IRRITABLE COLON SYNDROME (SPASTIC COLITIS MUCOUS COLITIS)

LESLEY A. REIN · 2026 · Case ID: A26002925

MIXED

Summary

The Veteran, who served in the U.S. Navy and Marine Corps Reserve from September 1985 to May 1988, appeals the denial of service connection for gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS). The GERD claim was denied because the Board found the evidence weighed against service connection, deeming the private medical opinion inadequate due to its speculative and conclusory nature, while finding the VA examiner's opinions more persuasive. The VA examiners noted the absence of GERD in service treatment records, the lack of a direct link between in-service symptoms like gastritis and sea sickness to GERD, and the absence of a known association between asbestos exposure and GERD. The Board also denied GERD as secondary to generalized anxiety disorder or chronic migraines, insomnia, and tinnitus, citing a lack of medical evidence supporting these links. The IBS claim was remanded due to a duty to assist error, as the VA examiner's opinion did not adequately address whether in-service symptoms were indicative of IBS or explain the lack of a definitive cause for IBS. The remand also requires addressing the Veteran's theory that immunizations caused his IBS and considering his lay statements regarding symptom continuity. The Board emphasized that it was not finding the Veteran's contentions credible at this stage, but rather remanding for further development.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250124-511231

Full Decision Text

Citation Nr: A26002925
Decision Date: 01/13/26 Archive Date: 01/13/26

DOCKET NO. 250124-511231
DATE: January 13, 2026

ORDER

Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to generalized anxiety disorder, and to include as due to in-service asbestos exposure, is denied.

REMANDED

Entitlement to service connection for irritable bowel syndrome (IBS), to include as due to in-service asbestos exposure, is remanded.

FINDING OF FACT

The most persuasive evidence demonstrates that the Veteran's currently diagnosed GERD did not have its onset during active duty service and was not otherwise etiologically related to service; nor was it caused or aggravated by a service-connected disability.

CONCLUSION OF LAW

The criteria for entitlement to service connection for GERD, to include as secondary to generalized anxiety disorder, and to include as due to in-service asbestos exposure, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the U.S. Navy from September 1985 to May 1988 with additional periods of service in the Marine Corps Reserve.

The rating decision on appeal was issued in January 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the January 24, 2025 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 January 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted after the AOJ issued the decision 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.

Finally, in the January 2025 rating decision, the AOJ found that new and relevant evidence had been received to reconsider the claims of entitlement to service connection for GERD and IBS. This is a favorable finding by the AOJ and the Board will proceed to the address the claims on the merits. See 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c).

Service Connection

1. Entitlement to service connection for GERD, to include as secondary to generalized anxiety disorder, and to include as due to in-service asbestos exposure

The Veteran asserts that his GERD developed due to his generalized anxiety disorder. See November 2023 VA Form 21-526EZ.

However, VA is obligated to consider all theories of entitlement reasonably raised by the record. See Robinson v. Peake, 21 Vet. App. 545, 553 (2008), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009); see also Schroeder v. West, 212 F.3d 1265, 1271 (Fed. Cir. 2000). In this case, VA has conceded that the Veteran had a minimal probability of exposure to asbestos while serving aboard the U.S.S. Stump (DD-978). See April 2024 VA memorandum and June 2024 rating decision. Even though the Veteran did not explicitly raise this theory of entitlement, the Board is obligated to address it.

The question before the Board is whether the Veteran's GERD is etiologically related to his active duty service or caused or aggravated by a service-connected disability. Based on a careful review of all the subjective and clinical evidence, the Board finds that the most persuasive evidence weighs against finding service connection for GERD is warranted.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110;
serving aboard the U.S.S. Stump (DD-978). See April 2024 VA memorandum and June 2024 rating decision. Even though the Veteran did not explicitly raise this theory of entitlement, the Board is obligated to address it.

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). Generally, service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In addition, service connection may be established on a secondary basis for a disability which is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).

With regard to the Veteran's asbestos exposure, the Board recognizes that there are no statutes specifically dealing with asbestos and service connection for asbestos related diseases and the Secretary of VA has not promulgated any specific regulations. An opinion by VA's Office of General Counsel discussed the development of asbestos claims. See VAOPGCPREC 4-2000.

VA has acknowledged that a relationship exists between asbestos exposure and the development of certain diseases, which may occur 10 to 45 years after exposure. When considering VA compensation claims, rating boards have the responsibility of ascertaining whether or not military records demonstrate evidence of asbestos exposure in service and of ensuring that development is accomplished to ascertain whether or not there was pre-service and/or post-service evidence of occupational or other asbestos exposure. A determination must then be made as to the relationship between asbestos exposure and the claimed diseases, keeping in mind the latency and exposure information noted above.

Asbestos particles have a tendency to break easily into tiny dust particles that can float in the air, stick to clothes, and may be inhaled or swallowed. Inhalation of asbestos fibers can produce fibrosis and tumors. The most common disease is interstitial pulmonary fibrosis (asbestosis). Asbestos fibers may also produce plural effusion and fibrosis, pleural plaque, mesotheliomas of pleura and peritoneum, lung cancer, and cancers of the gastrointestinal tract. Lung cancer associated with asbestos exposure originates in the lung parenchyma, rather than the bronchi.

Occupations involving asbestos exposure include mining and milling, shipyard and insulation work, demolition of old buildings, construction, manufacture and servicing of friction products such as clutch products and brake linings, manufacture and insulation of roofing and flooring materials, sheet and pipe products, and so forth. High exposure to asbestos and the high prevalence of disease have been noted in insulation and shipyard workers. The clinical diagnosis of asbestosis requires a history of asbestos exposure and radiographic evidence of parenchymal lung disease. It should be noted that there is no presumption that a veteran was exposed to asbestos in-service.

In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit-of-the-doubt when the competing evidence is in "approximate balance" or "nearly equal." That is, exact equipoise is not required to trigger the favorable benefit-of-the-doubt rule. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (en banc).

The Veteran's service records document that his military occupational specialty
a veteran was exposed to asbestos in-service.

The Veteran's service records document that his military occupational specialty (MOS) was Signalman. He served aboard the U.S.S. Stump (DD-978) in 1986 and 1987. As noted above, based on his MOS and his service aboard the U.S.S. Stump, the Veteran had a minimal probability of asbestos exposure.

The Veteran's service treatment records (STRs) document that he entered active duty service with a normal mouth and throat and abdomen and viscera clinical evaluation. See February 1985 enlistment examination. At a February 1986 clinic visit, the Veteran complained of having diarrhea, vomiting, headache, chills, and stomach cramps that morning. His last meal was the prior day at noon, and he had been unable to hold down any food or liquids since then. He was allergic to penicillin and was not taking any medications. After conducting an objective evaluation, the Veteran was diagnosed with gastritis. A day later, the Veteran returned indicating that the treatment with medication had improved his symptoms. He no longer had any vomiting or diarrhea. He was diagnosed with resolving gastritis. At a December 1986 clinic visit, the Veteran sought treatment for complaints of nausea and vomiting due to the high seas. Since he ate breakfast, he had vomiting 7 to 10 times. He felt faint, but had no loss of consciousness. There was no change in bowel movements. An objective evaluation revealed a nontender abdomen and increased discomfort. He was diagnosed as sea sick. A day later, the Veteran returned to the clinic complaining of nausea and vomiting for the past 24 hours. He also had dizziness and blurred vision. He had not eaten or drank for 48 hours. His examination was unremarkable. He was diagnosed with sea sickness and nausea and vomiting with secondary dehydration. At a May 1988 separation examination, the Veteran had a normal mouth and throat and abdomen and viscera clinical evaluation.

The record includes STRs during the Veteran's Marine Corps Reserve service. At an April 1990 physical, the Veteran had a normal mouth and throat and abdomen and viscera clinical evaluation, and on his associated report of medical history, he affirmatively denied having frequent indigestion or heartburn, stomach, liver, intestinal trouble, or ulcer, and rupture/hernia. He reported having car, train, sea, or air sickness. The examining physician noted that the Veteran had sea sickness, which was not considered disabling. At a June 1990 quadrennial examination, the Veteran had a normal mouth and throat and abdomen and viscera clinical evaluation, and on his associated report of medical history, he affirmatively denied having frequent indigestion or heartburn, stomach, liver, intestinal trouble, or ulcer, rupture/hernia, and car, train, sea, or air sickness. At a January 1991 Reserve separation examination, the Veteran had a normal mouth and throat and abdomen and viscera clinical evaluation, and on his associated report of medical history, he affirmatively denied having frequent indigestion or heartburn, stomach, liver, intestinal trouble, or ulcer, and rupture/hernia. He reported having sea sickness. At a July 1992 examination, the Veteran had a normal mouth and throat and abdomen and viscera clinical evaluation, and on his associated report of medical history, he affirmatively denied having frequent indigestion or heartburn, stomach, liver, intestinal trouble, or ulcer, and rupture/hernia. He reported having car, train, sea, or air sickness. On a September 1993 report of medical history, the Veteran affirmatively denied having frequent indigestion or heartburn, stomach, liver, intestinal trouble, or ulcer, and rupture/hernia. He reported having car, train, sea, or air sickness. At a June 1997 examination, the Veteran had a normal abdomen and viscera clinical evaluation, and on his associated report of medical history, he affirmatively denied having frequent indigestion or heartburn, stomach, liver, intestinal
medical history, he affirmatively denied having frequent indigestion or heartburn, stomach, liver, intestinal trouble, or ulcer, and rupture/hernia. He reported having car, train, sea, or air sickness. On a September 1993 report of medical history, the Veteran affirmatively denied having frequent indigestion or heartburn, stomach, liver, intestinal trouble, or ulcer, and rupture/hernia. He reported having car, train, sea, or air sickness. At a June 1997 examination, the Veteran had a normal abdomen and viscera clinical evaluation, and on his associated report of medical history, he affirmatively denied having frequent indigestion or heartburn, stomach, liver, intestinal trouble, or ulcer, and rupture/hernia. He reported having car, train, sea, or air sickness. The examining physician noted that the Veteran had a history of sea sickness, which was treated with patches, and he "did well." On an April 2006 report of medical history, the Veteran affirmatively denied having frequent indigestion or heartburn, stomach, liver, intestinal trouble, or ulcer, rupture/hernia, and car, train, sea, or air sickness.

During the applicable evidentiary window, the Veteran submitted private treatment records documenting his treatment for GERD and IBS. At a December 2023 private clinic visit, the Veteran reported that he had constant diarrhea, which he thought was due to anthrax shots given at work as well as his work environment. He said that the symptoms began in 1988. He also reported having dysphagia once every few weeks, which started as burning and was made worse by anxiety. He also reported having abdominal pain and nausea. The Veteran's private physician diagnosed him with IBS with diarrhea and GERD, which occurred intermittently and was controlled by diet. At a February 2024 private clinic visit, the Veteran reported that his diarrhea started after service, that other servicemembers had the same problems, and that he thought it was due to his exposure to anthrax. The Veteran's private physician diagnosed him with IBS with diarrhea and GERD.

At an April 2024 VA esophageal conditions examination, the Veteran reported that soon after he was aboard the ship during service, he started having bad motion sickness, dry heaving, and was vomiting. He said that he was diagnosed with GERD sometime after 1986. He reportedly managed his GERD by his diet and over-the-counter medications as needed for his symptoms of heartburn and acid reflux. After conducting an objective evaluation, the April 2024 VA examiner diagnosed the Veteran with GERD. The April 2024 VA examiner opined that the Veteran's GERD was less likely than not caused by the minimal probability of exposure to asbestos after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all toxic exposure risk activities of the Veteran. In providing a rationale, the April 2024 VA examiner referenced medical literature, which explained that GERD develops when one's lower esophageal sphincter becomes weak or relaxes when it should not, and thereby lets gastric contents refluxing up toward the esophagus and eroding its lining. The April 2024 VA examiner noted that there were multiple factors that may affect the lower esophageal sphincter and lead to GERD including: being overweight or having obesity; smoking or inhaling secondhand smoke; some medications can cause GERD or make GERD symptoms worse; and a hiatal hernia can also increase the change of getting GERD or make GERD symptoms worse, as it is a condition in which the opening in one's diaphragm lets the upper part of the stomach move up into one's chest. However, the April 2024 VA examiner found that asbestos exposure is not known to be a risk factor for the development of GERD.

In July 2024, the Veteran submitted an opinion from his private treating physician, Dr. M.G. Dr. M.G. Dr. M.G. stated that the Veteran's symptoms of nausea and vomiting initially started with symptoms of sea sickness while in the U.S. Navy. Dr. M.G. opined that these symptoms have "since persisted and been diagnosed as GERD and IBS which can be attributed to chemical and other exposures during his military service."

In a December 2024 VA addendum opinion, the VA examiner opined that the Veteran's GERD was less likely than not incurred in or caused by active duty service, including sea sickness, gastritis, diarrhea, vomiting, and stomach cramps during service. In providing a rationale, the December 2024 VA examiner referenced medical literature and reiterated the same discussion of the pathology of
. Dr. M.G. stated that the Veteran's symptoms of nausea and vomiting initially started with symptoms of sea sickness while in the U.S. Navy. Dr. M.G. opined that these symptoms have "since persisted and been diagnosed as GERD and IBS which can be attributed to chemical and other exposures during his military service."

In a December 2024 VA addendum opinion, the VA examiner opined that the Veteran's GERD was less likely than not incurred in or caused by active duty service, including sea sickness, gastritis, diarrhea, vomiting, and stomach cramps during service. In providing a rationale, the December 2024 VA examiner referenced medical literature and reiterated the same discussion of the pathology of GERD as noted by the April 2024 VA examiner. Noting that the Veteran's STRs were silent about a diagnosis of GERD, the December 2024 VA examiner stated that sea sickness, gastritis, diarrhea, vomiting, and stomach cramps do not cause GERD.

The Board recognizes that the record includes conflicting medical opinions regarding the etiology of the Veteran's GERD. With regard to the medical opinions obtained, as with all types of evidence, it is the Board's responsibility to weigh the conflicting medical evidence to reach a conclusion as to the ultimate grant of service connection. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The Board may favor the opinion of one competent medical expert over another if its statement of reasons and bases is adequate to support that decision. Owens v. Brown, 7 Vet. App. 429, 433 (1995). Stated another way, the Board decides, in the first instance, which of the competing medical opinions or examination reports is more probative of the medical question at issue. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 300 (2008).

In this case, the Board finds that the favorable July 2024 opinion provided by Dr. M.G. is inadequate. The private physician opined that the Veteran's GERD symptoms have persisted and been diagnosed since service and could be attributed to chemical and other exposures during service. However, the private physician did not indicate that he had reviewed the Veteran's STRs and did not provide an underlying rationale for his opinion. Moreover, Dr. M.G.'s opinion is more speculative than definitive in suggesting an association with chemicals and other exposures as the cause of the Veteran's GERD. For these reasons, the Board finds that the July 2024 private opinion is both speculative and conclusory, and thus, the Board cannot rely on it to decide the claim, as it provides no probative value. See Nieves-Rodriguez v. Peake, 22?Vet. App.?295, 300 (2008) (holding that a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two).

Nevertheless, the Board finds that the April 2024 and December 2024 VA examiners' opinions provide the most persuasive evidence regarding the etiology of the Veteran's GERD. The opinions were based on a review of the Veteran's relevant medical records, an objective evaluation, and consideration of his lay assertions. Although the Veteran asserts that his GERD was diagnosed during service, the December 2024 VA examiner found no such evidence. The Veteran's STRs document that he was diagnosed with gastritis in February 1986; however, the December 2024 VA examiner explicitly found that gastritis does not cause GERD. Furthermore, on multiple reports of medical history during his Reserve service from 1990 through 2006, the Veteran affirmatively denied having frequent indigestion or heartburn. Indeed, the first diagnosis for GERD was documented in 2023. Finally, in addressing the Veteran's in-service minimal probability of asbestos exposure, the April 2024 VA examiner discussed relevant medical literature and found no association between GERD and asbestos. Accordingly, the Board finds that the most persuasive evidence demonstrates that service connection for GERD on a direct basis is not warranted.

Finally, the evidence does not show that the Veteran's GERD was caused or aggravated by a service-connected disability. The record shows that the Veteran has not been service-connected for generalized anxiety disorder or any other psychiatric disorder. To the extent that the Veteran asserts that his GERD was caused or aggravated by his service-connected chronic migraines, insomnia, and/or tinnitus, the record does not include any medical evidence to support such a link. Therefore, the Board concludes that there is no basis upon which to grant service connection for GERD on a secondary basis.

The Veteran is competent to report his history of heartburn and
the Board finds that the most persuasive evidence demonstrates that service connection for GERD on a direct basis is not warranted.

The Veteran is competent to report his history of heartburn and acid reflux problems and any treatment that he may have undergone. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Generally, lay evidence can be competent and sufficient evidence of a diagnosis, or to establish etiology, if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). However, given that the Veteran has not demonstrated that he has specialized medical training or expertise, the Board must find that he is not competent to provide such a medically complex opinion regarding the etiology of his GERD. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

In summary, the evidence is neither evenly balanced or approximately so with regard to whether the Veteran's claim for service connection for GERD is warranted. Rather, the evidence persuasively weighs against service connection for GERD. The benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th (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). Accordingly, the service connection claim for GERD is denied.

REASONS FOR REMAND

1. Entitlement to service connection for IBS, to include as due to in-service asbestos exposure, is remanded.

The issue of entitlement to service connection for IBS is remanded to correct a duty to assist error that occurred prior to the January 2025 decision on appeal.

In a December 2024 VA addendum opinion, the VA examiner opined that the Veteran's IBS was less likely than not incurred in or caused by active duty service, including sea sickness, gastritis, diarrhea, vomiting, and stomach cramps during service. In providing a rationale, the December 2024 VA examiner referenced medical literature and discussed the pathology of IBS. The December 2024 VA examiner also noted that the Veteran was diagnosed with IBS in 1990, two years after his military service. Noting that there was no definite cause for IBS, the December 2024 VA examiner found that sea sickness, gastritis, diarrhea, vomiting and stomach cramps are not known to cause IBS.

The Board finds that the December 2024 VA examiner's opinion is inadequate. The December 2024 VA examiner does not address that diarrhea, vomiting, and stomach cramps are symptoms of IBS and does not explain whether the Veteran's in-service symptoms were indicative of his currently diagnosed IBS. Accordingly, the Board finds that a remand is required to obtain a supplemental opinion and to correct a pre-decisional duty to assist error. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate).

Further, a careful review of the record shows that during private clinic visits in 2023 and 2024, the Veteran indicated his belief that his IBS was caused by an anthrax shot and other immunization shots that he was provided during his military service. VA is obligated to consider all theories of entitlement reasonably raised by the record. See Robinson v. Peake, 21 Vet. App. 545, 553 (2008), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009); see also Schroeder v. West, 212 F.3d 1265, 1271 (
examination or opinion is adequate).

The Board recognizes that the record includes a favorable July 2024 opinion from the Veteran's private treating physician, Dr. M.G. Dr. M.G. stated that the Veteran's symptoms of nausea and vomiting initially started with symptoms of sea sickness while in the U.S. Navy. Dr. M.G. opined that these symptoms have "since persisted and been diagnosed as GERD and IBS which can be attributed to chemical and other exposures during his military service." However, the Board has previously noted above that this opinion is speculative and conclusory, and thus, it is inadequate for adjudicate purposes.

The Board emphasizes that it is not determining whether or not the Veteran's statements that his IBS was related to his active duty service 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 his lay contentions, this is for thoroughness and not based on a finding that these contentions are credible.

The matter is REMANDED for the following action:

Arrange for an opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran's IBS. The examiner should respond to the following:

Opine whether the Veteran's IBS had its onset during active duty service or was otherwise etiologically related to service.

In providing the above opinion, the examiner should consider the Veteran's assertion that his immunization shots during service caused him to develop IBS.

The examiner must address the Veteran's lay reports describing the onset and continuity of his IBS symptoms, to include reports that his IBS began after military service in 1990.

The examiner should consider the Veteran's complete and relevant medical history, including the following:

(a.) February 1986 STRs documenting complaints of diarrhea, vomiting, headache, chills, and stomach cramps.

(b.) December 1986 STRs documenting complaints of nausea and vomiting with associated symptoms of dizziness and blurry vision.

(c.) A February 2023 private treatment record documenting reports of constant diarrhea and symptoms of abdominal pain and nausea.

(d.) A July 2024 private opinion indicating that the Veteran's symptoms of nausea and vomiting initially started with symptoms of sea sickness while in the U.S. Navy.

The examiner should consider the findings of the December 2024 VA examiner and explain whether the Veteran's in-service symptoms of diarrhea, vomiting, and stomach cramps were indicative of his currently diagnosed IBS.

The examiner must not rely solely on the lack of medical documentation as the basis for a negative opinion.

A complete rationale with discussion of medical literature for any opinion expressed must be provided. If an opinion cannot be expressed without resort to speculation, discuss why this is the case.

LESLEY A. REIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Journet Shaw, 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.

20.1303.

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