GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Summary

The veteran, who served from May 1999 to September 2005, July 2012 to December 2012, and January 2016 to August 2016, including service in the Southwest Asia theater of operations, appeals the denial of service connection for gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA). The veteran claimed GERD was secondary to his service-connected lower back condition and OSA was secondary to his service-connected rhinitis. For GERD, the Board found the evidence in approximate balance. A VA examiner opined GERD was less likely than not related to the service-connected back condition, citing medical literature. However, a private nurse practitioner opined GERD was more likely service-connected, citing the stress and medication management associated with chronic lumbar spine issues. The Board found the private opinion probative and, affording the veteran the benefit of the doubt, granted service connection for GERD. For OSA, the Board noted the veteran's service-connected rhinitis and the lack of VA examiner discussion regarding aggravation. VA examiners opined OSA was less likely than not caused by rhinitis/sinusitis. A private nurse practitioner, however, opined that rhinitis could exacerbate or lead to OSA, and given the veteran's exposure to burn pit toxins, it was plausible this aggravated his rhinitis, contributing to OSA. The Board found this private opinion probative and concluded the evidence weighed in favor of aggravation, granting service connection for OSA secondary to rhinitis.

Rationale

Approximate balance of evidence; Benefit of the doubt applied; Prohibitive private opinion

Full Decision Text

Citation Nr: A26040598
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250115-537041
DATE: April 30, 2026

ORDER

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

Entitlement to service connection for obstructive sleep apnea (OSA) is granted.

FINDINGS OF FACT

1. The evidence is in approximate balance as to whether the Veteran's GERD was caused by his service-connected lower back condition.

2. The most probative evidence of record persuasively weighs in favor of a finding that the Veteran's OSA was aggravated by his service-connected rhinitis.

CONCLUSIONS OF LAW

1. The criteria for service connection for GERD, secondary to service-connected lower back condition on a causation basis, have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.304, 3.310.

2. The criteria for service connection for OSA, secondary to service-connected rhinitis on an aggravation basis, have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from May 1999 to September 2005, from July 2012 to December 2012, and from January 2016 to August 2016, including service in the Southwest Asia theater of operations.

This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 2024 (GERD) and a January 2025 (OSA) rating decision issued by the Department of Veterans Affairs (VA).

The January 2025 rating decision was issued in response to a June 2024 VA Form 20-0996, Decision Review Request: Higher-Level Review, seeking review of an April 2024 rating decision. In a September 2024 Higher-Level Review decision, the AOJ identified a duty to assist error in an April 2024 decision and returned the case for further review. The AOJ then issued the January 2025 rating decision on appeal.

In the January 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Submission docket. Therefore, the Board may only consider the evidence of record that the AOJ was permitted to consider at the time it issued the rating decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the issuance of the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

The Board notes that the Veteran explicitly listed the issues of service connection for GERD and OSA in the January 2025 Notice of Disagreement. The Board notes that the Veteran listed July 2021 (GERD) and December 2023 (OSA) rating decisions, which were issued more than one year prior to the January 2025 Notice of Disagreement. However, the issues were most recently denied in September 2024 (GERD) and January 2025 (OSA) rating decisions. In affording the Veteran's intent in a positive light, the Board will adjudicate based on these decisions, as is beneficial to the Veteran.

1. Entitlement to service connection for gastroesophageal reflux disease (GERD).

The Veteran contends that he developed GERD due to use of pain medication for his service-connected lower back injury.

In the September 2024 rating decision on appeal, the AOJ made a favorable finding that the Veteran has a current diagnosis of GERD, and that the claimed primary disability of lumbar spine herniated disc is service-connected. 38 C.F.R. § 3.104(c). No clear and unmistakable error has been shown by the evidence of record as to that finding; therefore, the current disability and in-service elements of the claim have been met. 

A December 2019 VA gastrointestinal consult notes a prescription to treat both his GERD and an NSAID ulcer. A June 2023 VA treatment note documents the Veteran's use of NSAID pain medication for his back and neck pain, which he has been doing since 2001. 

In July 2021, the Veteran was afforded a VA examination. The Veteran stated he had mild GERD since about 2016 and it gradually worsened since then. The examiner noted the Veteran is diagnosed with chronic back pain with a history of a L4/S1
 No clear and unmistakable error has been shown by the evidence of record as to that finding; therefore, the current disability and in-service elements of the claim have been met. 

A December 2019 VA gastrointestinal consult notes a prescription to treat both his GERD and an NSAID ulcer. A June 2023 VA treatment note documents the Veteran's use of NSAID pain medication for his back and neck pain, which he has been doing since 2001. 

In July 2021, the Veteran was afforded a VA examination. The Veteran stated he had mild GERD since about 2016 and it gradually worsened since then. The examiner noted the Veteran is diagnosed with chronic back pain with a history of a L4/S1 fusion, and the first complaint of reflux documented in 2014. The examiner then opined that medical literature does not indicate any innervation between the L5/S1 and the stomach. The examiner stated that reflux esophagitis is caused by an esophageal mucosal injury that occurs secondary to retrograde flux of gastric contents into the esophagus, Barrett's esophagus is caused by chronic or long-term regurgitation of the stomach contents up into the esophagus damages the normal inner lining of the esophagus, and hiatal hernia occurs when weakened muscle tissue allows your stomach to bulge up through your diaphragm. The examiner then stated that there is no evidence of ulcer formations that can be attributed to the use of NSAIDs to treat chronic back pain, and based on the foregoing, concluded that the Veteran's GERD was less likely than not due to or the result of his service-connected lumbar spine herniated disc, status post laminectomy.

In June 2024, the Veteran submitted a private opinion from A.S.B., an adult-gerontology primary care nurse practitioner who reviewed the Veteran's medical history, service records, and the relevant medical literature. A.S.B. noted that the Veteran underwent a laminectomy in June 2020 to treat a herniated disk in his lumbar spine. GERD is associated with chronic pain and the stress of managing such conditions, as the use of medications to manage pain and inflammation post-surgery can also contribute to the development of GERD. The physical and emotional stress associated with chronic lumbar spine issues, combined with the necessity of pain management, has likely played a role in the development and exacerbation of the Veteran's GERD and related complications. A.S.B. then concluded that the Veteran's GERD was more than likely service-connected to his lumbar spine, post laminectomy.

The Board finds that there is an approximate balance of positive and negative evidence regarding whether the Veteran's GERD is due to his service-connected back condition. The Board further notes that the June 2024 private opinion is supported by the Veteran's VA medical records reporting the use of NSAIDs since 2001 to treat his back pain and an ulcer due to NSAID use.

Accordingly, affording the Veteran the benefit of the doubt, service connection for the Veteran's GERD is warranted. 

2. Entitlement to service connection for obstructive sleep apnea (OSA).

The Veteran contends that his OSA is due to his service-connected sinusitis and rhinitis.

In the January 2025 rating decision on appeal, the AOJ made a favorable finding that the Veteran has a current diagnosis of OSA, and that the claimed primary disabilities of sinusitis and rhinitis are service-connected. 38 C.F.R. § 3.104(c). No clear and unmistakable error has been shown by the evidence of record as to that finding; therefore, the current disability and in-service elements of the claim have been met.

In November 2023, the Veteran was afforded a VA examination. The examiner opined that OSA is an anatomical condition in which the structures of the upper airway collapse during sleep, resulting in temporary obstruction of the airway, with risk factors including obesity; male gender; advanced age; pregnancy; supine sleeping position; large neck circumference; enlarged tonsils; the use of certain medications such as benzodiazepines, opioids, and sedatives; excessive alcohol consumption; and smoking. The examiner then stated that a review of the relevant medical literature failed to demonstrate a direct, causal relationship between OSA and sinusitis and/or rhinitis. Based on the foregoing, the examiner concluded that the Veteran's OSA is less likely than not due to or the result of service-connected sinusitis or rhinitis, but did not opine as to aggravation.

In September 2024, a VA examiner reviewed the Veteran's record and rendered a nexus opinion. The examiner stated that OSA is commonly known to be caused by the relaxation of various oropharynx muscles, blocking the flow of air, causing gasping, choking, and excessive snoring. Some of the
 and sedatives; excessive alcohol consumption; and smoking. The examiner then stated that a review of the relevant medical literature failed to demonstrate a direct, causal relationship between OSA and sinusitis and/or rhinitis. Based on the foregoing, the examiner concluded that the Veteran's OSA is less likely than not due to or the result of service-connected sinusitis or rhinitis, but did not opine as to aggravation.

In September 2024, a VA examiner reviewed the Veteran's record and rendered a nexus opinion. The examiner stated that OSA is commonly known to be caused by the relaxation of various oropharynx muscles, blocking the flow of air, causing gasping, choking, and excessive snoring. Some of the greatest risk factors include obesity, increased age, increased neck circumference, and being male. The examiner then concluded that, given the Veteran's risk factors, and anatomy playing a large contributory role, his OSA was less likely than not caused by sinusitis/rhinitis, but again did not opine as to aggravation.

In June 2024, the Veteran submitted a private opinion from A.S.B., an adult-gerontology primary care nurse practitioner who reviewed the Veteran's medical history, service records, and the relevant medical literature. A.S.B. stated that OSA is a condition characterized by repetitive episodes of upper airway obstruction during sleep, resulting in disrupted sleep patterns and daytime fatigue, and noted that the Veteran developed allergic rhinitis during his service. A.S.B. opined that rhinitis can contribute to the obstruction of the upper airway, thereby exacerbating or even leading to the development of sleep apnea. Given his documented exposure to burn pit toxins while serving in Kuwait, Saudi Arabia, and Qatar, it is plausible that these environmental factors aggravated his allergic rhinitis, contributing to the development of sleep apnea. Therefore, A.S.B. concluded that the Veteran's sleep apnea is more than likely associated with his service-connected allergic rhinitis.

The Board finds A.S.B.'s opinion probative, as it was based on a review of the Veteran's record and included rationale supported by relevant medical literature. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (noting that the probative value of a medical opinion derives from the factually accurate, fully articulated, sound reasoning for the conclusion). The Board further notes that the November 2023 and September 2024 VA examiners did not discuss whether the Veteran's sleep apnea was aggravated by either his sinusitis or rhinitis. The Board therefore finds the June 2024 private opinion to be the most probative nexus evidence of record.

Accordingly, the most probative evidence of record persuasively weighs in favor of a finding that the Veteran's OSA is due to his service-connected rhinitis, on an aggravation basis.

 

 

Marcus N. Fulton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Marshall, 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.