CHRONIC GASTRITIS

Summary

The Veteran, a veteran who served from October 2008 to October 2013, appeals the denial of an initial compensable rating for viral gastroenteritis. The Veteran sought review of a June 2022 decision via a Higher-Level Review, which was decided in January 2023. The Board's review was limited to the evidence of record as of the June 2022 decision. The Veteran's claim for viral gastroenteritis was rated noncompensable under DC 7399-7307, which pertains to chronic gastritis. The Veteran reported monthly flare-ups of symptoms including bloating, bowel movement issues, gas, diarrhea, and occasional abdominal pain, and muscle spasms. A September 2021 DBQ noted these symptoms but indicated no incapacitating episodes. The Board found the Veteran's reports credible and afforded them significant probative weight. However, the Board determined that the Veteran's symptoms did not more closely approximate chronic gastritis with small nodular lesions and symptoms, as the symptoms were not consistently chronic and no medical evidence of nodular lesions was present. The Board also considered other diagnostic codes but found them inapplicable. Consequently, the Board denied an initial compensable rating for viral gastroenteritis, finding the evidence did not warrant application of the benefit of the doubt doctrine.

Rationale

Veteran's reports of symptoms afforded significant probative weight.; Symptoms did not more nearly approximate chronic gastritis with small nodular lesions and symptoms.; Symptoms not consistently chronic; no medical evidence of nodular lesions.

Full Decision Text

Citation Nr: A25019004
Decision Date: 03/03/25	Archive Date: 03/03/25

DOCKET NO. 240103-406206
DATE: March 3, 2025

ORDER

Entitlement to an initial compensable rating for viral gastroenteritis is denied.

FINDING OF FACT

The Veteran's viral gastroenteritis symptomatology does not more nearly approximate chronic gastritis with small nodular lesions and symptoms.

CONCLUSION OF LAW

The criteria for entitlement to an initial compensable rating for viral gastroenteritis have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.21, 4.114, Diagnostic Code (DC) 7307.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from October 2008 to October 2013.

In October 2022, the Veteran submitted a Department of Veterans Affairs (VA) Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a June 2022 decision.  In January 2023, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior June 2022 decision.  

 In the January 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the June 2022 AOJ decision on appeal which was subsequently subject to higher-level review.  38 C.F.R. § 20.301.  If evidence was submitted during the period after the AOJ issued the decision which was subsequently subject to higher-level review, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence.  38 C.F.R. § 3.2501.  If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

HIGHER INITIAL RATING

Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity.  Individual disabilities are assigned separate diagnostic codes.  38 U.S.C. § 1155; 38 C.F.R. § 4.1.  The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment.  38 C.F.R. § 4.10.  

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability.  38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).

If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned.  38 C.F.R. § 4.7.  It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances.  38 C.F.R. § 4.21.  

In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staged" ratings.  See Fenderson v. West, 12 Vet. App. 119 (1999).

Viral Gastroenteritis

The Veteran's viral gastroenteritis is currently rated noncompensable under DC 7399-7307.  Hyphenated DCs are used when a rating under one code requires use of an additional DC to identify the basis for the rating assigned; the additional code is shown after the hyphen.  
 all instances.  38 C.F.R. § 4.21.  

In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staged" ratings.  See Fenderson v. West, 12 Vet. App. 119 (1999).

Viral Gastroenteritis

The Veteran's viral gastroenteritis is currently rated noncompensable under DC 7399-7307.  Hyphenated DCs are used when a rating under one code requires use of an additional DC to identify the basis for the rating assigned; the additional code is shown after the hyphen.  38 C.F.R. § 4.27.

DC 7307 pertains to chronic gastritis.  Under this code, a 10 percent rating will be assigned for chronic gastritis with small nodular lesions and symptoms.  A 30 percent rating will be assigned for chronic gastritis with multiple small eroded or ulcerated areas and symptoms.  A maximum 60 percent rating will be assigned for chronic gastritis with severe hemorrhages, or large ulcerated or eroded areas.

Words such as chronic and severe are not defined in the rating criteria.  It is thus 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).  In the context of medical definitions, the Court of Appeals for Veterans Claims has found it appropriate to refer to definitions in the Merriam-Webster dictionary.  See, e.g., Holmes v. Wilkie, 33 Vet. App. 67, 71 (2020). Accordingly, the Board will employ the Merriam-Webster dictionary meanings.  "Severe," as an adjective, is defined as "causing discomfort or hardship"; "very painful or harmful"; "of a great degree."  Severe, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/severe, Definitions 6a, 6b, and 8 (last visited Feb. 25, 2025).  "Chronic," as an adjective, is defined as "continuing or occurring again and again for a long time"; "always present or encountered."  Chronic, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/chronic, Definitions 1a, and 2a (last visited Feb. 25, 2025).

In a February 2022 statement, the Veteran reported that he has flare-ups of gastroenteritis approximately once a month that lasts 7 days.  He stated that during flare-ups he constantly feels bloated, has trouble with bowel movements and passing gas, and indicated that his stool is sometimes soft.  The Veteran added that a couple of times a month he has muscle spasms in his abdominal area. 

October 2012 medical treatment records reflect that the Veteran reported a 2-day history of nausea, vomiting, and diarrhea.  The Veteran denied blood or mucus in his vomit or stool but reported approximately 3 to 4 episodes of emesis.  He denied abdominal pain.  The records indicate that the Veteran was given medication to control nausea.

A September 2021 disability benefits questionnaire (DBQ) reflects that the Veteran has a diagnosis of viral gastroenteritis from 2010.  The Veteran reported that he started having abdominal cramps, diarrhea and bloating in 2010, and while it has improved since onset, he still has abdominal pain occasionally.  The examining nurse practitioner (NP) noted symptoms of bloating, diarrhea, and abdominal pain.  The Veteran's treatment plan did not include taking continuous medication, but the Veteran reported periodic abdominal pain.  The Veteran did not have incapacitating episodes due to signs or symptoms of any stomach or duodenum condition.

The Board finds that an initial compensable rating is not warranted for the Veteran's gastroenteritis.  The Veteran has consistently reported that his gastroenteritis symptomatology has included feeling bloated, trouble with bowel movements and gas, diarrhea, and abdominal cramps.  He has also indicated that he has muscle spasms a couple times a month as well as flare-ups of gastroenteritis once a month that last 7 days.  The Veteran is competent to report symptoms associated with his gastroenteritis and there is no indication in the evidence of record that he lacks credibility.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).  Thus, his reports regarding his gastroenteritis symptomatology are afforded significant prob
's gastroenteritis.  The Veteran has consistently reported that his gastroenteritis symptomatology has included feeling bloated, trouble with bowel movements and gas, diarrhea, and abdominal cramps.  He has also indicated that he has muscle spasms a couple times a month as well as flare-ups of gastroenteritis once a month that last 7 days.  The Veteran is competent to report symptoms associated with his gastroenteritis and there is no indication in the evidence of record that he lacks credibility.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).  Thus, his reports regarding his gastroenteritis symptomatology are afforded significant probative weight.  The September 2021 NP also noted symptoms of bloating, diarrhea, and abdominal pain, but indicated that the Veteran did not have incapacitating episodes due to his gastroenteritis.

However, the evidence of record does not indicate that the Veteran's gastroenteritis symptomatology more nearly approximates chronic gastritis with small nodular lesions and symptoms.  The Veteran has reported that he suffers from flare-ups of gastroenteritis symptoms approximately once a month, and the September 2021 DBQ reflects only occasional abdominal pain.  Thus, the Veteran's symptoms are not always present, or occurring again and again for a long time, i.e., chronic.  Additionally, there is no medical evidence of record which indicates that the Veteran has small nodular lesions, and he does not contend otherwise.

As to whether a higher rating could be assigned under any other applicable diagnostic code, no other diagnostic codes are applicable.  In this regard, the Veteran has not been diagnosed with or service-connected for esophagus stricture or spasm, adhesions of the peritoneum, an ulcer, postgastrectomy syndromes, a liver condition, cholecystitis, removal of gallbladder, irritable colon syndrome, amebiasis, dysentery, distomiasis, enteritis, diverticulitis, peritonitis, a rectal or anus condition, hernia, pancreatitis, vagotomy, liver transplant, or hepatitis to render those diagnostic codes applicable.  Moreover, as set forth above, 38 C.F.R. § 4.114 states that ratings under Diagnostic Codes 7301 through 7329, inclusive, will not be combined with each other; a single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, which, in this case, is best reflected by the diagnostic code for gastritis.

For the foregoing reasons, an initial compensable rating for the Veteran's gastroenteritis under DC 7307 is not warranted.  As the evidence is neither evenly balanced nor approximately so as to whether a higher or separate rating is warranted, the benefit of the doubt doctrine is not for application.  38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

 

PAULA B. McCARRON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Maddox, Rolen

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.