran's service-connected gastroenteritis with fundic gland polyp from the date of service connection under DC 7305. The assignment of a particular DC is dependent on the facts of the individual case, and it is permissible to change diagnostic codes to more accurately reflect the Veteran's current symptoms. Butts v. Brown, 5 Vet. App. 532, 538 (1993); Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Pursuant to Copeland v. McDonald, 27 Vet. App. 333, 337 (2015), the Board may assign an alternative DC where the Veteran's disability picture is more accurately reflected under another code that better describes the anatomical location, nature, and symptoms of the condition.

As indicated above, the RO rated the Veteran's service-connected gastroenteritis with fundic gland polyp by analogy to DC 7307 (gastritis, hypertrophic) prior to January 14, 2020 and by analogy to DC 7305 (ulcer, duodenal) thereafter. After a review of the evidence, the Board finds that DC 7305 (duodenal ulcer) is most appropriate from the date of service connection, as it encompasses the manifestations of the Veteran's abdominal pain, nausea, and recurrent moderate symptoms. Use of this code is not only proper but also more beneficial to the Veteran, as it allows for ratings higher than 20 percent from the date of service connection. To this end, the evidence supports assignment of a 20 percent evaluation under DC 7305 from the date of service connection. As detailed above, VA and private treatment records have documented the Veteran's report of intermittent abdominal pain with nausea from the date of service connection. See the VA treatment records dated May 2005, June 2005, and July 2005; see also private treatment record dated May 2009; see also the VA examination reports dated April 2016, January 2020, and June 2023. As detailed above, at the April 2016 VA examination, the Veteran described stomach pain, heartburn, and reflux, as well as abdominal bloating one to two weeks per month. In the January 2020 VA examination report, the examiner noted the Veteran's report of feeling bloated in the top part of her stomach with symptoms of pronounced and periodic abdominal pain, and transient nausea, occurring four or more times per year. The June 2023 VA examiner also noted the Veteran's pronounced, periodic abdominal pain, only partially relieved by standard ulcer therapy, as well as symptoms of transient nausea occurring four or more times per year. These findings are consistent with a moderate disability picture and more nearly approximate the criteria for a 20 percent rating under DC 7305 from the date of service connection. 38 C.F.R. § 4.114, DC 7305.

The Board finds that a higher, 40 percent, disability rating is not warranted for the Veteran's service-connected gastroenteritis with fundic gland polyps under DC 7305 because her symptoms do not more nearly approximate impairment of health manifested by anemia and weight loss, or with recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. As indicated above, the Veteran's treatment records document a history of anemia; however, there is no indication that she has experienced weight loss as a result of her service-connected gastroenteritis. Rather, the record on appeal reflects that the Veteran's weight was 213 lbs. in September 2004, 228 lbs. in October 2004
Board finds that a higher, 40 percent, disability rating is not warranted for the Veteran's service-connected gastroenteritis with fundic gland polyps under DC 7305 because her symptoms do not more nearly approximate impairment of health manifested by anemia and weight loss, or with recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. As indicated above, the Veteran's treatment records document a history of anemia; however, there is no indication that she has experienced weight loss as a result of her service-connected gastroenteritis. Rather, the record on appeal reflects that the Veteran's weight was 213 lbs. in September 2004, 228 lbs. in October 2004, 198 lbs. in April 2007, 258 lbs. in March 2022, and 235 lbs. in February 2023. She has not reported experiencing weight loss as a symptom of her gastrointestinal disability. Moreover, the evidence does not indicate that the Veteran suffers from incapacitating episodes averaging 10 days or more in duration at least four or more times a year. Although at the January 2020 VA examination, the Veteran endorsed experiencing an incapacitating episode within the last twelve months, there is no documentation of any such episode in her treatment records. Moreover, the Veteran denied incapacitating episodes at the time of the May 2016 and June 2023 VA examinations. As such, after weighing the evidence, the Board finds that it is persuasively against the assignment of a 40 percent rating for gastroenteritis with fundal gland polyp under DC 7305. 38 C.F.R. § 4.114, DC 7305.

A higher rating of 60 percent under DC 7305 is also not warranted, as that evaluation requires a severe duodenal ulcer with pain only partially relieved by standard therapy, periodic vomiting, and recurrent hematemesis or melena, with manifestations of anemia and weight loss productive of definite impairment of health. Here, VA examiners in May 2016, January 2020, and June 2023 consistently found no weight loss, no malnutrition, and no hematemesis or melena. As such, the record does not demonstrate systemic impairment of health to the degree contemplated by the 60 percent criteria.

Notably, in his written argument dated July 2024, the Veteran's attorney specifically asserted that the Veteran's service-connected gastrointestinal disability warrants an initial 20 percent rating prior to January 14, 2020 under DC 7399-7305. He did not argue that an initial rating in excess of 20 percent was warranted under DC 7305 or any other diagnostic code from the date of service connection. See the written argument dated July 2024.

The Board has nevertheless considered whether the Veteran's service-connected gastroenteritis with fundic gland polyp warrants a higher disability rating under an alternative diagnostic code.

The Board has considered rating the Veteran under DC 7307; however, there is no documentation of multiple small eroded or ulcerated areas. As such, a higher rating under DC 7307 is not warranted under the pre-revised criteria. 38 C.F.R. § 4.114, DC 7307 (2023). Pursuant to the revised criteria, the Board has considered the application of DC 7304 for peptic ulcer disease, which provides for a 40 percent rating for episodes of abdominal pain, nausea, or vomiting, that: lasted for at least three consecutive days in duration; occur four or more times in the past 12 months; and were managed by daily prescribed medication. However, the Veteran repeatedly described her abdominal pain symptoms as intermittent and there is no documentation of any such abdominal pain, nausea, or vomiting lasting at least three consecutive days in duration from May 19, 2024, the effective date of the revised criteria. 38 C.F.R. § 4.114, DC 7304 (2024). The Board therefore finds that a higher rating is not warranted under revised DC 7304.

It is undisputed that the Veteran suffers from symptoms of reflux and regurgitation, which have specifically been attributed to her nonservice-connected GERD and hiatal hernia. See the VA medical opinion dated April 2024. As these symptoms cannot be attributed to her service-connected gastroenteritis with fundal gland polyp, rating this disability by analogy to hiatal hernia or GERD would not afford the Veteran. A higher initial rating under DC 7346 (hiatal hernia) or DC 7206 (which created a separate diagnostic code for GERD effective from the May 19, 2024 revisions), is therefore not warranted.

In reaching the decision herein, the Board acknowledges that it must
7304.

In reaching the decision herein, the Board acknowledges that it must discount the ameliorative effects of medication. Jones v. Shinseki, 26 Vet. App. 56 (2012). To this end, the Board recognizes that the Veteran has been prescribed Omeprazole for her gastroenteritis symptoms from the date of service connection. See the VA examination reports dated May 2016, January 2020, and June 2023. Despite the Veteran's continuous use of Omeprazole, she has consistently experienced intermittent episodes of abdominal pain with nausea. There is nothing in the record to suggest that the Veteran's symptoms would increase in frequency or severity without the Omeprazole, sufficient to meet the criteria for a higher disability rating which, as set forth above. Neither the Veteran nor her attorney has contended otherwise.

While there may have been day-to-day fluctuations in the manifestations of the Veteran's service-connected gastroenteritis with fundic gland polyp, the evidence shows no distinct periods of time during period under review, when her disability varied to such an extent that a rating greater or less than the assigned rating would be warranted. Hart, supra.

For the reasons set forth above, the Board finds that an initial disability rating of 20 percent, but no higher, is warranted for the Veteran's service-connected gastroenteritis with fundic gland polyp from the date of service connection. The benefit sought on appeal is granted to that extent. See 38 U.S.C. § 5107(b).

K. Conner

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K. K. Buckley, 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.

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