Case A26036145

E. I. VELEZ · 2026 · Case ID: A26036145

GRANTED

Summary

The Veteran, a Veteran who served from January 2008 to January 2012, appealed the denial of service connection for a deviated septum and sought a higher rating for gastroesophageal reflux disease (GERD) with hiatal hernia and irritable bowel syndrome (IBS). During a September 2024 hearing, the Veteran explicitly withdrew the appeal for the deviated septum, leading to its dismissal. For the GERD claim, the Board reviewed the prior rating criteria applicable to the period on appeal. A March 2021 VA examination documented symptoms including pyrosis, reflux, regurgitation, substernal pain, sleep disturbance, nausea, and vomiting, consistent with the criteria for a 30 percent rating. Although the VA examiner did not explicitly state considerable impairment, the persistent and frequent nature of the symptoms, coupled with the Veteran's testimony about sleep disturbance and occasional vomiting, led the Board to find considerable impairment of health. The Board resolved reasonable doubt in the Veteran's favor, granting the 30 percent rating. The Board found that the evidence did not support a higher rating, as the Veteran's reported weight loss and hematemesis occurred after the period on appeal and were not persuasively demonstrated during the appeal period. The Board also considered the updated rating criteria for GERD but found they would not benefit the Veteran. The IBS was considered under its own diagnostic code, but the maximum rating remained 30 percent. Therefore, the Board granted a 30 percent rating for GERD with hiatal hernia and IBS, but denied any rating in excess of 30 percent.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210603-163911

Full Decision Text

Citation Nr: A26036145
Decision Date: 04/17/26 Archive Date: 04/17/26

DOCKET NO. 210603-163911
DATE: April 17, 2026

ORDER

Entitlement to service connection for a deviated septum is dismissed.

Entitlement to a rating of 30 percent, but no higher, for gastroesophageal reflux disease (GERD) with hiatal hernia and irritable bowel syndrome (IBS) is granted.

FINDINGS OF FACT

1. At his September 2024 hearing, the Veteran stated on the record that he wished to withdraw his appeal of the issue of entitlement to service connection for a deviated septum.

2. During the period on appeal, the Veteran's GERD with hiatal hernia and IBS manifested in symptoms of pyrosis, reflux, regurgitation, substernal pain, sleep disturbance, nausea, and vomiting which were productive of considerable impairment to health.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of claim of entitlement to service connection for a deviated septum are met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for a rating of 30 percent, but no higher, for GERD with hiatal hernia and IBS have been met. 38 U.S.C. §§ 1155, 5107 (2024); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 7346 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 2008 to January 2012. This matter came before the Board of Veterans Appeals (Board) on appeal from a March 2021 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In the June 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. Therefore, the Board may only consider the evidence of record at the time of the 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 Veteran testified before a Veteran's Law Judge during a September 2024 hearing. The transcript of the hearing is of record.

Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding the claims of entitlement to service connection for a deviated septum and entitlement to an increased rating for GERD with hiatal hernia and IBS, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim 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.

1. Entitlement to service connection for a deviated septum

An appeal may be withdrawn by an appellant or his or her authorized representative as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. At the September 2024 Hearing, the Veteran confirmed on the record that he wished to withdraw his appeal of the issue of entitlement to service connection for a deviated septum. The undersigned Veteran's Law Judge advised the Veteran of the impact of such a withdrawal and the Veteran confirmed his wish to withdraw. As the Veteran confirmed on the record that he wished to withdraw his appeal regarding this issue after being advised of the impact of the withdrawal, the Board finds that the withdrawal was explicit, unambiguous and done with the full understanding of the consequences of such an action. See DeLisio v. Shinseki, 25 Vet. App. 45 (2011). Accordingly, the Board does not have jurisdiction to review the issue of entitlement to service connection for a deviated septum and the appeal as it pertains to this issue is dismissed. 38 C.F.R. § 20.204.

2. Entitlement to a rating in excess of 10 percent for GERD with hiatal hernia and IBS

The Veteran contends that he is entitled to
wished to withdraw his appeal regarding this issue after being advised of the impact of the withdrawal, the Board finds that the withdrawal was explicit, unambiguous and done with the full understanding of the consequences of such an action. See DeLisio v. Shinseki, 25 Vet. App. 45 (2011). Accordingly, the Board does not have jurisdiction to review the issue of entitlement to service connection for a deviated septum and the appeal as it pertains to this issue is dismissed. 38 C.F.R. § 20.204.

2. Entitlement to a rating in excess of 10 percent for GERD with hiatal hernia and IBS

The Veteran contends that he is entitled to a higher rating for his GERD with hiatal hernia and IBS.

Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4.

When a question arises as to which of two ratings applies under a particular DC, the higher rating is assigned if the disability more nearly approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. If the evidence is not in approximate balance or nearly equal, the claim is to be denied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001).

At the time the AOJ initially assigned the Veteran's rating, GERD did not have its own diagnostic code. The AOJ therefore rated the Veteran's GERD under DC 7346, which contemplates hiatal hernia. Under DC 7346, a 10 percent rating is appropriate if the Veteran experiences two or more symptoms for the 30 percent evaluation of less severity. A 30 percent rating is appropriate for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 60 percent rating is appropriate for symptoms of pain, vomiting, material weight loss, and hematemesis or melena with moderate anemia, or other symptom combinations productive of severe impairment of health.

The terms "severe impairment of health" and "considerable impairment of health" are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. In the absence of an express definition, words are given their ordinary meaning. Prokarym v. McDonald, 27 Vet. App. 307, 310 (2015) (citing Terry v. Principi, 340 F.3d 1378, 1382-83 (Fed. Cir. 2003)).

The ordinary meaning of "severe" is "very great [or] intense," or "of a great degree." Id. (quoting, respectively, the New Oxford American Dictionary 1599 (3d ed. 2010); see also Merriam-Webster Dictionary, https://www.merriam-webster.com/dictionary/severe (last visited March 26, 2026).

The ordinary meaning of "considerable" is "worth consideration: significant" or "large in extent or degree." See Merriam-Webster Dictionary, https://www.merriam-webster.com/dictionary/considerable (last visited March 26, 2026).

The Board acknowledges that, effective May 19, 2024, the DCs applicable to GERD changed. In this case, the entire period on appeal falls prior to this date, so only the old rating criteria apply.

A March 2021 VA esophageal examination documented that the Veteran had symptoms of pyrosis, reflux, regurgitation, substernal pain, sleep disturbance 4 or more times per year with a duration of 10 days or more, nausea 4 or more times per year with a duration of less than a day, and vomiting 4 or more times per year with a duration of 10 days or more. The examiner did not find that the Veteran had an esophageal stricture, spasm of the esophagus, or an acquired diverticulum of the esophagus. The Veteran reported that his symptoms did not significantly improve with medication and that they sometimes woke him at night. The examiner noted functional impairment with difficulty sleeping and concentrating. At the outset, the Board finds that the VA examination is adequate for appellate review. There is no evidence that the examiner was not competent or credible, and as the report is based on the Veteran's statements, in-person examination, and the examiner's observations, the Board finds it is entitled to significant probative weight with respect to the severity of the Veteran's GERD at the time of the examination. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-05 (2008).

The Board notes that the Veteran was afforded another VA esophageal examination in November 2022. However, as this evidence was added to the record after the rating decision on appeal was rendered and prior to the evidentiary window for the Hearing docket, it cannot be considered by the Board herein.

During the September 2024 hearing, the Veteran reported that he had experienced weight loss related to his persistent vomiting and diarrhea, as well as recent emergency treatment for hematemesis. However, the Veteran and his representative both conceded that these were recent symptoms/treatment and did not expressly state that they were present prior to the rating decision on appeal. However, he did endorse pain, sleep loss, nausea, and vomiting during the appeal period. The Board notes that the Veteran is competent to report lay-observable symptoms and the time of their onset, and it accords his statements significant probative weight. See Layno v. Brown, 6 Vet. App. 465, 470 (1994).

Upon review of the above, the Board finds that the criteria for a 30 percent rating under the prior criteria are met. The March 2021 VA examination found symptoms of pyrosis, regurgitation, and substernal pain which are all associated with the 30 percent criteria. While the examiner did not make an explicit finding that the Veteran's GERD resulted in considerable impairment to his health, he also noted that the Veteran had persistent and prolonged symptoms of sleep disturbance, nausea, and vomiting which may reasonably be expected to further impair his overall health and functioning. This is consistent with the Veteran's testimony during the September 2024 hearing, as well. As noted above, "considerable" impairment of health involves significant impairments that are "large in extent and degree", which encompasses not only the Veteran's specific symptoms but their persistence and frequency. Resolving all reasonable doubt in the Veteran's favor, the Board therefore finds that his GERD with hiatal hernia and IBS resulted in symptoms productive of considerable impairment of health during the period on appeal. A 30 percent rating was therefore warranted under the prior criteria for DC 7346.

The Board has also considered whether a rating in excess of 30 percent was warranted for the period on appeal. A 60 percent rating under the prior DC 7346 is warranted for pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. While the Veteran reported weight loss and hematemesis occurred after the period on appeal, the evidence does not persuasively show that the Veteran had material weight loss, hematemesis, melena, or anemia during the appeal period. His sleep impairment, nausea, and vomiting which were already considered by the Board above in assigning the 30 percent rating. Neither the medical record nor the March 2021 VA examination noted any other systemic impairments related to his GERD or hiatal hernia which would have had a great deal of impact on his overall health. For example, there is no evidence that his symptoms interfered with his nutrition or his ability to eat sufficient food to maintain his health, obtain sufficient sleep to function adequately, maintain employment, perform physical tasks, or otherwise function independently.
on appeal, the evidence does not persuasively show that the Veteran had material weight loss, hematemesis, melena, or anemia during the appeal period. His sleep impairment, nausea, and vomiting which were already considered by the Board above in assigning the 30 percent rating. Neither the medical record nor the March 2021 VA examination noted any other systemic impairments related to his GERD or hiatal hernia which would have had a great deal of impact on his overall health. For example, there is no evidence that his symptoms interfered with his nutrition or his ability to eat sufficient food to maintain his health, obtain sufficient sleep to function adequately, maintain employment, perform physical tasks, or otherwise function independently. The Board therefore finds that the Veteran's GERD with hiatal hernia and IBS did not mere nearly approximate the severity contemplated by the criteria for a 60 percent rating under the prior criteria for the period on appeal.

In reaching this determination, the Board acknowledges that VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use," Ingram v. Collins, 38 Vet. App. 130, 131 (2025). The prior version of the criteria for DC 7346 do not specifically contemplate medication use. The Board has considered the fact that the Veteran is using medication in the process of resolving reasonable doubt for the grant of a 30 percent rating and finding considerable impairment of health throughout the period. The March 2021 VA examination noted that the Veteran was prescribed medication for his disability, but he reported that relief was minimal. This suggests that the Veteran's medication was not significantly impactful on his overall functional impairment or his development of the systemic symptoms associated with the 60 percent rating criteria during the appeal period.

The Board has also considered whether a rating under the new version of the criteria would benefit the Veteran. To warrant a rating above 30, however, the evidence would need to show a documented history of recurrent or refractory esophageal stricture causing dysphagia that requires dilatation at least 3 or more times per year, dilatation using steroids, or esophageal stent placement. In this case, the March 2021 VA examination did not find esophageal stricture. A rating under the new criteria would therefore provide no benefit to the Veteran.

The Board notes that the Veteran is also service connected for IBS, but he may only be assigned a single evaluation for his three digestive disabilities. See 38 C.F.R. § 4.114 (noting that a single evaluation will be assigned under the DC which reflects the predominant disability picture for certain disabilities of the digestive system, to include GERD/hiatal hernias and IBS). However, the Board considered whether an alternative rating under DC 7319, which evaluates IBS, was warranted. These criteria were also changed as of May 19, 2024. Under both versions of the DC, the maximum rating assignable is 30 percent. Therefore, a rating under either version of DC 7319 would provide no benefit to the Veteran.

The Board therefore finds that a 30 percent rating is warranted for GERD under the prior version of the rating criteria. However, a rating in excess of 30 percent is not warranted and the evidence is not in approximate balance in favor of the Veteran in that regard. As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. Thus, a rating of 30 percent, but no higher, for GERD with hiatal hernia and IBS is granted.

E. I. VELEZ

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board E. Bock

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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