GASTROESOPHAGEAL REFLUX DISEASE (GERD)

LESLEY A. REIN · 2026 · Case ID: A26037365

MIXED

Summary

The veteran, who served from January 2017 to May 2020, appeals the denial of service connection for acid reflux, traumatic brain injury (TBI), and chronic fatigue syndrome (CFS). The Board denied service connection for acid reflux, finding no current diagnosis or functional impairment, and noting the Veteran's symptoms were attributed to an understood etiology, not an undiagnosed illness under Persian Gulf War presumptions. For TBI, the Board found no current diagnosis or persistent symptoms, despite the Veteran's testimony of hitting his head in service and subsequent headaches, as VA treatment records were silent and a screening was negative. For CFS, the Board found the Veteran's fatigue symptoms were related to his service-connected PTSD, not a separate CFS diagnosis, and that the VA examination was highly probative in this medically complex issue. The Board considered the benefit of the doubt doctrine for all denied claims but found it inapplicable as the evidence weighed against the claims. The claim for bilateral plantar fasciitis was remanded due to an inadequate VA examination that failed to address the Veteran's contentions of in-service onset due to carrying heavy gear and patrols in rough terrain.

Rationale

No current diagnosis of esophageal disability; No functional impairment in earning capacity from symptoms; No in-service or post-service treatment/complaints for acid reflux

Special Benefit

NO SPECIAL BENEFIT

Docket No.

240301-420636

Full Decision Text

Citation Nr: A26037365
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 240301-420636
DATE: April 21, 2026

ORDER

Entitlement to service connection for acid reflux is denied.

Entitlement to service connection for traumatic brain injury (TBI) is denied.

Entitlement to service connection for chronic fatigue syndrome (CFS) is denied.

REMANDED

Entitlement to service connection for bilateral plantar fasciitis (claimed as bilateral foot pain) is remanded.

FINDINGS OF FACT

1. The Veteran does not have a current esophageal disability, to include symptoms that result in functional impairment in earning capacity.

2. The Veteran does not have a current diagnosis of a TBI.

3. The Veteran does not have a current diagnosis of CFS; his fatigue is a symptom of his service-connected posttraumatic stress disorder.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for acid reflux have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for a TBI have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for CFS have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 2017 to May 2020.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from October 2023, December 2023, and February 2024 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office, which is the Agency of Original Jurisdiction (AOJ).

In the March 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held in January 2026. A transcript of the hearing is of record.

Therefore, for the acid reflux and bilateral plantar fasciitis claims, the Board may only consider the evidence of record at the time of the October 2023 AOJ decision on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. For the TBI claim, the Board may only consider the evidence of record at the time of the December 2023 AOJ decision on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. For the CFS claim, the Board may only consider the evidence of record at the time of the February 2024 AOJ decision on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a).

Evidence submitted either (1) during the period after the AOJ issued the decisions on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, was not considered by the Board in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. Here, evidence was not submitted during a period the Board could not consider. Nonetheless, specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease 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).

Direct service connection may not be granted without evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

VA is authorized to compensate any Persian Gulf Veteran with a chronic disability resulting from an undiagnosed illness, or combination of undiagnosed illnesses, which became manifest at anty time and to any degree following service in
disease was incurred in service. 38 C.F.R. § 3.303(d).

VA is authorized to compensate any Persian Gulf Veteran with a chronic disability resulting from an undiagnosed illness, or combination of undiagnosed illnesses, which became manifest at anty time and to any degree following service in the Southwest Theater of Operations during the Persian Gulf War. 38 U.S.C. § 1117. VA has conceded that the Veteran is a Persian Gulf Veteran. See January 2023 VA Memo.

The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997). In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

For the current disability element of a service connection claim to be met, the disability must be present at the time the claim was filed or at any time during the pendency of the appeal, even if it resolves prior to adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319 (2007).

1. Entitlement to service connection for acid reflux.

The Veteran contends that he experiences acid reflux related to food eaten during service and the environment See January 2023 VA Form 21-526EZ and January 2026 Board Hearing Transcript.

The Board acknowledges that while the Veteran is considered to be a Persian Gulf War Veteran, his claimed acid reflux disability has been attributed to an understood, conclusive pathophysiology or etiology, which means that it is not considered "a qualifying chronic disability" that may result from an undiagnosed illness or a medically unexplained chronic multisymptom illness. Therefore, the Board finds that service connection based on the presumption in favor of Persian Gulf War veterans is not warranted in this case. 38 C.F.R. § 3.317.

In making this determination, the Board finds the September 2023 VA Gulf War examination highly probative. The examiner indicated that there were no diagnosed illnesses for which no etiology was established. Specifically, there was no evidence of a disorder with no etiology, or any "undiagnosed illness" or "diagnosed medically unexplained chronic multisymptom illness." Id.

Regarding service connection on a direct basis, in September 2023 the Veteran was afforded a VA esophageal condition examination. The Veteran reported current symptoms of nausea, stomach pain, and chest pain that impacted him when eating certain foods. The examiner noted that there were no encounters, complaints, or treatments for gastroesophageal reflux disease, acid reflux, or heartburn in the Veteran's medical records or during his active-duty service of thereafter. The examiner noted that there was no trial of proton pump inhibitors (PPI) to offer a clinical diagnosis.

In a January 2026 Board hearing, the Veteran testified that he experiences lots of heartburn and uses the restroom often. He reported that he takes over the counter medications for his reflux.

A review of the Veteran's medical records does not show complaints, treatment, or diagnosis of an acid reflux disability.

Thus, the Board finds that the evidence weighs against finding that the Veteran has a currently diagnosed esophageal disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain, 21 Vet. App. at 321.

Although the Veteran reported symptoms of nausea, stomach pain, and chest pain when eating certain foods, he did not state, and the record does not show, that these symptoms created functional impairment in earning capacity. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Veteran's subjective reports of symptoms are not a disability that meets the first element of a service connection claim.

The Board finds the evidence of record persuasively weighs against finding that the Veteran has a current diagnosis of an esophageal disability. Therefore, entitlement to service
26 Vet. App. 289, 294 (2013); McClain, 21 Vet. App. at 321.

The Board finds the evidence of record persuasively weighs against finding that the Veteran has a current diagnosis of an esophageal disability. Therefore, entitlement to service connection is not warranted, and the claim is denied.

In reaching this decision the Board considered the benefit of the doubt doctrine, however, as the evidence persuasively weighs against the claim, the doctrine is not for application. 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).

2. Entitlement to service connection for TBI.

The Veteran contends that he has a current TBI disability related to an incident in service when he struck his head. See October 2023 VA Form 21-526EZ.

The Veteran's service treatment records do not show any evidence of a disease or injury in service that may serve as a basis for a TBI. However, in a January 2026 Board hearing, the Veteran testified that he hit his head during a training exercise in service. He testified that he was in a Bradley when it fell into the water. He was in the gunner seat and hit his head going forward. He testified that he felt a sharp pain. He did not experience a loss of consciousness, but he testified that he began experiencing headaches afterwards.

A review of the Veteran's medical records post-separation is silent for complaints, treatment, or diagnosis of a TBI. Indeed, an April 2022 VA treatment record documents a negative TBI screening.

The Veteran reported that he began experiencing headaches after he hit his head in service. The Board notes that the Veteran is currently service connected for a migraine disability. See October 2025 Rating Decision. The Veteran has not reported any other persistent or recurrent symptoms related to a TBI. Further, he has not shown that he has any other symptoms associated with a TBI that result in functional impairment of earning capacity. See Saunders, 886 F.3d 1356.

The Board acknowledges that there is no VA examination of record in connection for this claim. However, the evidence of record does not show competent evidence of a current disability or persistent or recurrent symptoms of a disability. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, the low threshold set forth in McLendon is not satisfied and VA was not required to provide an examination. Id. There was no pre-decisional duty to assist error.

Accordingly, the Board finds the evidence of record persuasively weighs against finding that the Veteran has a current diagnosis of a TBI. Therefore, entitlement to service connection is not warranted, and the claim is denied.

3. Entitlement to service connection for CFS.

The Veteran contends that he has CFS that is related to his deployments during service. See December 2023 VA Form 21-526EZ.

There is a specific standard for "chronic fatigue syndrome" as a diagnosis. Applicable VA regulations specifically define "chronic fatigue syndrome" at 38 C.F.R. § 4.88a in terms of identifying characteristics. A diagnosis of CFS requires: (1) new onset of debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least six months; and (2) the exclusion, by history, physical examination, and laboratory tests, of all other clinical conditions that may product similar symptoms; and (3) six or more of the following: (i) acute onset of the condition; (ii) low grade fever; (iii) nonexudative pharyngitis; (iv) palpable or tender cervical or axillary lymph nodes; (v) generalized muscle aches or weakness; (vi) fatigue lasting 24 hours or longer after exercise; (vii) headaches (of a type, severity, or pattern that is different from headaches in a pre-m
fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least six months; and (2) the exclusion, by history, physical examination, and laboratory tests, of all other clinical conditions that may product similar symptoms; and (3) six or more of the following: (i) acute onset of the condition; (ii) low grade fever; (iii) nonexudative pharyngitis; (iv) palpable or tender cervical or axillary lymph nodes; (v) generalized muscle aches or weakness; (vi) fatigue lasting 24 hours or longer after exercise; (vii) headaches (of a type, severity, or pattern that is different from headaches in a pre-morbid state); (viii) migratory joint pains; (ix) neuropsychologic symptoms; (x) sleep disturbance. 38 C.F.R. § 4.88a.

The Veteran was afforded a VA examination in February 2024. The Veteran reported that he is currently having a hard time with excessive tiredness. The examiner noted that the Veteran did not have a current diagnosis of CFS because the symptoms the Veteran is experiencing are related to his mental health condition rather than a separate diagnosis of CFS.

In a January 2026 Board hearing, the Veteran testified that he rarely experiences a full eight hours of sleep. He testified that he usually gets around four to five hours of sleep per night, and he lacks energy throughout the day. He testified that he was prescribed vitamin D to help with the tiredness.

The Board acknowledges the Veteran's belief that he has a current diagnosis of CFS. While he is competent to report experiencing symptoms fatigue and tiredness, he is not competent to provide a diagnosis or determine that these symptoms are manifestations of CFS. The issue is medically complex. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).

The Board finds the February 2024 VA examination highly probative. The examination was conducted by a qualified medical professional who conducted an in-person examination of the Veteran and reviewed his medical history. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

Based on the above, the Board finds that the evidence weighs against finding that the Veteran has a current, separate diagnosis of CFS and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321. The Veteran is currently compensated for his symptoms of fatigue as a result of his service-connected psychiatric disability.

Accordingly, entitlement to service connection for CFS is not warranted. The claim is denied.

REASONS FOR REMAND

1. Entitlement to service connection for bilateral plantar fasciitis.

The Veteran contends that his current foot disability is related to carrying 50-pound gear and a machine gun, along with conducting daily patrols in a rough terrain during service. See January 2023 VA Form 21-526EZ.

The Veteran was afforded a VA examination in September 2023. The examiner opined that the Veteran's bilateral plantar fasciitis was less likely than not related to service. The examiner noted that there are no encounters, complaints, or treatments of a chronic foot condition during service. The examiner noted that the Veteran's separation examination was silent for a foot disability. The examiner noted that the Veteran performed hard labor and opined that was the reason why his feet hurt.

The Board finds the September 2023 VA examination inadequate. The opinion relies on the lack of contemporaneous medical records. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). The examiner relates the Veteran's bilateral foot disability to his current occupation. However, the examiner did not address the Veteran's contention that his bilateral foot pain had its onset in service due to carrying heavy gear/weapons daily on rough terrain during service. Failure to obtain a VA opinion addressing these contentions constitutes a pre-decisional duty to assist error. Remand is warranted to correct this error.

The Board emphasizes that it is not determining whether or not the Veteran's statements regarding the onset of his bilateral foot pain are credible at this time, as the additional development set forth in the directives below could impact that determination. Although the Board is requesting a medical opinion regarding this statement
1, 1337 (Fed. Cir. 2006). The examiner relates the Veteran's bilateral foot disability to his current occupation. However, the examiner did not address the Veteran's contention that his bilateral foot pain had its onset in service due to carrying heavy gear/weapons daily on rough terrain during service. Failure to obtain a VA opinion addressing these contentions constitutes a pre-decisional duty to assist error. Remand is warranted to correct this error.

The matter is REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate examiner to determine the nature and etiology of the Veteran's bilateral plantar fasciitis. The examiner is asked to opine as to the following:

(a.) Whether the Veteran's bilateral plantar fasciitis is related to his active-duty service.

Although an independent review of the claims file is required, the Board calls attention to the following:

(a.) A January 2023 VA Form 21-526EZ in which the Veteran reported that daily patrols in rough terrain, carrying 50-pound gear on marches and field training, and carrying a machine gun caused bilateral foot pain during service.

(Continued on the next page)

A complete rationale should be provided for any opinion expressed.

LESLEY A. REIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Dennis, Associate Counsel

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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