IRRITABLE COLON SYNDROME (SPASTIC COLITIS MUCOUS COLITIS)

Summary

The Veteran, a Marine Corps Veteran who served from June 1967 to June 1970 with verified service in Vietnam, appeals the denial of service connection for GERD, IBS, headaches, and erectile dysfunction, all claimed as secondary to his service-connected PTSD with insomnia disorder. The Agency of Original Jurisdiction (AOJ) had previously granted service connection for IBS, GERD, and tension headaches in October 2023, which are binding on the Board. The primary issue on appeal is erectile dysfunction. The Board considered conflicting medical opinions regarding the secondary connection of erectile dysfunction to PTSD with insomnia disorder. A January 2022 private medical opinion found it at least as likely as not that erectile dysfunction was secondary to PTSD, citing loss of sexual interest and hormonal changes associated with the mental health condition. Conversely, January 2022 and February 2021 VA medical opinions found it less likely than not, citing an organic cause. However, the Board found the VA opinions insufficient due to reliance on inaccurate information and failure to consider the Veteran's lay statements and treatment history. The Board found the private opinion more probative, and after resolving all doubt in the Veteran's favor, granted service connection for erectile dysfunction as secondary to PTSD with insomnia disorder.

Rationale

AOJ granted service connection for IBS; Binding AOJ decision; Criteria for secondary service connection met

Full Decision Text

Citation Nr: A25010157
Decision Date: 02/04/25	Archive Date: 02/04/25

DOCKET NO. 230615-356800
DATE: February 4, 2025

ORDER

Service connection for gastroesophageal reflux disease (GERD), as secondary to posttraumatic stress disorder (PTSD) with insomnia disorder, is granted.

Service connection for irritable bowel syndrome (IBS), as secondary to PTSD with insomnia disorder, is granted.

Service connection for headaches, as secondary to PTSD with insomnia disorder, is granted.

Service connection for erectile dysfunction, as secondary to PTSD with insomnia disorder, is granted.

FINDINGS OF FACT

1. In October 2022, the agency of original jurisdiction (AOJ) granted service connection for IBS to include GERD with hiatal hernia and Barrett's esophagitis, which is binding on the Board.

2. In October 2022, the AOJ granted service connection for tension headaches, as secondary to PTSD with insomnia disorder, which is binding on the Board.	

3. Resolving reasonable doubt in favor of the Veteran, his erectile dysfunction was caused as secondary to PTSD with insomnia disorder.

CONCLUSIONS OF LAW

1. The criteria for service connection for GERD, as secondary to PTSD with insomnia disorder, have been met.  38 C.F.R. §§ 3.303, 3.310. 

2. The criteria for service connection for IBS, as secondary to PTSD with insomnia disorder, have been met.  38 C.F.R. §§ 3.303, 3.310.

3. The criteria for service connection for tension headaches, as secondary to PTSD with insomnia disorder, have been met.  38 C.F.R. §§ 3.303, 3.310.

4. The criteria for service connection for erectile dysfunction, caused as secondary to PTSD with insomnia disorder, have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from June 1967 to June 1970, with verified service in the Republic of Vietnam, and subsequent reserve service.

In an April 2022 rating decision, the Department of Veterans Affairs (VA) AOJ denied the Veteran's claim to the above enumerated issues.  The Veteran's VA Form 20-0996 request for higher level review (HLR) of the April 2022 rating decision was received in February 2023.  Rating Decision, Receipt Date: April 22, 2022; VA Form 20-0996, Receipt Date: February 9, 2023.

The AOJ issued a HLR rating decision in May 2023, which is the rating decision on appeal.  Evidence considered by the AOJ in an HLR decision is limited to the evidence considered in the rating decision for which HLR is requested.  38 C.F.R. § 3.2601(f). Thus, in this case, the evidence considered by the AOJ was limited to evidence received by April 22, 2022.

The AOJ rating decision on appeal constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In a June 2023 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected direct review.  See VA Form 10182, Receipt Date: June 15, 2023.  Therefore, the Board of Veterans' Appeals (Board) may only consider the evidence of record at the time of the April 2022 AOJ decision on appeal.  38 C.F.R. §?20.301.

The Board notes that because the Veteran filed a HLR application within one year of the April 2022 rating decision denial, the question that follows is whether the Veteran submitted new and relevant evidence at the time of the February 2023 application to keep the December 2020 claim in continuous pursuit.  In this regard, in the May 2023 rating decision, the AOJ adjudicated the claims on the merits, which constitutes an implicit favorable finding of new and relevant evidence.  Therefore, the Board finds that the Veteran continuously pursued his December 2020 claim, and that the intent to file application as received on December 13, 2020, constitutes the date of the claim.  38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c).  

Except for its discussion of the Veteran's specific contentions and (where applicable) those
 new and relevant evidence at the time of the February 2023 application to keep the December 2020 claim in continuous pursuit.  In this regard, in the May 2023 rating decision, the AOJ adjudicated the claims on the merits, which constitutes an implicit favorable finding of new and relevant evidence.  Therefore, the Board finds that the Veteran continuously pursued his December 2020 claim, and that the intent to file application as received on December 13, 2020, constitutes the date of the claim.  38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c).  

Except for its discussion of the Veteran's specific contentions and (where applicable) those reasonably raised by the record, the Board has limited the analysis below to the relevant evidence required to support its findings of fact and conclusions of law.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008).

Service connection for GERD, as secondary to PTSD with insomnia disorder.

Service connection for IBS, as secondary to PTSD with insomnia disorder.

Service connection for tension headaches, as secondary to PTSD with insomnia disorder.

The present appeal includes a claim for service connection for, separately, (1) GERD; (2) IBS; and (3) headaches.  In October 2023, the AOJ granted service connection for (1) IBS to include GERD with hiatal hernia and Barrett's esophagitis; and (2) tension headaches.  Notably, the AOJ assigned one disability evaluation for both IBS and GERD even though these were claimed separately.  These decisions constitute favorable findings and are binding on the Board.  For purposes of the present appeal, therefore, service connection is granted for (1) GERD, as secondary to posttraumatic stress disorder (PTSD) with insomnia disorder; (2) IBS, as secondary to PTSD with insomnia disorder; and (3) tension headaches, as secondary to PTSD with insomnia disorder, and these claims are thus fully resolved in the Veteran's favor.

Service connection for erectile dysfunction, as secondary to PTSD with insomnia disorder.

Service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury.  38 C.F.R. § 3.310. 

The Veteran is service connected for PTSD with insomnia disorder at 50 percent from August 2020.

The Veteran has a diagnosis of erectile dysfunction, per a February 2021 VA examination.  

Thus, the question for the Board is whether the Veteran's erectile dysfunction is proximately caused or is aggravated beyond its natural progress by his PTSD with insomnia disorder.  On this question there are probative medical opinions in favor of and against the claim.  For the reasons that follow, the Board concludes that the evidence favors finding that the Veteran's erectile dysfunction is caused by his service-connected PTSD with insomnia disorder.

The evidence in favor of the claim includes January 2022 private medical opinion that it is at least as likely as not that the Veteran's erectile dysfunction is secondary to, related to, and/or aggravated by his service-connected PTSD with insomnia disorder.  Although the opinion included aggravation, the Board notes that the rationale offered was a causation rationale, such that those suffering from PTSD with insomnia disorder experience a loss in sexual interest, arousal, and overall interference in intimacy with associated erectile and orgasm incapability related to mood changes, difficulty focusing, and hormonal changes that occur related to the mental health condition.  The Board acknowledges that the private medical opinion does not include the Veteran's specific medical history apart from his diagnosis of PTSD with insomnia disorder.

The pertinent evidence against the claim includes January 2022 and February 2021 VA medical opinions that the Veteran's erectile dysfunction is less likely as not (less than 50 percent probability) proximately due to or aggravated by the Veteran's service-connected PTSD with insomnia disorder.  The rationale offered by the January 2022 VA medical examiner was that the Veteran's history is most supportive of an organic cause of erectile dysfunction.  However, the rationale relies on inaccurate information to include that the records do not identify any mental health issues associated with the veteran's ED and records also do not document any medication prescribed for PTSD, both of which are contradicted by the Veteran's treatment records and lay statements, and thus the January 2022 VA medical opinion is insufficient.  

Similarly, the February 2021 VA examiner noted the Veteran's years long use of medications to treat depression/low mood without considering the same as favorable evidence for the Veteran, erroneously concluding that because there are no medical records that therefore there is no temporal or clinical correlation between the symptoms of erectile dysfunction and
 VA medical examiner was that the Veteran's history is most supportive of an organic cause of erectile dysfunction.  However, the rationale relies on inaccurate information to include that the records do not identify any mental health issues associated with the veteran's ED and records also do not document any medication prescribed for PTSD, both of which are contradicted by the Veteran's treatment records and lay statements, and thus the January 2022 VA medical opinion is insufficient.  

Similarly, the February 2021 VA examiner noted the Veteran's years long use of medications to treat depression/low mood without considering the same as favorable evidence for the Veteran, erroneously concluding that because there are no medical records that therefore there is no temporal or clinical correlation between the symptoms of erectile dysfunction and PTSD with insomnia disorder, without considering the Veteran's lay statements that his erectile dysfunction had its onset around the time that the Veteran sought treatment for his low mood and depression.  Therefore, the February 2021 VA medical opinion is likewise insufficient.

In light of the foregoing, the Board finds that the January 2022 and February 2021 VA medical opinions have less probative value.  The Board also acknowledges the that the January 2022 favorable private medical opinion does not include the Veteran's specific medical history apart from his diagnosis of PTSD with insomnia disorder.  Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for erectile dysfunction, as secondary to PTSD with insomnia disorder, is warranted.  38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

A. C. MACKENZIE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Akkerman, Shayna R.

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.