Service connection for gastroesophageal reflux disease (GERD) secondary to service-connected allergic rhinitis is granted.

Citation Nr: A26069906 Decision Date: 07/30/26 Archive Date: 07/30/26 DOCKET NO. 260429-652861 DATE: July 30, 2026 ORDER Service connection for gastroesophageal reflux disease (GERD) secondary to service-connected allergic rhinitis is granted. Service connection for erectile dysfunction secondary to service-connected prostatitis with epididymitis and hematospermia is granted. Service connection for migraines secondary to service-connected tinnitus is granted. FINDINGS OF FACT 1. The Veteran's GERD is secondary to service-connected allergic rhinitis. 2. The Veteran's erectile dysfunction is secondary to service-connected prostatitis with epididymitis and hematospermia. 3. The Veteran's migraines are secondary to service-connected tinnitus. CONCLUSIONS OF LAW 1. The criteria for service connection for GERD secondary to service-connected allergic rhinitis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for erectile dysfunction secondary to service-connected prostatitis with epididymitis and hematospermia have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for migraines secondary to service-connected tinnitus have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1998 to September 2002. In January 2025, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the above issues, most recently addressed in the October 2024 rating decision. In May 2025 rating decisions, the agency of original jurisdiction (AOJ) issued the supplemental claim decisions on appeal, which found that new and relevant evidence had been received and denied the claims based on the evidence of record at the time of that decision. In the April 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the May 2025 supplemental claim decisions on appeal. 38?C.F.R. § 20.301. If evidence was submitted after the AOJ issued the supplemental claim decisions on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300,?20.301, 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. 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, 1131;?38?C.F.R. §?3.303. 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). The three-element test for service connection requires evidence of: (1)?a current disability; (2)?in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Establishing service connection on a secondary basis requires evidence sufficient to show that (1) a current disability exists and (2) the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310. Secondary causation exists when, but for the service-connected disability, the nonservice-connected disability was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023). In the May 2025 rating decisions on appeal, the AOJ determined that the Veteran had current diagnoses of GERD, migraines, and erectile dysfunction, as well as participation in toxic exposure risk activity (TERA) due to confirmed service in UAE and possible chemical exposures related to military occupational specialty. Pursuant to 38 C.F.R. § 3.104(c), the Board is bound by these favorable findings absent clear and unmistakable evidence to the contrary. 1. Service connection for GERD secondary to service-connected allergic rhinitis is granted. Service treatment records are silent for silent for any complaint, diagnosis and treatment for GERD. The Veteran was shown to have no chronic illness or medical problems in the May 2001 post-deployment health assessment and June 2001 volunteer police physical examination. In the August 2001 IFC-III medical examination, there was no related abnormality. In the August 2001 Report of Medical History (RMH), the Veteran denied frequent indigestion and stomach, liver or intestinal trouble. The July 2002 separation examination indicated that there were no known medical problems, except recent treatment for resolved tinea manus. See also July 2002 Report of Medical Assessment. In October 2024 and February 2025, the Veteran was afforded a VA examination, which confirmed a diagnosis of GERD. The Veteran reported onset in 2004 with heartburn, reflux, and regurgitation symptoms. In the October 2024 opinion, the examiner indicated that the Veteran's GERD was not likely due to his TERA, including the total potential exposure and the synergistic combined effect of all TERAs. The examiner explained that there was no medical literature to support an etiological link between the Veteran's TERA and his GERD. Rather, GERD is due to a malfunctioning sphincter in the lower esophagus. In support of his claim, the Veteran submitted the December 2024 opinion of Dr. D. who reviewed the claims file. Dr. D. opined that the Veteran's GERD, which began in 2004, was likely due to his service-connected allergic rhinitis. The current medical literature documented a relationship between allergic rhinitis and the development of GERD in multiple ways. In particular, Dr. D. explained that posterior nasal dripping associated with allergic rhinitis caused increase frequency of swallowing and exacerbated GERD through increased transient lower esophageal sphincter relaxation. Allergic rhinitis also impacted the nasal mucosa and could give rise to similar effects on laryngeal mucosa leading to symptoms of laryngopharyngeal reflux and the development of GERD. Lastly, GERD can be caused by the release of histamine from mast cells which are abundantly present in patients suffering from allergic rhinitis. Upon review, the Board finds that service connection for GERD on a secondary basis is warranted. The Board finds the December 2024 opinion probative. The clinician, an internal medicine doctor, has the appropriate training, expertise and knowledge to evaluate the claimed disability. Dr. D. provided a rationale for his opinion, which included consideration of the known pathology of the Veteran's GERD in relation to his service-connected allergic rhinitis. There are no competent opinions to the contrary. Thus, the persuasive evidence is in favor of the Veteran's GERD as secondary to his service-connected allergic rhinitis. The Board considered whether service connection is warranted on a direct basis, but finds that it is not. GERD was not diagnosed during service, and consistent with this history, the Veteran has reported that GERD began in 2004 approximately two years after separation from service. Further, the October 2024 VA opinion is probative on this question. The examiner reviewed the claims file, the Veteran's lay statements, and conducted an in-person examination. The negative nexus opinion was supported with a clear and cogent rationale. Hence, the Board finds the opinion highly probative and that there is not a nexus between the Veteran's GERD and his military service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304(2008); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In summary, the evidence weighs in favor of the Veteran's GERD as secondary to his service-connected allergic rhinitis. Service connection for GERD as secondary to service-connected allergic rhinitis is granted. 38 C.F.R. § 3.102, 3.310; Lynch v. McDonough, 21 F.4th 776, 781-82 (2021). 2. Service connection for erectile dysfunction secondary to prostatitis with epididymitis and hematospermia is granted Service treatment records dated in April 2000 show the Veteran reported painful ejaculations in with an impression of prostatitis with secondary epididymitis and hematospermia. The Veteran was shown to have no chronic illness or medical problems in the May 2001 post-deployment health assessment and June 2001 volunteer police physical examination. In the August 2001 IFC-III medical examination, there was no abnormality of the genitourinary system. In the August 2001 RMH, the Veteran reported an operation to remove fluid buildup around testicles. The July 2002 separation examination indicated that there were no known medical problems, except recent treatment for resolved tinea manus. See also July 2002 RMA. At a January 2014 VA examination for male reproductive conditions, the only diagnosis was resolved epididymitis and resolved prostatitis without residuals on current exam and lab studies. The medical history showed that the Veteran was treated for epididymitis with oral antibiotics in 1999 and 2000. The Veteran did not have erectile dysfunction. In the October 2024 opinion, the VA examiner concluded that the Veteran's erectile dysfunction was not related to active service, to include as due to his TERA. The examiner noted that the Veteran reported that difficulties with achieving or maintaining an erection and painful ejaculation in 1999 and 2000 (during service). The examiner found that service treatment records were silent for erectile dysfunction, and there was no mention of erectile dysfunction in an August 2001 examination. Erectile dysfunction is a diagnosable chronic multi-symptom illness with a partially explained etiology. Erectile dysfunction is due to underlying medical conditions. Citing an article from the Mayo Clinic, the examiner indicated that these underlying conditions included heart disease, high cholesterol, high blood pressure, diabetes, obesity, and smoking. There was no medical literature to support TERA exposure causing erectile dysfunction. Thus, the Veteran's erectile dysfunction was not likely due to exposure activities, even considering the total potential exposure and the synergistic combined effect of all TERAs. In a December 2024 letter, Dr. D. (a private clinician) indicated he had reviewed the entire file, not limited to the military medical records, private medical records, VA medical records, DBQ exams, and rating decision. Dr. D. opined that the Veteran's erectile dysfunction was at least as likely as not due to his service -connected prostatitis. Like the VA examiner, Dr. D. indicated that the etiology of erectile dysfunction can come from a variety of factors ranging from an organic source to a psychogenic source. Some of the common etiologies included vascular disease, neuropathy, complications from a procedure, and as a component of mental health illness. Moreover, Dr. D. indicated that the relationship between erectile dysfunction and existing prostatitis is well-established in the current medical literature. Dr. D. explained that, in diseased prostatic tissue from men, decreased nitrergic innervation was demonstrated, which suggests a lack of vasodilatation leading to the development of erectile dysfunction. At a February 2025 VA examination, a diagnosis of erectile dysfunction, with or without penile deformity was noted. The Veteran indicated that painful ejaculation began in 1999 and 2000, and difficulty achieving or maintaining an erection began in 1999. At that time, he was diagnosed with prostatitis with epididymitis for painful ejaculation. In a May 2025 VA opinion, a VA examiner reached a different conclusion. The examiner opined that the Veteran's erectile dysfunction was not likely due to service or proximately due to his service-connected prostatitis. The examiner noted that there were no treatment or complaints of erectile dysfunction in service treatment records. The examiner acknowledged that prostatitis and epididymitis can be a cause or contributing factor to erectile dysfunction. However, the examiner indicated that this is not known to cause erectile dysfunction in and of itself. The examiner explained that the Veteran's prostatitis was an acute infection that was treated per records, and the Veteran did not have ongoing prostatitis. Thus, it would be mere speculation to state that the Veteran's ongoing erectile dysfunction would have been solely caused by the past history of acute prostatitis and epididymitis. Therefore, the examiner concluded that it was less likely than not proximately due to or the result of the Veteran's prostatitis with epididymitis and hematospermia. Upon review, the Board finds that service connection on a secondary basis is warranted. There are conflicting opinions concerning the etiological relationship of the Veteran's erectile dysfunction to his service-connected prostatitis with epididymitis and hematospermia. The December 2024 private opinion is the most probative. That clinician considered the evidence of record, and the medical literature regarding the known development of erectile dysfunction and provided cogent rationale. The May 2025 VA The May 2025 VA examiner did not opine as to whether the Veteran's erectile dysfunction was aggravated by his service-connected disability; hence, it is not adequate for adjudicative purposes. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013). The Board considered whether service connection may be granted on a direct basis; however, the evidence persuasively weighs against this theory of entitlement. The October 2024 VA opinion is the most probative evidence regarding whether the Veteran's erectile dysfunction began during, or is directly related to, service. The examiner concluded that the Veteran's erectile dysfunction was not likely related to service, to include the Veteran's TERA participation. The examiner was competent and provided sufficient rationale for the conclusions reached. Hence, the opinion is probative. Given the above, the Board finds service connection for erectile dysfunction as secondary to his service-connected prostatitis with epididymitis and hematospermia is warranted. The appeal is granted. 38 C.F.R. § 3.102, 3.310. 3. Service connection for migraines secondary to service-connected tinnitus is granted. Service treatment records noted a complaint of headaches in April 2000. However, the Veteran was shown to have no chronic illness or medical problems in the May 2001 post-deployment health assessment and June 2001 volunteer police physical examination. In the August 2001 IFC-III medical examination, there was no head, face, neck, or scalp abnormality. In the August 2001 RMH, the Veteran denied having had frequent or severe headaches. The July 2002 separation examination did not reveal any headache or migraine condition. See July 2002 RMA. In October 2024 and February 2025, the Veteran was afforded a VA examination, which confirmed a diagnosis of migraine including migraine variants. The Veteran reported onset in 1999, during service. In the October 2024 opinion, the examiner concluded that the Veteran's migraines were not likely related to his TERAs, including the total potential exposure and the synergistic combined effect of all TERAs. The examiner considered the Veteran's report that headaches began in 1999 during service, and treatment records noted complaints of headaches; however, the subsequent examinations and treatment records were negative for frequent or severe headaches. The examiner found that the currently diagnosed disability is a diagnosable chronic multi-symptom illness with a partially explained etiology. Migraines are due to family history, misfiring neurons within the brain, underlying medical conditions, stress at work or home, and sensory stimuli (loud sounds and bright lights). There was no medical literature to support TERAs a cause of migraines. Therefore, there was no nexus between the Veteran's diagnosed migraines and his service. In support of his claim, the Veteran submitted the December 2024 private opinion of Dr. D., who concluded that the Veteran's migraine headaches were likely due to his service-connected tinnitus. The clinician explained that the association between tinnitus and chronic headaches was widely accepted in contemporary medicine. The clinician explained that there may be a connection regarding how the brain neurologically interprets input or a biochemical component. Specifically, both the central pain processing network and the trigeminal system represent a common link in the pathophysiology of idiopathic headache syndromes and the presence of tinnitus. As to the biochemical component, the trigeminal nerve input interacts with the activity of central auditory pathways. In addition, the trigeminal nerve releases inflammatory peptides which could cause headaches. Upon review, the Board finds that service connection for migraine on a secondary basis is warranted. The Board finds the December 2024 opinion probative. As noted above, Dr. D. is competent to evaluate the claimed disability. He also provided a rationale for his opinion, which included consideration of the known pathology of the Veteran's migraine in relation to his service-connected tinnitus. There are no competent opinions to the contrary. Thus, the persuasive evidence is in favor of the claim for secondary service connection. The Board has also considered the direct theory of entitlement. On this question, the October 2024 VA opinion is the most probative evidence. The opinion is adequate as it is based on an accurate factual premise and reasoned analysis with supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Hence, the Board finds the opinion probative on the matter of nexus between the Veteran's migraines and his military service. In summary, the evidence weighs in favor of the Veteran's migraines as secondary to his service-connected tinnitus. However, the evidence persuasively weighs against finding that the Veteran's migraines were related to an in-service disease or injury, to include any exposure activity. Service connection for migraines as secondary to service-connected tinnitus is granted. 38 C.F.R. § 3.102, 3.310. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Vuong, K. 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.