Citation Nr: 0003569 Decision Date: 02/11/00 Archive Date: 02/15/00 DOCKET NO. 95-34 395 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to service connection for a stomach disorder. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L. J. Nottle, Counsel INTRODUCTION The veteran served on active duty from May 1967 to December 1968. His claim comes before the Board of Veterans' Appeals (Board) on appeal from a June 1995 rating decision of the Department of Veterans Affairs (VA) Regional Office in Muskogee, Oklahoma (RO), which determined that the veteran had not submitted new and material evidence to reopen his claim of entitlement to service connection for stomach ulcers. In September 1997, the Board reopened the veteran's claim on the basis that new and material evidence had been submitted, but remanded it to the RO for additional development. The issue now before the Board is whether the veteran is entitled to service connection for a stomach disorder. FINDINGS OF FACT 1. There is no medical evidence of record linking the veteran's hiatal hernia or gastroesophageal reflux disease to his gastrointestinal complaints treated in service, or establishing that an ulcer manifested to a degree of 10 percent within a year of the veteran's discharge from service. 2. There is no medical evidence of record establishing that the veteran had a chronic stomach disorder in service, or linking the veteran's hiatal hernia or gastroesophageal reflux disease to his alleged continuity of gastrointestinal symptomatology experienced after discharge from service. CONCLUSION OF LAW The claim of entitlement to service connection for a stomach disorder is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran claims that he is entitled to service connection for a stomach disorder that first manifested during active service. The Board must initially determine whether the veteran has presented evidence sufficient to justify a belief by a fair and impartial individual that his claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). In the absence of evidence of a well-grounded claim, there is no duty to assist the veteran in developing the facts pertinent to his claim, and the claim must be denied. Epps v. Gober, 126 F.3d 1464, 1467-1468 (Fed. Cir. 1997). To establish that a claim for service connection is well grounded, the record must include lay or medical evidence, whichever is appropriate in the particular case, demonstrating that a disease or injury was incurred or aggravated during active service, and medical evidence showing that the veteran currently has a disability, and that a nexus exists between that disability and the in-service injury or disease. Id. at 1467-1468. Service connection may be presumed if it is shown that the veteran manifested peptic (gastric or duodenal) ulcers to a degree of ten percent within one year of separation from service. 38 C.F.R. §§ 3.307, 3.309(a) (1999). A claimant may also establish a well-grounded claim for service connection under the chronicity provision of 38 C.F.R. § 3.303(b), which is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service or during an applicable presumption period, and that that same condition currently exists. Such evidence must be medical unless the condition at issue is a type as to which, under case law, lay observation is considered competent to demonstrate its existence. If the chronicity provision is not applicable, a claim still may be well grounded pursuant to the same regulation if the evidence shows that the condition was observed during service or any applicable presumption period and continuity of symptomatology was demonstrated thereafter, and includes competent evidence relating the current condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488, 495-98 (1997). In this case, the veteran served on active duty from May 1967 to December 1968. His service medical records confirm that he was treated for stomach complaints during that time period. In June 1968 and July 1968, the veteran complained of intermittent stomach cramps, and the examining physicians diagnosed mild enteritis and gastritis respectively. The veteran presented twice in October 1968 and November 1968 with complaints of pain in his right side and stomach cramps. The same examining physician diagnosed colonic spasm. During the veteran's separation examination in December 1968, the veteran indicated that he had not had stomach, liver or intestinal trouble, and the examining physician noted no clinical gastrointestinal abnormalities. The veteran alleges that he continued to experience gastrointestinal symptomatology following his discharge from service. Post-service medical records confirm treatment for stomach complaints within a year of the veteran's discharge. From April 1969 to May 1969, the veteran was hospitalized at a VA hospital after complaining of upper abdominal cramps. A sigmoidoscopy was performed for the purpose of observing peptic ulcer disease, but no such disease was found. There is no medical evidence of record disclosing that the veteran was seen for stomach complaints from 1969, when he was hospitalized, to 1977. According to VA outpatient treatment records and progress notes from the office of Thomas C. Glasscock, M.D., the veteran has received intermittent treatment and has been on prescriptions for stomach complaints since 1977. In March 1993, Dr. Glasscock referred the veteran for an upper gastrointestinal examination. A report of this examination reflects that the veteran had duodenitis with perhaps a small erosion/ulcer in the apex of the duodenal bulb. In 1995 and 1997, during visits to a VA Medical Center, physicians diagnosed peptic ulcer disease and gastroesophageal reflux disease. During a VA examination in January 1998, an esophagogastroduodenoscopy and antral biopsies were conducted. These tests showed that the veteran had a sliding hiatal hernia, a normal stomach, antrum and duodenum, and no duodenitis, scarring in the duodenum or duodenal ulcer disease. Based on these findings, the examiner indicated that the veteran does not have a gastric ulcer or Helicobacter pylori infection, which explains 70 to 90 percent of gastric and duodenal ulcers, but rather, endoscopically silent gastroesophageal reflux disease and a hiatal hernia. He indicated that although it is possible that the veteran has non-ulcerative dyspepsia, it is more likely that his current complaints are caused by gastroesophageal reflux disease. Clearly, the evidence establishes that the veteran currently has a stomach disorder that has most recently been diagnosed as a hiatal hernia and gastroesophageal reflux disease. That notwithstanding, there is no evidence, beyond the veteran's contentions, linking this disorder to service, establishing that an ulcer manifested to a degree of 10 percent within a year of the veteran's discharge from service, establishing that the veteran had a chronic stomach disorder in service, or linking the veteran's hiatal hernia or gastroesophageal reflux disease to his alleged continuity of gastrointestinal symptomatology experienced after discharge from service. As the veteran is a layperson with no medical training or expertise, his contentions, alone, are insufficient to establish any of the previously noted elements of a well- grounded claim. Espiritu v. Derwinski, 2 Vet.App. 492, 494-5 (1992) (holding that laypersons are not competent to offer medical opinions). During the January 1998 VA examination, the examiner was specifically asked to determine whether the veteran's current gastrointestinal complaints relate to the documented in- service gastrointestinal complaints. The examiner, after thoroughly reviewing the veteran's service and post-service medical records, opined that no such relationship exists. He explained that the veteran's in-service complaints were likely caused by irritable bowel syndrome or possibly by non- ulcerative dyspepsia, a related disease, but not by gastroesophageal reflux disease. He also opined that neither the veteran's gastroesophageal reflux disease nor his hiatal hernia developed during his period of active service. Inasmuch as the veteran has not submitted competent medical evidence to the contrary, his claim must be denied as not well grounded. The Board acknowledges the contentions of the veteran and his representative, including those presented during a May 1997 hearing held before the undersigned Board Member. However, until competent medical evidence is submitted supporting the contentions that the veteran's current stomach complaints are related to service and/or that an ulcer was diagnosed during the 1969 VA hospitalization, the Board cannot find the claim well grounded. Moreover, contrary to the representative's argument set forth in a Written Brief Presentation dated January 2000, case law is clear. In the absence of evidence of a well-grounded claim, there is no duty to assist the veteran in developing the facts pertinent to his claim, and his claim must be denied. Epps v. Gober, 126 F.3d at 1467- 1468. ORDER Evidence of a well-grounded claim not having been submitted, entitlement to service connection for a stomach disorder is denied. WARREN W. RICE, JR. Member, Board of Veterans' Appeals