PANCREATITIS

Summary

The Veteran, an Air Force Veteran who served from August 1992 to August 1993, appeals for an increased rating for his service-connected alcohol-induced chronic pancreatitis with pancreatic insufficiency and gastroesophageal reflux disease. The Veteran was initially granted service connection for pancreatitis at 30% and GERD at 10% in prior decisions. In November 2024, the Veteran filed a supplemental claim seeking an increased rating, which the agency of original jurisdiction (AOJ) granted at 100% effective November 19, 2024. The Veteran appealed this decision, primarily contesting the effective date of the increased rating. The Board reviewed the evidence, including VA examinations from March 2024 and January 2025, and a private DBQ submitted by the Veteran. The VA examinations indicated recurrent pancreatitis with frequent mild abdominal pain and maldigestion, but the January 2025 exam noted only one hospitalization per year and no severe malnutrition. The Board found the private DBQ to be unprobative due to internal inconsistencies and reliance on incomplete evidence. However, after reviewing the VA examinations and the Veteran's lay statements, the Board found that the Veteran's chronic pancreatitis met the criteria for a 100% rating under the former rating criteria effective for the entire period on appeal. The Board resolved all doubt in the Veteran's favor, granting the 100% rating.

Rationale

Veteran's condition meets 100% criteria under former rating schedule; Resolving all doubt in Veteran's favor; Frequent recurrent disabling attacks of abdominal pain with few pain-free intermissions, diarrhea, malabsorption

Full Decision Text

Citation Nr: A26032812
Decision Date: 04/09/26	Archive Date: 04/09/26

DOCKET NO. 250919-588475
DATE: April 9, 2026

ORDER

Entitlement to an increased initial rating of 100 percent disabling for service-connected alcohol induced chronic pancreatitis with pancreatic insufficiency and gastroesophageal reflux disease, to include gallbladder, is granted.

FINDING OF FACT

Resolving all doubt in the Veteran's favor, for the entire period on appeal, his alcohol induced chronic pancreatitis with pancreatic insufficiency and gastroesophageal reflux disease, to include gallbladder, manifested with symptoms consistent with frequently recurrent disabling attacks of abdominal pain with few pain-free intermissions, diarrhea, and malabsorption. 

CONCLUSION OF LAW

For the entire period on appeal, the criteria for a 100 percent rating for alcohol induced chronic pancreatitis with pancreatic insufficiency and gastroesophageal reflux disease, to include gallbladder, have been met.   38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.114, Diagnostic Code 7318-7347.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Air Force from August 1992 to August 1993.

In November 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the issue of an increased rating for service-connected alcohol induced chronic pancreatitis with pancreatic insufficiency and gastroesophageal reflux disease to include gallbladder most recently addressed in an October 2024 rating decision.  In February 2025, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and granted an increased rating of 100 percent disabling effective November 19, 2024.  

In the September 2025 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 February 2025 agency of original jurisdiction (AOJ) decision on appeal.  38 C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board.  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. 

Increased Rating

Disability evaluations are determined by comparing a Veteran's present symptomatology with criteria set forth in the VA's Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity.  38 U.S.C. § 1155; 38 C.F.R. Part 4.  When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating.  38 C.F.R. § 4.7.  After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran.  38 C.F.R. § 4.3.  The Veteran's entire history is reviewed when making disability evaluations.  See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995).

Evidence to be considered in the appeal of the assignment of a disability rating is not limited to that reflecting the current severity of the disorder.  Fenderson v. West, 12 Vet. App. 119 (1999).  In cases where an initially assigned disability evaluation has been disagreed with, it is possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period (i.e., "staged ratings").  Fenderson at 126-28; see also Hart v. Mansfield, 21 Vet. App. 505 (2007).

In making all determinations, the Board must fully consider the lay assertions of record.  A layperson is competent to report on the onset and recurrence of his
 appeal of the assignment of a disability rating is not limited to that reflecting the current severity of the disorder.  Fenderson v. West, 12 Vet. App. 119 (1999).  In cases where an initially assigned disability evaluation has been disagreed with, it is possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period (i.e., "staged ratings").  Fenderson at 126-28; see also Hart v. Mansfield, 21 Vet. App. 505 (2007).

In making all determinations, the Board must fully consider the lay assertions of record.  A layperson is competent to report on the onset and recurrence of his symptoms.  Layno v. Brown, 6 Vet. App. 465, 470 (1994).

Board decisions must be based on the entire record, with consideration of all the evidence.  38 U.S.C. § 7104.  The law requires only that the Board address its reasons for rejecting evidence favorable to the claimant.  Timberlake v. Gober, 14 Vet. App. 122 (2000).  The Board must review the entire record but does not have to discuss each piece of evidence.  Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000).

It is VA's defined and consistently applied policy to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant.  By reasonable doubt it is meant that an approximate balance of positive and negative evidence exists which does not satisfactorily prove or disprove the claim.  Reasonable doubt is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

1. Entitlement to an increased initial rating of 100 percent disabling for service-connected alcohol induced chronic pancreatitis with pancreatic insufficiency and gastroesophageal reflux disease, to include gallbladder, is granted.

The Veteran is currently seeking an increased rating for his service-connected alcohol induced chronic pancreatitis with pancreatic insufficiency and gastroesophageal reflux disease to include gallbladder disability.

By way of background, the Veteran was initially granted service connection for alcohol induced chronic pancreatitis with pancreatic insufficiency in a June 2024 rating decision and assigned an initial rating of 30 percent disabling effective June 27, 2023.  In an August 2024 rating decision, the AOJ granted service connection for gastroesophageal reflux disease with an evaluation of 10 percent disabling effective January 11, 2024, and evaluated the condition with alcohol induced chronic pancreatitis with pancreatic insufficiency.  In an October 2024 rating decision, the AOJ continued the rating of 30 percent disabling for service-connected alcohol induced chronic pancreatitis with pancreatic insufficiency and gastroesophageal reflux disease.  

As discussed above, in November 2024, the Veteran filed a supplemental claim seeking an increased rating.  In the February 2025 rating decision, the AOJ granted an increased rating of 100 percent disabling from November 19, 2024, for service-connected alcohol induced chronic pancreatitis with pancreatic insufficiency and gastroesophageal reflux disease to include gallbladder associated with insomnia disorder with alcohol use disorder.  

The Veteran has not contested the 100 percent rating assigned November 19, 2024; rather, he has contested the effective date for the grant of the increased rating.  Therefore, despite coming before the Board under the guise of an earlier effective date claim for the rating for pancreatitis, the analysis of consequence actually deals with an increased rating prior to November 19, 2024.  The Board notes that the continuous prosecution of the initial rating claim renders the appeal one for a higher initial rating.  Under these circumstances, the Board has recharacterized the claim for an earlier effective date for the 100 percent increased rating for the Veteran's pancreatitis disability as reflected herein.  As such increased rating claim encompasses an earlier effective date claim, there is no prejudice to the Veteran.  

While the AOJ subsequently granted an earlier effective date of August 19, 2024, for the 100 percent rating in a September 2025 rating decision, the August 19, 2024, this grant does not encompass the entire time period on appeal; as such, the issue remains properly before the Board.   AB v. Brown, 6 Vet. App. 35 (1993).


 appeal one for a higher initial rating.  Under these circumstances, the Board has recharacterized the claim for an earlier effective date for the 100 percent increased rating for the Veteran's pancreatitis disability as reflected herein.  As such increased rating claim encompasses an earlier effective date claim, there is no prejudice to the Veteran.  

While the AOJ subsequently granted an earlier effective date of August 19, 2024, for the 100 percent rating in a September 2025 rating decision, the August 19, 2024, this grant does not encompass the entire time period on appeal; as such, the issue remains properly before the Board.   AB v. Brown, 6 Vet. App. 35 (1993).

The Veteran's pancreatitis was initially rated under Diagnostic Code 7347 effective June 27, 2023, and under Diagnostic Code 7318-7347 from November 19, 2024.  Hyphenated codes are used when a rating for a particular disability under one DC is based upon rating of the residuals of that disability under another DC.  38 C.F.R. § 4.27.

There are 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.  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.  38 C.F.R. §§ 4.14, 4.113.  Accordingly, ratings for certain disabilities of the digestive system under DCs 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348, inclusive, are not to be combined.  Rather, 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.  38 C.F.R. § 4.114.

Under DC 7318, a noncompensable evaluation is warranted for the non-symptomatic residuals of removal of the gallbladder; a 10 percent evaluation is warranted where there is intermittent abdominal pain and diarrhea characterized by one to two watery bowel movements per day; and a 30 percent rating is warranted where there is recurrent abdominal pain (post-prandial or nocturnal); and chronic diarrhea characterized by three or more watery bowel movements per day.  38 C.F.R. § 4.114.

Under DC 7347, for pancreatitis, a 30 percent rating applies to moderately severe pancreatitis with at least 4 to 7 typical attacks of abdominal pain per year with good remission between attacks.  A 60 percent rating applies to pancreatitis with frequent attacks of abdominal pain, loss of normal body weight, and other findings showing continuing pancreatic insufficiency between acute attacks.  A 100 percent rating applies to pancreatitis with frequently recurrent disabling attacks of abdominal pain with few pain-free intermissions and with steatorrhea, malabsorption, diarrhea, and severe malnutrition.  38 C.F.R. § 4.114.

Per Note 1, the above-described abdominal pain must be confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies. 38 C.F.R. § 4.114, DC 7347.

The rating criteria for evaluating digestive disabilities under 38 C.F.R. § 4.114 were amended effective May 19, 2024.  The current rating criteria for pancreatitis is 100 percent for daily episodes of abdominal or mid-back pain that require three or more hospitalizations per year; and pain management by a physician, and maldigestion and malabsorption requiring dietary restriction and pancreatic enzyme supplementation; 60 percent for three or more episodes of abdominal or mid-back pain per year and at least one episode per year requiring hospitalization for management either of complications related to abdominal pain or complications of tube enteral feeding; and 30 percent for at least one episode per year of abdominal or mid-back pain that requires ongoing outpatient medical treatment for pain, digestive problems, or management of related complications including but not limited to cyst, pseudocyst, intestinal obstruction, or ascites.

VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran.  In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation.  If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the
 at least one episode per year of abdominal or mid-back pain that requires ongoing outpatient medical treatment for pain, digestive problems, or management of related complications including but not limited to cyst, pseudocyst, intestinal obstruction, or ascites.

VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran.  In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation.  If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change.  The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change.

VA thus must consider a claim for a higher rating pursuant to the former and revised during the latter part of this appeal.  See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997).  Therefore, the Board will consider the Veteran's claim under the old criteria prior to May 19, 2024, and both the old and new rating criteria from May 19, 2024.  The criteria that is more favorable to the Veteran will be applied.

Turning to the evidence, the Veteran was afforded a VA Gallbladder and Pancreas Conditions examination in March 2024.  Based on an in-person examination and review of the Veteran's VA e-folder, the examiner diagnosed cholecystitis, chronic, and cholecystectomy.  The examiner reported that the Veteran had infrequent attacks (not over two or three a year) of gallbladder colic involving mild symptoms.  The examiner also reported that the Veteran had symptoms attributable to a pancreas condition including few pain-free intermissions between attacks.  In a separate March 2024 VA Gallbladder and Pancreas Conditions examination, the examiner reported a diagnosis of alcohol induced chronic pancreatitis and pancreatic insufficiency.  The examiner noted the Veteran's report of treatment and hospitalization for recurrent episodes of pancreatitis and that he is still having pains.  The examiner reported that the Veteran had symptoms attributable to a pancreas condition including 8 or more attacks of mild abdominal pain, confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies, in the previous 12 months.  The VA examiner reported that the Veteran did not have any symptoms attributable to a pancreas condition including steatorrhea, malabsorption, diarrhea, severe malnutrition, or loss of normal body weight.   See May 2024 VA examination reports. 

The Veteran was afforded another VA Pancreas Conditions examination in January 2025.  Based on an in-person examination and review of the Veteran's VA e-folder, the VA examiner reported a diagnosis of alcohol induced chronic pancreatitis with pancreatic insufficiency.  The examiner noted the Veteran's report of diagnosis around 2012; that he was in the ICU for about 8 days for treatment; that he is currently on Creon; that he reported last hospitalization was 8/2024 and prior to that was in 5/2023; that he goes to the hospital about once per year due to pancreatitis flare up; that during the flare up he has stabbing pain radiating to the back, nausea, vomiting, constipation/diarrhea; and that he is not currently in a flare up.  The examiner reported that the Veteran takes continuous medication for control of his pancreas condition including Creon.  The examiner reported that the Veteran has chronic pancreatitis; one episode per year of abdominal or mid-back pain; one episode of abdominal or mid-back pain per year requiring hospitalization for management or complications related to abdominal pain; pain managed by a physician; and maldigestion and malabsorption requiring dietary restriction and pancreatic enzyme supplementation.  The examiner reported no other pertinent physical findings, complications, conditions, signs, symptoms, or scars.  See February 2025 VA examination report. 

The Veteran was afforded a VA Esophageal Conditions examination in January 2025.  Based on an in-person examination and review of the Veteran's VA e-folder, the examiner reported a diagnosis of gastroesophageal reflux disease.  The examiner reported that the Veteran's treatment plan includes taking daily prescribed medication including pantoprazole and omeprazole.  The examiner reported symptoms including dysphagia, aspiration, heartburn, regurgitation, reflux, aspiration, waking up at night,
 maldigestion and malabsorption requiring dietary restriction and pancreatic enzyme supplementation.  The examiner reported no other pertinent physical findings, complications, conditions, signs, symptoms, or scars.  See February 2025 VA examination report. 

The Veteran was afforded a VA Esophageal Conditions examination in January 2025.  Based on an in-person examination and review of the Veteran's VA e-folder, the examiner reported a diagnosis of gastroesophageal reflux disease.  The examiner reported that the Veteran's treatment plan includes taking daily prescribed medication including pantoprazole and omeprazole.  The examiner reported symptoms including dysphagia, aspiration, heartburn, regurgitation, reflux, aspiration, waking up at night, and nausea.  See February 2025 VA examination report. 

Given the VA examiners' review of the claims file, personal interview of the Veteran, and physical examination, the Board finds the VA examiners' findings are highly probative.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) ("It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion.").

In support of his claim for an increased rating, the Veteran submitted a Pancreas Conditions Disability Benefits Questionnaire in December 2024.  The provider indicated that they were not a VA Healthcare provider, but that the Veteran was regularly seen as a patient in their clinic and was examined in person.  The provider noted review of evidence including service treatment records; a VA claim letter 10/24/2024; Novant Health hospital admission 3/2/2012, 2/19/2012, and 3/30/3022; ARC hospital admission 6/24/2022; and Perpetual Succor Hospital admission 5/21/2023.  The provider reported diagnoses including chronic pancreatitis, type 3c diabetes, and pancreatic insufficiency.  The provider reported that the Veteran was first hospitalized at Novant Health 3/1/2012; he has had a consistent and recurrent battle with the disease every year since; he suffers with daily abdominal pain, frequent hospitalizations, weight loss, severe malnutrition, multiple recurrent bouts of abdominal, significant digestive issues, and ongoing problems with his diagnosed pancreatic insufficiency.  The provider indicated that continued medication is prescribed by a medical provider required for control of the Veteran's pancreas condition.  The provider reported that the Veteran has three or more episodes per year of abdominal or mid-back pain; ongoing outpatient medical treatment for pain, digestive problems, or management of related complications including but not limited to cyst, pseudocyst, intestinal obstruction, or ascites; one episode of abdominal or mid-back pain per year requiring hospitalization for management of complications related to abdominal pain; one episode of abdominal or mid-back pain per year requiring hospitalization for management of complications of tube enteral feeing; pain managed by a physician; maldigestion and malabsorption requiring dietary restriction and pancreatic enzyme supplementation; diabetes mellitus due to pancreatic insufficiency; and other symptoms including hypoglycemia and glucose intolerance.  

The provider reported that the Veteran had not had a total or partial pancreatectomy, but that the Veteran has symptoms including post-prandial (meal-induced) lightheadedness (syncope) with seating; vomiting less than 2 times a week despite medical treatment including oral dietary modification; 4 daily episodes of watery bowel movements or diarrhea; explosive bowel movements that are difficult to predict or control; recurrent abdominal pain; recurrent abdominal distention; and discomfort or pain within an hour of eating and requiring ongoing oral dietary modification.  The provider also reported that the Veteran has recurrent emergency treatment for episodes of intestinal obstruction or regurgitation due to poor gastric emptying, abdominal pain, recurrent nauseas, or recurrent vomiting; symptomatology comparable to severe inflammatory bowel disease that is unresponsive to treatment; intermittent signs of toxicity such as fever, tachycardia, and anemia; recurrent episodes of rectal incontinence; malabsorption - undernutrition; malabsorption - anemia; requiring total parenteral nutrition (TPN); vitamin or mineral deficiency as a result of pancreatic surgery; and vitamin D deficiency - hospitalized in 2022 for severe malnutrition at Arch Hospital.  The provider reported that the Veteran had not had a pancreas transplant but that he was hospitalized in May 2023 for chronic pancreatitis.  The provider reported other pertinent findings including pancreatic insufficiency, chronic constipation, and Type 3c diabetes.  The provider reported that the Veteran's condition does not impact his ability to work, but then reported that chronic abdominal distress, severe pain requiring opioid medications, and
 and anemia; recurrent episodes of rectal incontinence; malabsorption - undernutrition; malabsorption - anemia; requiring total parenteral nutrition (TPN); vitamin or mineral deficiency as a result of pancreatic surgery; and vitamin D deficiency - hospitalized in 2022 for severe malnutrition at Arch Hospital.  The provider reported that the Veteran had not had a pancreas transplant but that he was hospitalized in May 2023 for chronic pancreatitis.  The provider reported other pertinent findings including pancreatic insufficiency, chronic constipation, and Type 3c diabetes.  The provider reported that the Veteran's condition does not impact his ability to work, but then reported that chronic abdominal distress, severe pain requiring opioid medications, and permanent consistent complications of the condition would severely impair and compromise efforts of employment.  See December 2024 Veteran Provided DBQ.   

The Board affords the private DBQ no probative weight for several reasons.  Initially, the Board finds that the report is inconsistent with the record as a whole, and as well as internally inconsistent.  The report was not signed by the provider; and the provider indicated review of only part of the record, including service treatment records, the October 2024 VA claim letter, and three specific hospital admission records.  The Board notes that an opinion based on an inaccurate factual premise has no probative value.  Reonal v. Brown, 5 Vet. App. 458, 461 (1993).  Here, the opinion as to the severity of the Veteran's symptoms is based on an incomplete - and therefore inaccurate - factual premise.  For these reasons, the Board affords the private DBQ no probative value.  

A review of the Veteran's private treatment records reflects that the Veteran was admitted to a hospital in March 2012 with probable pancreatitis.  See January 2024 private treatment records. 

An April 2013 treatment note reflects that the Veteran had an episode of pancreatitis in January that required hospitalization and that he had recurrent pain a few weeks prior and went to the ER.  The record indicates that the Veteran was seen in Texas and Florida ERs but was not admitted.  See February 2024 private treatment records.  

Private treatment records reveal a history of episodic and recurrent abdominal pain, severe at times, with previous episodes of pancreatitis.  See October 2015, January 2017, and November 2017 private treatment records. 

A November 2020 treatment note indicates that the Veteran had improved anemia after a pancreatitis episode in August 2020.  See March 2024 private treatment records. 

The private treatment records further indicate that the Veteran received hospital treatment for recurrent pancreatitis from May 21, 2023, to May 24, 2023.  See October 2023 private treatment records. 

The Board has also considered the Veteran's lay statements in support of his claim.  He is competent to describe his symptoms of abdominal pain and weight loss, as this is capable of lay observation and experience.  Layno v. Brown, 6 Vet. App. 465, 469 (1994).

After a thorough review of the evidence of record, and resolving all doubt in the Veteran's favor, the Board finds that the Veteran's chronic pancreatitis meets the criteria for an initial 100 percent rating under the former rating criteria in effect prior to May 19, 2024.  The March 2024 VA examiner reported frequently recurrent disabling attacks of abdominal pain with few pain-free intermissions.  The record shows that the Veteran experiences diarrhea as well as maldigestion and malabsorption requiring dietary restriction and pancreatic enzyme supplementation despite taking daily medication to control his symptoms. 

In summary, the Board concludes that the Veteran is entitled to a higher 100 percent rating for the entire period on appeal for his service-connected alcohol induced chronic pancreatitis with pancreatic insufficiency and gastroesophageal reflux disease, to include gallbladder.  The claim is hereby GRANTED. 

J.P. Norman

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	L. Fulmer

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.