IRON DEFICIENCY ANEMIA

DAVID A. BRENNINGMEYER · 2026 · Case ID: 26004854

DENIED

Summary

The Veteran, an Army Veteran who served from May 1971 to December 1972, appeals the denial of a higher disability rating for anemia and a stomach disability. The Board reviewed the evidence, including treatment records, private DBQs, and VA examinations from March 2018 and February 2024. For anemia, the Veteran sought a rating higher than the current 10 percent. The Board noted the change in rating criteria for hematologic conditions effective December 2018. Evidence showed the Veteran's iron deficiency anemia was corrected with iron infusions and oral supplements, with normal hemoglobin levels in recent tests. The Board found the evidence persuasively against a rating higher than 10 percent, as the criteria for higher ratings (e.g., specific hemoglobin levels, transfusion frequency, infection recurrence) were not met. For the stomach disability, the Veteran sought higher ratings for periods before and after December 21, 2023. The Board considered former and current rating criteria for duodenal ulcer, gastritis, and postgastrectomy syndromes. Evidence indicated the Veteran's symptoms were controlled by medication, with no severe symptoms, incapacitating episodes, or significant complications like anemia or weight loss. The Board found the evidence persuasively against higher ratings for both periods. Service connection for anemia at a rating higher than 10 percent was denied. A compensable rating for the stomach disability prior to December 21, 2023, and a rating higher than 40 percent thereafter, were also denied.

Rationale

Evidence did not meet criteria for rating higher than 10 percent; No hemoglobin level of 8gm/100ml or less documented; No requirement for transfusions or infections recurring annually, or IV iron infusions 4+ times/year; No indication of other anemia types (folic acid deficiency, pernicious anemia, acquired hemolytic anemia)

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

19-05 736

Full Decision Text

Citation Nr: 26004854
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 19-05 736
DATE: April 22, 2026

ORDER

A disability rating in excess of 10 percent for anemia is denied.

A compensable disability rating for duodenal ulcer with helicobacter pylori and gastritis, status post partial gastrectomy (stomach disability) is denied for the period on appeal prior to December 21, 2023.

A disability rating in excess of 40 percent for duodenal ulcer with helicobacter pylori and gastritis, status post partial gastrectomy, is denied from December 21, 2023.

FINDINGS OF FACT

1. Throughout the period on appeal, the Veteran's anemia has required continuous medication for control; the disability is not shown to have been manifested by hemoglobin 8 gm/100ml or less, required transfusion of platelets or red cells at least once per year (on average), infections recurring at least once per year (on average), or required intravenous iron infusions 4 or more times per 12-month period.

2. Prior to December 21, 2023, the Veteran's stomach disability is not shown to have been manifested by alkaline gastritis or symptomatic chronic hypertrophic gastritis, a recurrent ulcer, or mild circulatory symptoms; nor is it shown to have been manifested by continuous mild manifestations of a postgastrectomy syndrome.

3. While a December 2023 examiner indicated that the Veteran would have had residual epigastric pain in the absence of ameliorative medication, Diagnostic Code 7305 (pertaining to duodenal ulcer) references "standard ulcer therapy," and thereby appears to contemplate the ameliorative effects of medication.

4. From December 21, 2023, the Veteran's stomach disability is not shown to have been manifested by periodic or intermittent vomiting, recurrent hematemesis or melena, manifestations of anemia and weight loss productive of definite impairment of health, or manifestations of anemia that have required hospitalization at least once in a 12-month period; nor is the disability shown to have been manifested by chronic hypertrophic gastritis with severe hemorrhages or large ulcerated or eroded areas, by symptoms of severe postgastrectomy syndrome associated with nausea, sweating, circulatory disturbance after meals, diarrhea, hypoglycemic symptoms, and weight loss with malnutrition and anemia, by explosive bowel movements that are difficult to predict or control, or by meal-induced light-headedness with sweating and the need for medications to specifically treat complications of upper gastrointestinal surgery such as dumping syndrome or delayed gastric emptying.

CONCLUSIONS OF LAW

1. The criteria for a rating in excess of 10 percent for anemia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.117, Diagnostic Codes 7700, 7716, 7720.

2. The criteria for a compensable disability rating for stomach disability prior to December 21, 2023, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Codes 7305, 7307, 7308, 7348.

3. The criteria for a rating in excess of 40 percent for stomach disability from December 21, 2023, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Codes 7304, 7305, 7307, 7308, 7348.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Army from May 1971 to December 1972.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office.

In April 2023, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record.

The Veteran served on active duty in the U.S. Army from May 1971 to December 1972.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office.

In April 2023, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record.

In June 2023, the Board remanded the issues on appeal to the agency of original jurisdiction (AOJ) for additional development. In February 2024, after taking further action, the AOJ increased the rating for the Veteran's stomach disability to 40 percent, effective December 21, 2023. The prior ratings were otherwise confirmed and continued, and the case was returned to the Board. See July 2024 Supplemental Statement of the Case. There has been at least substantial compliance with the Board's remand directives. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998).

Higher Ratings

Disability evaluations are determined by the application of a schedule of ratings, which is in turn based on the average impairment of earning capacity caused by a given disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the evaluations to be assigned to the various disabilities.

If there is a question as to which of two evaluations shall be applied, the higher evaluation 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. If different disability ratings are warranted for different periods of time over the life of a claim, "staged" ratings may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999).

1. Entitlement to a disability rating in excess of 10 percent for anemia

The Veteran's service-connected anemia is currently rated as 10 percent disabling pursuant to 38 C.F.R. § 4.117, Diagnostic Code 7716. On appeal, he seeks a higher rating.

Although the AOJ has rated the Veteran's disability under Diagnostic Code 7716 (pertaining to aplastic anemia), the record contains diagnoses of iron deficiency anemia. Accordingly, the Board will consider the diagnostic codes applicable to both conditions.

As an initial matter, the Board notes that VA issued a final rule revising 38 C.F.R. § 4.117, the portion of the VA Schedule for Rating Disabilities that addresses the hemic and lymphatic systems, effective December 9, 2018. See Schedule for Rating Disabilities: The Hematologic and Lymphatic Systems, 83 Fed. Reg. 54,250 (Oct. 29, 2018). The final rule updated medical terminology, added certain hematologic diseases, and provided detailed and updated criteria for evaluating conditions pertaining to the hematologic and lymphatic systems. The rule removed Diagnostic Code 7700 (anemia, hypochromic-microcytic and megaloblastic, such as iron-deficiency and pernicious anemia) and added separate diagnostic codes (Diagnostic Codes 7720-7723) for the four major types of anemia that are neither hereditary nor secondary (addressed under the diagnostic code for the causative condition). Because the rating criteria were changed during the appeal period, the old regulations are applicable both before and after the date of the change, and the new regulations are for application only on or after their effective date. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003); VAOPGCPREC 7-2003.

Prior to December 9, 2018, iron deficiency anemia was evaluated under Diagnostic Code 7700. A 30 percent rating was assigned for a hemoglobin level of 8gm/100ml or less, with findings such as weakness, easy fatigability, headaches, lightheadedness, or shortness of breath. A 70 percent rating was assigned for a hemoglobin level of 7gm/100ml or less, with findings such as dyspnea on mild exertion, cardiomegaly, tachycardia (100 to 120 beats per minute), or syncope (three episodes in the last six months). A 100 percent rating was assigned for a hemoglobin level of 5gm/100ml or less, with findings such as high output congestive heart failure or dyspnea at rest. A note to Diagnostic Code 7700 provided that complications of pernicious anemia, such as dementia or peripheral neuropathy, should be evaluated separately. 38 C.F.R. § 4.117.

Under the rating criteria in effect prior to December 9, 2018, aplastic anemia requiring continuous medication for control was rated at 10 percent. Aplastic anemia requiring transfusion of platelets or red cells at least once per year, but less than once every three months, or with infections recurring at least once per year, but less than once every three months, warranted a 30 percent rating. Aplastic anemia requiring transfusion of platelets or red cells at least once every three months, or with infections recurring at least once every three months, warranted a 60 percent rating. Aplastic anemia requiring bone marrow transplant, or requiring transfusion of platelets or red cells at least once every six weeks, or with infections recurring at least once every six weeks, warranted a 100 percent rating. 38 C.F.R. § 4.117, Diagnostic Code 7716 (2017).

Under the criteria in effect since December 9, 2018, iron deficiency anemia is rated under Diagnostic Code 7720. Under that diagnostic code, a noncompensable rating is provided for iron deficiency anemia that is asymptomatic or requires treatment only by dietary modification. A 10 percent rating is provided for iron deficiency anemia requiring intravenous iron infusions at least 1 time, but less than 4 times, in a 12-month period, or requiring continuous treatment with oral supplementation. Iron deficiency anemia requiring intravenous iron infusions 4 or more times per 12-month period warrants a maximum 30 percent rating. 38 C.F.R. § 4.117, Diagnostic Code 7720.

Under the version of Diagnostic Code 7716 in effect since December 9, 2018, aplastic anemia requiring transfusion of platelets or red cells, on average, at least once per 12-month period, or with infections recurring, on average, at least once per 12-month period, warrants a 30 percent rating. Aplastic anemia requiring transfusion of platelets or red cells, on average, at least once every three months per 12-month period, or with infections recurring, on average, at least once every three months per 12-month period, or with use of continuous therapy with an immunosuppressive agent or newer platelet stimulating factors warrants a 60 percent rating. Aplastic anemia requiring peripheral blood or bone marrow stem cell transplant, or requiring transfusion of platelets or red cells, on average, at least once every six weeks per 12-month period, or with infections recurring, on average, at least once every six weeks per 12-month period, warrants a 100 percent rating. 38 C.F.R. § 4.117, Diagnostic Code 7716.

Turning to the evidence of record, a September 2015 PennState Health treatment record reflects that the Veteran's iron deficiency anemia was corrected with iron infusions. A January 2018 PennState Health treatment record similarly notes that the Veteran's anemia was corrected following iron infusions, and that he was on oral iron supplements.

In a February 2018 disability benefits questionnaire (DBQ), a private physician noted that the Veteran exhibited recurrent anemia following a 1998 gastrectomy. He underwent an iron infusion in 2014 and took oral iron supplements.

The Veteran was afforded a VA examination in March 2018. He was diagnosed with iron deficiency anemia. The examiner noted continuous medication was required for control of the Veteran's condition. More specifically, it was noted that he was treated with FeSO4 BID (i.e., iron sulfate). The
. A January 2018 PennState Health treatment record similarly notes that the Veteran's anemia was corrected following iron infusions, and that he was on oral iron supplements.

The Veteran was afforded a VA examination in March 2018. He was diagnosed with iron deficiency anemia. The examiner noted continuous medication was required for control of the Veteran's condition. More specifically, it was noted that he was treated with FeSO4 BID (i.e., iron sulfate). The Veteran's primary hematologic or lymphatic condition was in remission. The examiner noted the Veteran had completed treatment and was currently in watchful waiting status with oral iron supplements. He did not have recurrent infections, polycythemia vera, sickle cell anemia, or any other pertinent physical findings, complications, conditions, signs, or symptoms.

A January 2019 PennState Health treatment record notes that the Veteran was having no symptoms of anemia recurring, and minimal side effects of the iron supplement. He reported occasional diarrhea from the iron.

A February 2022 Mount Nittany Physician Group treatment record notes a history of iron deficiency anemia with antiplatelet and anticoagulation therapy. His most recent hemoglobin test was normal. Similar results were observed in August 2022 and August 2023.

During the April 2023 Board hearing, it was noted that the Veteran had received iron transfusions in the past, that he had had the last one in 2015 or 2016, and that his condition was being controlled by oral medication. See April 2023 Hearing Transcript at p. 3. Upon questioning, he denied any complications or infections associated with his anemia. Id. at p. 6.

The Veteran underwent another VA examination in February 2024. The diagnosis remained iron deficiency anemia requiring continuous treatment with oral supplementation. He reported that his current symptoms included being tired. It was noted that he was treated with ferrous sulfate. The examiner noted that the Veteran had completed treatment and was currently in watchful waiting status. He did not have recurrent infections, polycythemia vera, sickle cell anemia, or any other pertinent physical findings, complications, conditions, signs, or symptoms. Laboratory testing revealed the Veteran had a hemoglobin of 13.8 gm/ml, hematocrit of 41.2, red blood cell (RBC) count of 4.13, white blood cell (WBC) count of 6.1, and a platelet count of 215.

On review, the Board finds that the evidence is persuasively against the assignment of a rating in excess of 10 percent for the Veteran's anemia under any of the applicable criteria during any portion of the period on appeal. At no point during the rating period does the evidence show that the Veteran's anemia was productive of a hemoglobin level of 8gm/100ml or less. In addition, the record does not show that he required transfusions of platelets or red cells at least once per year (on average), that he had infections recurring at least once per year (on average), or that he required intravenous iron infusions 4 or more times per 12-month period during the period on appeal.

The Board has considered whether the other diagnostic codes (7721, 7722, and 7723) are applicable. However, the record does not reflect that the Veteran has a folic acid deficiency (7721), pernicious anemia and/or B12 deficiency anemia (7722), or acquired hemolytic anemia (7723).

As the evidence of record persuasively weighs against the assignment of a rating in excess of 10 percent, the benefit-of-the-doubt rule does not apply. The appeal of this issue must be denied.

2. Entitlement to a higher disability ratings for a stomach disability

The Veteran's service-connected stomach disability is currently rated at zero (0) percent disabling prior to December 21, 2023, and 40 percent thereafter, under Diagnostic Code 7348-7305. See 38 C.F.R. § 4.114. On appeal, he seeks higher ratings.

The Board notes that 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; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. With diseases, preference is given to the number assigned to the disease itself. If the rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. Id. The hyphenated diagnostic code in this case indicates that vagotomy with pyloroplasty or gastroenterostomy under Diagnostic Code 7348 is the service-connected disability, and that duodenal ulcer under Diagnostic Code 7305 is the residual disability.

Disabilities of the digestive system are evaluated under 38 C.F.R. § 4.114. The Board notes that VA issued a final rule revising 38 C.F.R. § 4.114, effective May 19, 2024. See Schedule for Rating Disabilities: The Digestive System, 89 Fed. Reg. 19735 (Mar. 20, 2024). The former version of the regulation provided that ratings under Diagnostic Codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348, inclusive, would not be combined with each other. Rather, a single rating was to be assigned under the diagnostic code that reflected the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warranted such a rating. 38 C.F.R. § 4.114. The current regulation contains a parallel provision that applies to Diagnostic Codes 7301 to 7329 inclusive, 7331, 7342, 7345 to 7350 inclusive, 7352, and 7355 to 7357 inclusive.

Under former Diagnostic Code 7305, for duodenal ulcer, a 10 percent rating was warranted if the disability was mild with recurring symptoms once or twice yearly. A 20 percent rating was warranted if the disability was moderate with recurring episodes of severe symptoms two or three times per year averaging 10 days in duration, or with continuous moderate manifestations. A 40 percent rating was warranted if the disability was moderately severe, with less than severe symptomatology, but with impairment of health manifested by anemia and weight loss, or where there were recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times per year. A maximum 60 percent rating was warranted for severe symptoms with pain only partially relieved by standard ulcer therapy, periodic vomiting, recurrent hematemesis or melena, with manifestations of anemia and weight loss productive of definite impairment of health. 38 C.F.R. § 4.114, Diagnostic Code 7305.

"Moderate," "moderately severe," "marked, and "severe" were not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board had to evaluate all of the evidence to the end that its decisions were "equitable and just." 38 C.F.R. § 4.6. In that regard, the use of terminology such as "severe" by VA examiners and others, although an element of evidence to be considered by the Board, was not dispositive of an issue. All of the evidence had to be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6.

Under former Diagnostic Code 7307, hypertrophic gastritis (identified by gastroscope) warranted a 10 percent rating when the condition was chronic, with small nodular lesions and symptoms. A 30 percent rating was warranted if the condition was chronic, with multiple small eroded or ulcerated areas and symptoms, and a maximum 60 percent was warranted when the condition was chronic with severe hemorrhages or large ulcerated or eroded areas. 38 C.F.R. § 4.114, Diagnostic Code 7307.

Under former Diagnostic Code 7308, postgastrectomy syndromes were rated at 10 percent if the condition was mild, with infrequent episodes of epigastric distress and characteristic mild circulatory symptoms or continuous mild manifestations. A 40 percent rating was warranted for less frequent episodes of epigastr
when the condition was chronic, with small nodular lesions and symptoms. A 30 percent rating was warranted if the condition was chronic, with multiple small eroded or ulcerated areas and symptoms, and a maximum 60 percent was warranted when the condition was chronic with severe hemorrhages or large ulcerated or eroded areas. 38 C.F.R. § 4.114, Diagnostic Code 7307.

Under former Diagnostic Code 7308, postgastrectomy syndromes were rated at 10 percent if the condition was mild, with infrequent episodes of epigastric distress and characteristic mild circulatory symptoms or continuous mild manifestations. A 40 percent rating was warranted for less frequent episodes of epigastric disorders with characteristic mild circulatory symptoms after meals, but with diarrhea and weight loss. A maximum 60 percent rating was warranted where the condition was severe, associated with nausea, sweating, circulatory disturbance after meals, diarrhea, hypoglycemic symptoms, and weight loss with malnutrition and anemia.

During the pendency of this appeal, Diagnostic Code 7305 was eliminated, effective May 19, 2024. See Schedule for Rating Disabilities: The Digestive System, 89 Fed. Reg. 19735, 19743, 19754 (Mar. 20, 2024). The disorder is now evaluated under Diagnostic Code 7304, for peptic ulcer disease. Because these amendments were not made retroactive, the Board can consider the pre-amended criteria for the entire period on appeal, but the amended criteria apply only as of May 19, 2024. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).

Pursuant to the amended rating criteria under Diagnostic Code 7304, a noncompensable rating is assigned for a history of peptic ulcer disease documented by endoscopy or diagnostic imaging studies. A 20 percent rating is assigned for episodes 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. A 40 percent rating is assigned 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 rating is assigned 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 rating is assigned for post-operative for perforation or hemorrhage, for three months, after which the condition is rated on residuals determined by mandatory VA medical examination. 38 C.F.R. § 4.114, Diagnostic Code 7304.

Under the former and current versions of Diagnostic Code 7348, for vagotomy with pyloroplasty or gastroenterostomy, a 20 percent rating is assigned for recurrent ulcer with incomplete vagotomy, a 30 percent rating is assigned for symptoms and confirmed diagnosis of alkaline gastritis, or with confirmed persisting diarrhea, and a maximum 40 percent rating is assigned when the surgical intervention is followed by demonstrably confirmative postoperative complications of stricture or continuing gastric retention. 38 C.F.R. § 4.114, Diagnostic Code 7348. A Note to former Diagnostic Code 7348 instructs adjudicators to rate recurrent ulcer following complete vagotomy under Diagnostic Code 7305, with a minimum rating of 20 percent; and to rate dumping syndrome under Diagnostic Code 7308. Pursuant to the amended rating criteria, the Note now provides that adjudicators should rate recurrent ulcer following complete vagotomy under Diagnostic Code 7304 (peptic ulcer disease) with a minimum rating of 20 percent; and rate post-operative residuals not addressed by this diagnostic code under Diagnostic Code 7303.

Under the amended criteria, postgastrectomy syndromes and chronic gastritis are rated under Diagnostic Codes 7303 and 7304, respectively. Under current Diagnostic Code 7303, pertaining to chronic complications of upper gastrointestinal surgery, a 0 percent rating is assigned when the veteran is in post-operative status and asymptomatic. A 10 percent rating is assigned with either nausea or vomiting managed by ongoing medical treatment. A 30 percent rating is assigned with two or more of the following symptoms: (1) vomiting two or more times per week or vomiting despite medical treatment; (2) discomfort or pain within an hour of eating and requiring ongoing oral dietary modification; (3) three to five watery bowel movements per day every
amended criteria, postgastrectomy syndromes and chronic gastritis are rated under Diagnostic Codes 7303 and 7304, respectively. Under current Diagnostic Code 7303, pertaining to chronic complications of upper gastrointestinal surgery, a 0 percent rating is assigned when the veteran is in post-operative status and asymptomatic. A 10 percent rating is assigned with either nausea or vomiting managed by ongoing medical treatment. A 30 percent rating is assigned with two or more of the following symptoms: (1) vomiting two or more times per week or vomiting despite medical treatment; (2) discomfort or pain within an hour of eating and requiring ongoing oral dietary modification; (3) three to five watery bowel movements per day every day. A 50 percent rating is assigned for any one of the following symptoms with or without pain: (1) daily vomiting despite oral dietary modification or medication; (2) six or more watery bowel movements per day every day, or explosive bowel movements that are difficult to predict or control; (3) post-prandial (meal-induced) light-headedness (syncope) with sweating and the need for medications to specifically treat complications of upper gastrointestinal surgery such as dumping syndrome or delayed gastric emptying. A maximum 80 percent rating is assigned if the condition requires continuous total parenteral nutrition (TPN) or tube feeding for a period longer than 30 consecutive days in the last six months. Note 3 to this diagnostic code provides that the code includes operations performed on the esophagus, stomach, pancreas, and small intestine, including bariatric surgery. 38 C.F.R. § 4.114, Diagnostic Code 7303.

Turning to the relevant medical evidence, the Veteran submitted a private stomach and duodenal conditions DBQ in February 2018. It was noted that he had a history of peptic ulcer disease resulting in partial gastrectomy with vagotomy in 1998 and that an upper endoscopy in July 2014 showed gastritis. It was also noted that he was prescribed famotidine and pantoprazole, which he took on a continuous basis. On examination, the Veteran was noted to have zero recurring episodes of symptoms per year that were not severe, no incapacitating episodes due to signs or symptoms of his condition, and no other conditions or symptoms, to include no hypertrophic gastritis or postgastrectomy syndrome.

In a February 2018 PennState Health treatment note, the Veteran denied abdominal pain, vomiting, or change in bowel habit. He was instructed to continue famotidine.

The Veteran was afforded a VA examination in March 2018. The examiner recorded diagnoses of duodenal ulcer with diagnosis in 1972, helicobacter pylori and gastritis with diagnoses in 1998, and partial gastrectomy in 1998. The Veteran affirmed the history set out in the February 2018 DBQ and reported no new symptoms. It was noted that he had been prescribed pantoprazole and famotidine, which he took on a continuous basis. He was noted to have no symptoms or incapacitating episodes associated with any stomach or duodenum condition. The examiner also noted the presence of hypertrophic gastritis, status-post gastrectomy, and vagotomy with pyloroplasty or gastroenterostomy, with no symptoms or findings. It was further noted that the Veteran's disability did not impact his ability to work.

In a January 2019 PennState Health treatment note, the Veteran denied abdominal pain and vomiting, and reported only occasional diarrhea. He was instructed to continue famotidine.

PennState Health treatment notes dated in May 2019, March 2021, and May 2023 reflect that the Veteran continued to deny any nausea, vomiting, or diarrhea. Mount Nittany treatment records reflect no gastrointestinal complaints. See Mount Nittany treatment records dated May 2021, February 2022, February 2023.

During the April 2023 Board hearing, the Veteran testified that he had been taking continuous medication for his ulcer since 1998, following gastrectomy. He testified that his symptoms were controlled and he had not had major ulcer symptoms since his operation.

The Veteran underwent a VA interview examination on December 21, 2023. At that time, he reported current symptoms of epigastric pain. It was noted that he had been prescribed Prilosec, which he took once a day. He was noted to have four or more recurring episodes per year of abdominal pain, only partially relieved by standard ulcer therapy, that were not severe and had a duration of 10 or more days. There was no evidence of severe recurring symptoms, weight loss, nausea, vomiting, hematemesis, melena, or incapacitating episodes. The examiner also identified postgastrectomy syndrome, described as mild with infrequent episodes of epigastric distress with characteristic mild circulatory symptoms or continuous mild manifestations, and incomplete vagotomy with recurrent ulcer. As for the ameliorative effects of his medication on symptoms contemplated by Diagnostic Codes 7307, 7308, and 7348, the examiner noted residual epigastric pain with no restrictions. The examiner also indicated that none of the Veteran's stomach or duodenum conditions impacted his ability to work.

On review, the Board finds that the evidence is persuasively against the assignment of a compensable rating for the Veteran's stomach disability for the period on appeal prior to December 21, 2023. During that period, his disability is not shown to have been manifested by alkaline gastritis or symptomatic chronic hypertrophic gastritis, a recurrent ulcer, or mild circulatory symptoms. Nor is it shown to have been manifested by continuous mild manifestations of a postgastrectomy syndrome. In addition, while the December 2023 examiner indicated that the Veteran would have had residual epigastric pain in the absence of ameliorative medication, former Diagnostic Code 7305 (pertaining to duodenal ulcer) references "standard ulcer therapy," and thereby appears to contemplate the ameliorative effects of medication. Furthermore, as discussed above, the Veteran's digestive conditions cannot be separately rated as 38 C.F.R. § 4.114 expressly prohibits it.

The Board also finds that the evidence is persuasively against the assignment of a rating in excess of 40 percent from December 21, 2023. In that regard, the Veteran's stomach disability is not shown to be manifested by periodic or intermittent vomiting, recurrent hematemesis or melena, manifestations of anemia and weight loss productive of definite impairment of health, or manifestations of anemia that have required hospitalization at least once in a 12-month period. Nor is it shown to be manifested by chronic hypertrophic gastritis with severe hemorrhages or large ulcerated or eroded areas, by symptoms of severe postgastrectomy syndrome associated with nausea, sweating, circulatory disturbance after meals, diarrhea, hypoglycemic symptoms, and weight loss with malnutrition and anemia, by explosive bowel movements that are difficult to predict or control, or by meal-induced light-headedness with sweating and the need for medications to specifically treat complications of upper gastrointestinal surgery such as dumping syndrome or delayed gastric emptying.

Accordingly, as the evidence is persuasively against the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The appeal of this issue is denied.

DAVID A. BRENNINGMEYER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board R. Kettler, 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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