GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Summary

The veteran, who served from June 1977 to June 1980, appeals the denial of service connection for gastroesophageal reflux disease (GERD) and hiatal hernia. The veteran's service treatment records were silent regarding gastroesophageal issues, and separation examinations indicated normal abdominal findings. However, the veteran asserted that the GERD was related to a service-connected psychiatric disability. The Board reviewed multiple VA medical opinions. An August 2022 VA examination diagnosed a hiatal hernia, suggesting GERD was related to this hernia, but noted the hernia was congenital and failed to address secondary service connection. A January 2024 VA examination concluded the hiatal hernia was caused by active-duty service, specifically linking it to the veteran's job as a parachutist. A December 2024 addendum opinion from a VA examiner stated GERD is primarily caused by factors like obesity and smoking, not physical trauma, and found it unlikely related to parachuting, neglecting to address the hiatal hernia or the veteran's theory of psychiatric connection. The Board found the January 2024 opinion most probative due to its positive nexus and specific rationale, while affording some value to the August 2022 opinion despite its flaws. The Board afforded low probative value to the December 2024 opinion due to its omissions. Ultimately, the Board granted service connection for both GERD and hiatal hernia, applying the benefit of the doubt due to the conflicting opinions and the veteran's favorable evidence.

Rationale

Conflicting VA opinions regarding GERD causation.; January 2024 opinion found hiatal hernia caused by service.; August 2022 opinion linked GERD to hiatal hernia but noted congenital nature.; December 2024 opinion found GERD unlikely related to parachuting.; Benefit of the doubt applied due to conflicting opinions and favorable evidence.

Full Decision Text

Citation Nr: A26037312
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 260105-619980
DATE: April 21, 2026

ORDER

Entitlement to service connection for gastroesophageal reflux disease (GERD) and hiatal hernia is granted.

FINDING OF FACT

The competent and credible evidence of record persuasively establishes a finding that the hiatal hernia is related to active-duty service, and that the GERD is related to the hiatal hernia.

CONCLUSION OF LAW

The criteria for entitlement to service connection for GERD and hiatal hernia have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 1977 to June 1980. This case comes before the Board of Veterans' Appeals (Board) on appeal from a December 2024 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In the January 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the December 2024 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Entitlement to service connection for GERD and hiatal hernia

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may also be granted on a secondary basis for disability which is proximately due to or the result of service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability. 38 C.F.R. § 3.310 (2018); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

The Veteran alleges that the GERD is related to the service-connected major depressive disorder with anxious distress and residuals of traumatic brain injury (TBI).

First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran underwent a VA examination in August 2022 where the examiner confirmed a diagnosis of hiatal hernia. He underwent another VA examination in January 2024 where the examiner confirmed diagnoses of GERD and hiatal hernia. Accordingly, the
3.310 (2018); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

The Veteran alleges that the GERD is related to the service-connected major depressive disorder with anxious distress and residuals of traumatic brain injury (TBI).

First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran underwent a VA examination in August 2022 where the examiner confirmed a diagnosis of hiatal hernia. He underwent another VA examination in January 2024 where the examiner confirmed diagnoses of GERD and hiatal hernia. Accordingly, the first element of service connection is met.  

Second, the Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran's service treatment records (STRs) are silent for any complaints of or treatment for any gastroesophageal symptoms. The reports of medical examination at entry to and separation from service indicated that the abdomen and viscera were normal. As indicated above, the Veteran has asserted that the condition is related to the service-connected psychiatric disability. The Board finds the Veteran's statements competent as they are capable of lay observation. 38?U.S.C. §?1154(a); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge; Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (noting that the probative value of a witness statement may be affected by inconsistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Accordingly, the second element of service connection is met.

Third, the Board finds that the evidence of record does support a finding that the GERD and hiatal hernia are related to active service.

The August 2022 VA examiner provided an opinion that the GERD is less likely due to any mental health condition as he has been diagnosed with hiatal hernia. They explained that a hiatal hernia is due to an enlargement in the opening through which the esophagus passes on its way to the stomach, and that part of the stomach can slide through this hole, resulting in GERD symptoms. The examiner concluded that therefore it is at least as likely as not that his GERD is due to this congenital condition of a hiatal hernia.

The January 2024 examiner provided a positive nexus opinion and indicated that the hiatal hernia is closely associated with the Veteran's job of being a parachutist which can develop with strain. Therefore, they concluded that the hiatal hernia was caused by active-duty service.

And in a December 2024 addendum opinion, a VA examiner provided a negative nexus opinion that the GERD is related to the in-service parachute jumps. They explained that GERD is primarily caused by dysfunction of the lower esophageal sphincter, allowing stomach acid to flow back into the esophagus, and that contributing factors include obesity, smoking, certain foods, and medications, rather than physical trauma associated with parachuting. The examiner noted that while parachuting involves significant physical impact, such as abrupt landings, this type of mechanical stress typically affects the musculoskeletal system rather than the gastrointestinal system. 

The Board affords the January 2024 medical opinion significant probative value as it was conducted by a medical professional with consideration of the Veteran's lay statements, and specific facts in this case, and is supported by well-reasoned rationale. Factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion. Prejean v. West, 13 Vet. App. 444, 448-9 (2000). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).

The Board affords some probative value to the August 2022 opinion. The opinion is in the Veteran's favor, in some part, in that they concluded that the GERD is related to the hiatal hernia; however, the examiner also indicated that the hiatal hernia is congenital in nature, without providing any supporting rationale. Id. Additionally, although the examiner addressed the causation element of secondary service connection, they neglected to address the secondary element. In a secondary service connection claim, causation and aggravation are independent concepts and should have separate
 but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).

The Board affords some probative value to the August 2022 opinion. The opinion is in the Veteran's favor, in some part, in that they concluded that the GERD is related to the hiatal hernia; however, the examiner also indicated that the hiatal hernia is congenital in nature, without providing any supporting rationale. Id. Additionally, although the examiner addressed the causation element of secondary service connection, they neglected to address the secondary element. In a secondary service connection claim, causation and aggravation are independent concepts and should have separate findings and rationale. El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013).

The Board affords low probative value to the December 2024 opinion. Although on its surface it appears to be thorough, on closer reflection, it is inherently flawed. First, the examiner only addressed the GERD diagnosis, they did not address the hiatal hernia. Although a Veteran may identify a particular disorder when they file a claim, the scope of the claim cannot be limited only to the disorder stated, but must be considered a claim for any disorder that may reasonably be encompassed by several factors including the description of the claim, the symptoms the claimant describes, and the information the claimant submits or that VA obtains in support of the claim. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Additionally, the examiner neglected to address the Veteran's theory of entitlement that the condition is related to the service-connected psychiatric disability. Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007).

Here, the Veteran has opinions in his favor that the hiatal hernia is related to service, and that the GERD is related to the hiatal hernia. Although the opinions are in some part flawed, rather than remanding in hopes of a more perfect opinion, the Board will afford the Veteran the benefit of the doubt and find that the criteria for the claim of entitlement to service connection for GERD and hiatal hernia have been met, and the appeal is granted.  

 

 

Thomas L. English

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Rogos, J.

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.