HIATUS HERNIA

D. MARTZ AMES · 2026 · Case ID: A26035724

GRANTED

Summary

The Veteran, a Veteran who served from June 1984 to March 1988 and October 1995 to November 2012, appeals the denial of service connection for hiatal hernia with gastritis and dysphagia. The Board found that the Veteran had a current diagnosis of these conditions, and that the second element of service connection was met by a May 2008 service treatment record noting food poisoning and an April 2012 notation of a hernia. The Board afforded high probative value to a January 2018 private medical record and a February 2019 Disability Benefits Questionnaire, which indicated the Veteran experienced symptoms consistent with hiatal hernia during his service, including chest discomfort and difficulty swallowing. Although a VA examiner opined that the conditions were not related to service and that the Veteran's claims were not supported by objective medical evidence, the Board found this opinion to have low probative value due to inadequate rationale for both direct causation and aggravation. The Board found the private medical opinion more persuasive, concluding that the Veteran's hiatal hernia was etiologically related to his active-duty service, particularly given the timing of symptoms and the potential contribution of carrying heavy equipment. Service connection for hiatal hernia with gastritis and dysphagia is granted.

Rationale

Favorable finding by RO on current diagnosis; Service treatment records noted food poisoning and hernia; Persuasive private medical opinion linking symptoms to service

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210819-330236

Full Decision Text

Citation Nr: A26035724
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 210819-330236
DATE: April 16, 2026

ORDER

Entitlement to service connection for hiatal hernia with gastritis and dysphagia is granted.

FINDING OF FACT

The Veteran's hiatal hernia with gastritis and dysphagia is related to an in-service event.

CONCLUSION OF LAW

The criteria for a?grant?of service connection for hiatal hernia with gastritis and dysphagia have been met. 38?U.S.C. §§?1101, 1112, 1113, 1131, 5107; 38?C.F.R. §§?3.102, 3.303, 3.304, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 1984 to March 1988, and October 1995 to November 2012. These matters are before the Board of Veterans Appeals (Board) on appeal from the rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) in December 2020.

In the August 19, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held before the undersigned Veterans Law Judge on March 14, 2025. Therefore, the Board may only consider the evidence of record at the time of the December 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). The Board notes that evidence was submitted during the period after the AOJ issued the decision on appeal and prior to the Board hearing, therefore it could not be considered by the Board as it was outside of the evidence window. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, he 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.

Service connection for hiatal hernia with gastritis and dysphagia is granted.

The Veteran is of the position that he is entitled to service connection for hiatal hernia with gastritis and dysphagia.

Service connection may be established for a disability resulting from a disease or injury incurred in or aggravated by service. 38?U.S.C. §?1131; 38?C.F.R. §?3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38?C.F.R. §?3.303(d).

Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

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 v. Nicholson,?21?Vet. App.?303, 308?(2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence considering the entirety of the record.? In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. 38?U.S.C. §?5107(b).

The benefit of the doubt rule provides that a veteran will prevail in a case where
-step inquiry.? First, the Board must determine whether the evidence comes from a "competent" source.

The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in approximate balance with the negative evidence.? 38?U.S.C. §?5107(b);?38?C.F.R. §?3.102.? It is only when the weight of the evidence is persuasively against the claim that the claim must be denied. Lynch v. McDonough,?21 F.4th 776 (Fed. Cir. 2021).

In the December 2020 rating decision, the RO found that the Veteran had been diagnosed with a hiatal hernia with gastritis and dysphagia. Favorable findings made by the agency of original jurisdiction (AOJ) are binding on all AOJ adjudicators as well as on the Board.? 38 U. S. C. §5104A;?38 C.F.R. § 20.801. As such, the first element of service connection has been met.

A May 2008 service treatment record shows that the Veteran had food poisoning during active service. There is also an April 2012 notation that the Veteran has a hernia. Accordingly, the second element of service connection has also been met.

The evidence includes a January 2018 private medical record. During the medical visit, the Veteran complained that food would become stuck in his throat and that he had difficulty swallowing. He was diagnosed with dysphagia and discomfort swallowing.

The evidence also includes a February 2019 Disability Benefits Questionnaire for Esophageal Conditions. The Veteran was diagnosed with dysphagia, gastritis and hiatal hernia. It was noted that the first symptoms were noted during a post-deployment examination.

In April 2019, the Veteran was afforded a VA examination for Esophageal Conditions. He was diagnosed with gastritis and dysphagia. He stated that he experienced chest discomfort, choking, persistent coughing and shortness of breath.

In an April 2019 General Gulf War VA examination, the Veteran asserted his symptoms of shortness of breath and coughing on the post deployment was the beginning of the hiatal hernia in 2008. The examiner noted that hiatal hernia, gastritis and dysphagia were not diagnosed until 2018. The examiner opined that it cannot be stated without resort to mere speculation that symptoms of chest pain or pressure, chronic cough, difficulty breathing is related to his current hiatal hernia, gastritis and dysphagia.

The examiner further opined that the Veteran's assertion that hiatal hernia, gastritis and dysphagia issues starting in in the Gulf War is not supported by the objective medical evidence. The examiner noted that, according to the Post Deployment Health Assessment, the Veteran complained of a chronic cough and difficulty breathing "during" deployment, but not at that current time. The examiner also noted that the Veteran darkened the circle for "no" for frequent indigestion. The May 2008 chest X-ray was normal.

The Veteran was afforded a VA examination in September 2020. He was diagnosed with gastroesophageal reflux disease and hiatal hernia. The Veteran reported that the conditions began in 2008 with burning in the throat and dysphagia. During his VA examination for Stomach and Duodenal Conditions that same month, the Veteran was diagnosed with gastritis with dysphagia. The condition began in 2018 with occasional upper abdominal lower chest pain with dysphagia for solid food.

The examiner opined that the Veteran does not have a diagnosis of a gastritis that was incurred in active service or caused by the food poisoning or heavy equipment lifting during active service. The rationale was that the diagnosis and complaints of gastritis are documented to have onset years after service. There is no biomechanical basis that can be used to state that food poisoning in Iraq and heavy equipment lifting during service would cause gastritis. The examiner opined that the Veteran's hiatal hernia was not secondary to a service-connected disability because the diagnosis and complaints of gastritis are documented to have onset
dysphagia. The condition began in 2018 with occasional upper abdominal lower chest pain with dysphagia for solid food.

The examiner opined that the Veteran does not have a diagnosis of a gastritis that was incurred in active service or caused by the food poisoning or heavy equipment lifting during active service. The rationale was that the diagnosis and complaints of gastritis are documented to have onset years after service. There is no biomechanical basis that can be used to state that food poisoning in Iraq and heavy equipment lifting during service would cause gastritis. The examiner opined that the Veteran's hiatal hernia was not secondary to a service-connected disability because the diagnosis and complaints of gastritis are documented to have onset years after service. There is no biomechanical basis that can be used to state that bilateral inguinal hernia, status post surgery would cause or aggravate the Veteran's gastritis.

The Board affords low probative value to the September 2020 secondary service connection opinion. The rationale is the same that the examiner provided for direct service connection. To be adequate, a VA opinion must provide separate rationales for both causation and aggravation. Atencio v. O'Rourke, 30 Vet. App. 74 (2018).

The examiner also opined that the Veteran's hiatal hernia was not related to his active service. The examiner quoted a study stating that hiatal hernia is known to be caused by, "...weakened muscle tissue [which] allows your stomach to bulge up through your diaphragm. It's not always clear why this happens." It was noted that a hiatal hernia may be caused by age-related changes in the diaphragm, injury to an area, being born with an unusually large hiatus and persistent and intense pressure on the surrounding muscles. The examiner opined that, based on the above list of causation, there is not a soldier or for that matter a civilian that would not be at risk for hiatal hernia as all military training and many civilian job activities requires persons to sustain increases in abdominal pressure associated with lifting activities, etc. The incidence of straining for stool or vomiting is also high in both the civilian and military world. Documentation and timing of onset of symptoms suggestive of hiatal hernia is the only practical way to determine when in time the hiatal hernia had its onset. The examiner found that the timing of onset is not established to coincide with service. There is no documentation of the onset time of the Veteran's symptoms until nearly 10 years after separation from service. The Veteran's hiatal hernia with resultant GERD is not related to his active service. The examiner opined that the Veteran's dysphagia and that his hiatal hernia was not caused by food poisoning in Iraq for the same reasons.

The examiner also opined that there is no biomechanical basis to conclude that an inguinal hernia would result in aggravation of a hiatal hernia or cause gastritis.

The evidence also includes a June 2020 private medical record from Dr. P.M., who has treated the Veteran since April 2012. He was diagnosed with hiatal hernia and chronic gastritis without bleeding in March 2018. Dr. P.M. indicated that he does not know any other risk factors that precipitated the Veteran's condition. His symptoms began in approximately 2007-08 during deployment. The equipment that he carried was approximately 40 pounds and could have contributed to the development of a hiatal hernia. He has had bilateral inguinal hernia repairs, which increases the probability of developing hernias in other areas of the body including the hiatus.

The clinician indicated that there are many symptoms associated with hiatal hernias, and none are exclusive to the diagnosis of hiatal hernia. However, when taken together in context with the findings on the Veteran's endoscopy in 2012, it appears that his complaint appears to have come from his hiatal hernia, namely chronic cough, vomiting, and chest pain. Although his symptoms improved initially but came back, that is not unusual. The symptoms match the presence of a hiatal hernia. Patients can develop resistance to proton-pump inhibitor therapy, as was initiated in his case. There was some resolution of his symptoms for a period of time, resulting in his symptoms returning such as a complaint in 2018. The clinician opined that the Veteran's claimed condition of hiatal hernia was related to an in-service injury, event, or illness.

In the Veteran's June 2020 Statement in Support of Claim, he stated that his hiatal hernia was caused by wearing 40 pounds of personal protective equipment, which included a helmet, flack vest,
and chest pain. Although his symptoms improved initially but came back, that is not unusual. The symptoms match the presence of a hiatal hernia. Patients can develop resistance to proton-pump inhibitor therapy, as was initiated in his case. There was some resolution of his symptoms for a period of time, resulting in his symptoms returning such as a complaint in 2018. The clinician opined that the Veteran's claimed condition of hiatal hernia was related to an in-service injury, event, or illness.

The Veteran appeared for a Board hearing before the undersigned Veterans Law Judge in March 2025. He testified that he believes that he was first diagnosed with the hernia at issue in 2011 or 2012. It began as a sensation in his chest. He was sent for X-rays, which came back negative, but the sensation continued.

The Veteran is competent to provide evidence of that which he experiences, including his symptomatology and medical history. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran has competently related experiencing symptoms since active service. His accounts are corroborated by his medical records.

The Board finds that entitlement to service connection for a hiatal hernia is warranted. High probative value is afforded to the private opinion authored by Dr. P.M., who has been treating the Veteran since 2012.

The Board finds that the Veteran has been complaining of symptoms associated with his hiatal hernia since his active-duty service. In light of the totality of the circumstances, the most persuasive evidence weighs in favor of finding that the Veteran's hiatal hernia is etiologically related to his active-duty service.

D. Martz Ames

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Sanders, Danielle A.

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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