IRRITABLE COLON SYNDROME (SPASTIC COLITIS MUCOUS COLITIS)

L. STEPANICK · 2026 · Case ID: A26003581

MIXED

Summary

The Veteran, who served from September 1989 to October 1992 and again from March 2003 to June 2004, appeals decisions denying service connection for a right great toenail disability and remanding claims for lumbosacral strain and bilateral lower extremity radiculopathy. The Veteran also sought service connection for IBS and GERD, asserting they were secondary to his service-connected adjustment disorder. The Board granted service connection for IBS and GERD, finding the evidence in approximate balance and resolving doubt in the Veteran's favor, based on a favorable June 2024 VA opinion that linked these conditions to his service-connected psychiatric disorder. This opinion was given greater weight than subsequent negative opinions from other VA examiners. Service connection for the right great toenail disability was denied due to a lack of current diagnosis, symptoms affecting earning capacity, or evidence of in-service complaints or treatment. The Board noted the absence of a current diagnosis and the lack of functional impairment. The claims for lumbosacral strain and bilateral lower extremity radiculopathy were remanded due to pre-decisional duty to assist errors. Specifically, the VA examinations were deemed inadequate for failing to consider the Veteran's MOS duties and lay statements regarding heavy lifting. Additionally, the AOJ failed to obtain relevant private treatment records for the lumbar spine that were identified in the record. The case was remanded for new opinions addressing the etiology of the lumbosacral strain and radiculopathy, considering the Veteran's MOS and lay statements, and for the AOJ to obtain the outstanding private medical records.

Rationale

Favorable June 2024 VA opinion linking IBS to service-connected adjustment disorder; Approximate balance of evidence; Benefit of the doubt resolved in Veteran's favor

Special Benefit

NO SPECIAL BENEFIT

Docket No.

241216-500511

Full Decision Text

Citation Nr: A26003581
Decision Date: 01/14/26 Archive Date: 01/14/26

DOCKET NO. 241216-500511
DATE: January 14, 2026

ORDER

Entitlement to service connection for irritable bowel syndrome (IBS) is granted.

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

Entitlement to service connection for a great right toenail disability is denied.

REMANDED

Entitlement to service connection for lumbosacral strain is remanded.

Entitlement to service-connection for radiculopathy, left lower extremity (sciatic nerve) is remanded.

Entitlement to service-connection for radiculopathy, right lower extremity (sciatic nerve) is remanded.

FINDINGS OF FACT

1. The evidence is approximately balanced as to whether the Veteran's IBS is due to his service-connected adjustment disorder with mixed anxiety and depressed mood with insomnia.

2. The evidence is approximately balanced as to whether the Veteran's GERD is due to his service-connected adjustment disorder with mixed anxiety and depressed mood with insomnia.

3. The record does not show a current toenail disability, to include symptoms causing functional impairment of earning capacity.

CONCLUSIONS OF LAW

1. Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for IBS are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for GERD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for service connection for a right great toenail disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1989 to October 1992, and from March 2003 to June 2004.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2023 rating decision (toenail disability) and an October 2024 rating decision (all other issues) of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In the December 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, regarding the claim of entitlement to service connection for a right great toenail disability, the Board may only consider the evidence of record at the time of the December 2023 AOJ decision. 38 C.F.R. § 20.301. Regarding the remaining claims, the Board may only consider the evidence of record at the time of the October 2024 AOJ decision. Id.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision. 38 C.F.R. § 20.300. Regarding the issues the Board is remanding, any such evidence will be considered by the AOJ on remand. Regarding the issues the Board is deciding, if the Veteran would like VA to consider any evidence that was added to the claims file 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 related claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision.

While this appeal was pending, the AOJ awarded the Veteran service connection for IBS secondary to his service-connected adjustment disorder with mixed anxiety and depressed mood with insomnia, effective April 18, 2025. See September 2025 Rating Decision-Narrative. However, as the claim period associated with this appeal predates April 18, 2025, meaning an earlier effective date is potentially available, the issue of entitlement to service connection for IBS remains before the Board.

Service Connection

Service connection will be granted for a disability resulting from an injury or disease contracted during military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Direct
this decision.

Service Connection

Service connection will be granted for a disability resulting from an injury or disease contracted during military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Direct service connection may be granted if the evidence supports (1) a current disability, (2) an in-service incurrence or aggravation of that disability, and (3) a causal nexus between the current disability and the in-service event. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also 38 C.F.R. § 3.304. Service connection may also be granted for a disease diagnosed after discharge, when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability results from the service-connected disability. 38 U.S.C. §§ 1110, 1131; Spicer v. McDonough, 61 F.4th 1360, 1364, 1366 n.1 (Fed. Cir. 2023) (holding that section 1110 "requires compensation when a service-connected disease or injury is a but-for cause of a present-day disability" and noting that, apart from distinguishing whether service was during a period of war, 38 U.S.C. §§ 1110 and 1131 are identical).

After careful consideration of the evidence, any reasonable doubt remaining is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. If the evidence is not in approximate balance or nearly equal, the claim is to be denied. See Lynch v. McDonough, 21 F.4th 776 (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).

1. Entitlement to service connection for IBS is granted.

The Veteran was afforded a VA examination in June 2024, during which the examiner diagnosed him with IBS and provided a positive secondary nexus opinion. She explained that the current severity of his service-connected adjustment disorder with mixed anxiety and depressed mood with insomnia "warrants by proximity, association of the IBS." In support of her opinion, the examiner noted that clinical and research data suggest the importance of the brain-gut interaction in IBS and observe the high prevalence of psychiatric disorders in patients with IBS. She further stated that "recent information suggests that the association of IBS and psychiatric disorders may be more fundamental than was previously believed." The examiner concluded that the Veteran's IBS began subsequent to his service connected psychiatric condition and is the direct result of his service-connected psychiatric condition, as supported by medical literature. See June 2024 Disability Benefits Questionnaire (DBQ). The examiner offered a thorough explanation to support the conclusion, and the Board affords the opinion great probative weight.

In contrast, a September 2024 VA examiner and an October 2024 VA examiner noted the June 2024 VA examiner's diagnosis of IBS but were unable to confirm a diagnosis of IBS. See September 2024 DBQ; see also October 2024 DBQ. The October 2024 VA examiner provided a negative nexus opinion, finding that a without a diagnosis a nexus could not be established. She explained that diagnosis of IBS is not warranted "based on subjective symptoms alone" and noted that other conditions that cause similar symptoms must first be ruled out prior to the diagnosis of IBS. Both the September 2024 and the October 2024 examiners also stated that the claims file was silent for any treatment or diagnostic testing for IBS prior to the June 2024 VA examination. See September 2024 DBQ; see also October 2024 DBQ.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary is required to give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. The Board also notes that it is prohibited from developing additional evidence for the purpose of obtaining evidence against a
and noted that other conditions that cause similar symptoms must first be ruled out prior to the diagnosis of IBS. Both the September 2024 and the October 2024 examiners also stated that the claims file was silent for any treatment or diagnostic testing for IBS prior to the June 2024 VA examination. See September 2024 DBQ; see also October 2024 DBQ.

Here, the Board finds the opinion of the June 2024 VA examiner brings the evidence addressing whether the Veteran has IBS that is due to his service-connected connected adjustment disorder at least into approximate balance. Accordingly, reasonable doubt must be resolved in the Veteran's favor, and the claim is granted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Entitlement to service connection for GERD is granted.

The Veteran is also seeking service connection for GERD, which he asserts is due to his service-connected adjustment disorder with mixed anxiety and depressed mood with insomnia.

The AOJ has favorably found that the evidence shows that a qualifying event, injury, or disease had its onset during service; specifically, that the Veteran's service treatment records (STRs) dated July 29, 1992 and July 30, 1992 show treatment for viral gastritis and hematemeses. See October 2024 Rating Decision-Narrative. As noted above, the Veteran is in receipt of service connection for adjustment disorder with mixed anxiety and depressed mood with insomnia. Thus, the remaining question is whether the Veteran's GERD is related to his service or a service-connected disability. The Board finds that it is.

Turning to the evidence, the Veteran was afforded a June 2024 VA examination where he was diagnosed with GERD. The examiner provided a positive secondary nexus opinion, finding that "the current severity of the service connected adjustment disorder with mixed anxiety and depressed mood with insomnia warrants by proximity, association of the GERD." In support of her opinion, the examiner stated that it is known that anxiety and stress can trigger or worsen symptoms related to GERD, and that GERD can develop due to symptoms such as anxiety, stress, and depression which can lead to an overproduction of stomach acid; further, some medications can also cause GERD as a side effect. The examiner concluded that the Veteran's GERD began subsequent to his adjustment disorder with mixed anxiety and depressed mood with insomnia and is the direct result of the service connected psychiatric condition, as supported by medical literature. See June 2024 DBQ. The examiner offered a thorough explanation to support the conclusion, and the Board affords the opinion great probative weight.

In contrast, a September 2024 VA examiner and an October 2024 examiner both noted the June 2024 diagnosis of GERD but were unable to confirm a GERD diagnosis. See September 2024 DBQ; see also October 2024 DBQ. The September 2024 examiner noted the medical record was otherwise silent for diagnostic testing done for GERD or a GERD diagnosis or treatment. The October 2024 examiner stated that she could not determine whether the Veteran currently had signs or symptoms attributable to an esophageal condition without resorting to speculation and provided a negative secondary nexus opinion, finding that a "thorough review of the claims file is silent for chronic symptoms, treatment, and/or diagnosis of the claimed condition of GERD." She noted the Veteran's June 2024 statements that he takes pantoprazole and TUMS PRN, but found them to be subjective only, and concluded a nexus could not be established. See October 2024 DBQ.

As noted above, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary is required to give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. The Board again notes that it is prohibited from developing additional evidence for the purpose of obtaining evidence against a claimant's case. See Mariano, 17 Vet. App. 305.

Here, the Board finds the opinion of the June 2024 VA examiner brings the evidence addressing whether the Veteran's GERD is due to his service-connected connected adjustment disorder with mixed anxiety and depressed mood with insomnia at least into approximate balance. Accordingly, reasonable doubt must be resolved in the Veteran's favor,
above, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary is required to give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. The Board again notes that it is prohibited from developing additional evidence for the purpose of obtaining evidence against a claimant's case. See Mariano, 17 Vet. App. 305.

3. Entitlement to service connection for a great right toenail disability is denied.

The Veteran is seeking service connection for right great toenail removal. Specifically, he contends that "[his] service issued boots caused an issue with [his] foot that required surgery." See June 2023 VA Form 21-526EZ.

Turning to the evidence, the Board initially notes that the Veteran's STRs are silent for any complaints, treatment, or diagnosis of a right great toenail removal or surgery.

A January 29, 1990 STR documents the Veteran was treated for complaints of right foot toe pain. He reported that cold weather causes him feet pain. The clinician observed pain and swelling in the toe area when walking and assessed the Veteran with possible myospasm of the right toes. The Veteran was instructed not to run and to exercise at his own pace for two weeks. See January 29, 1990 STR.

The Veteran's STRs also reflect that he was treated for left foot plantar warts in January 1991, and for possible glass in his left heel ("patient believed he extracted all of it"). See e.g., January 14, 1991 STR; January 30, 1991 STR; February 20, 1991 STR.

A November 2002 medical exanimation documents the Veteran's feet as 'normal.' See November 2002 Medical Examination-Enlistment. In his November 2002 report of medical history for enlistment in the National Guard, the Veteran did not report a toenail removal surgery but provided information on another (hernia) surgery that occurred during his service in 1992. See November 2002 Report of Medical History-Enlistment. If he had undergone a toenail surgery at that point it is reasonable to assume that he would have also reported that surgery at the time.

A March 21, 2003 pre-deployment health assessment documents that the Veteran had not been treated by a physician or other health care provider since his last periodic physical examination and had not been hospitalized or had surgery since his last periodic physical examination. See March 21, 2003 Pre-Deployment Health Assessment.

In an April 29, 2004 post deployment report of medical assessment, the Veteran reported that his overall health was the same compared to his last medical assessment/physical examination. He also reported that since his last medical assessment/physical examination he had not been treated by a health care provider, admitted to the hospital, or had surgery. See April 29, 2024 Report of Medical Assessment -Post-Deployment.

After reviewing the record, the Board finds that the record does not contain complaints related to a right great toenail disability during or after service that required surgery or toenail removal. Post-service medical treatment records do not show a diagnosis of or treatment for a right great toenail disability, removal, or surgery. The Veteran has provided no contentions with regard to any functional impairment caused by a right great toenail disability. The Veteran is not considered medically competent to diagnose a specific toenail disability (as opposed to the symptoms he experiences) as he lacks the requisite medical expertise.

The Board concludes that the Veteran does not have a current diagnosis of a right great toenail disability or similar disability causing functional impairment of earning capacity, nor has he had such a disability at any time during the pendency of or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

In the absence of a current disability, to include symptoms causing functional impairment of earning capacity, service connection is not warranted. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (holding that the term disability "refers to the functional impairment of earning capacity, not the underlying cause of said disability"); Martinez-Bodon v. Wilkie, 32 Vet. App. 393, 398 (2020) (concluding the holding in Saunders extends beyond pain, "to include other manifestations of a condition without a diagnosis"); Wait v. Wilkie, 33 Vet. App. 8, 17 (2020) (reiterating that "to establish the presence of a disability pursuant to Saunders, there must be competent evidence specific to the claimant tending to show that his or her impairment rises to a level to affect earning capacity..."). Moreover, given the lack of a current diagnosis or any symptoms causing functional impairment of earning capacity, the AOJ did not err in issuing a decision without obtaining a medical examination.

The evidence is persuasively against the claim, and entitlement to service connection for a right great toenail disability is denied.

REASONS FOR REMAND

1. Entitlement to service connection for lumbosacral strain is remanded.

2. Entitlement to service connection for radiculopathy, left lower extremity (sciatic nerve) is remanded.

3. Entitlement to service connection for radiculopathy, right lower extremity (sciatic nerve) is remanded.

The Board must remand an appeal to the AOJ for correction of an error on the part of the AOJ to satisfy its duties under 38 U.S.C. 5103A if the error occurred prior to the date of the AOJ decision on appeal. 38 C.F.R. § 20.802. These claims must be remanded for correction of the following pre-decisional duty to assist error.

The AOJ has favorably found that the Veteran has current diagnoses of lumbosacral strain and bilateral lower extremity radiculopathy. See October 2024 Rating Decision-Narrative. It has also favorably found that the Veteran's STRs dated March 29, 1991 show treatment for back muscle spasm; that the claimed bilateral lower extremity radiculopathy is a chronic disease which may be presumptively linked to military service when it manifests to a compensable degree within one year after active duty; that the Veteran has sufficient service to meet the minimum requirements for presumptive service connection; and that his bilateral lower extremity radiculopathy is secondary to his lumbosacral strain disability. Id.

The Veteran was afforded a VA examination in December 2023. The examiner diagnosed him with lumbosacral strain and with bilateral lower extremity radiculopathy with sciatic nerve involvement. The Veteran reported that he started to have low back pain while in service "due to overuse and disuse" for which he sought medical attention. The examiner provided a negative direct nexus opinion for his back condition, stating that "there is no record of back problems while the [V]eteran was in service or after service to show chronicity of medical condition until now." The examiner reiterated the same rationale for bilateral lower extremity radiculopathy and concluded it was not proximately due to or the result of the Veteran's low back condition. See December 2023 DBQ.

Another VA opinion was issued in June 2024. The examiner acknowledged that the Veteran was treated for back pain during service but provided a negative nexus opinion. The examiner stated that the Veteran has chronic back pain and bilateral lower extremity radiculopathy, however, it could not be established that it was the back pain in 1991 that caused chronic back pain in 2023.

When VA undertakes to provide a VA examination or medical opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Here, the VA opinions are inadequate as they failed to consider the Veteran's lay statement as to the duties of repetitive heavy lifting due to his military occupational specialty (MOS) of cannon crewmember. See May 2024 HLR Informal Conference.

The AOJ should have obtained a medical opinion that addressed this evidence prior to issuing the decision on appeal, and this pre-decisional
, it could not be established that it was the back pain in 1991 that caused chronic back pain in 2023.

The AOJ should have obtained a medical opinion that addressed this evidence prior to issuing the decision on appeal, and this pre-decisional error must be corrected on remand.

In addition, a December 2023 private treatment record documents that X-ray imaging was taken of the Veteran's lumbar spine. See December 2023 Private Treatment Record (labeled C&P Exam). VA's duty to assist claimants to obtain evidence needed to substantiate a claim includes making reasonable efforts to obtain relevant private medical records. 38 C.F.R. § 3.159(c)(1).

The December 2023 private treatment record put VA on notice of the existence of outstanding and potentially relevant private treatment records at the time of the rating decision on appeal. There is no indication the AOJ attempted to obtain those records or that complete records associated with that treatment are otherwise included in the Veteran's claims file.

Therefore, the AOJ erred by failing to request those records prior to issuing the decision on appeal, and this pre-decisional duty to assist error must be corrected on remand. 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

1. Ask the Veteran to complete a VA Form 21-4142 for any private physicians who have treated him for low back pain and/or lower extremity radiculopathy, specifically Dr. E.R. indicated in the December 2023 private treatment record. If the form is received, make two requests for the records, unless it is clear after the first request that a second request would be futile. Any negative responses should be in writing and should be associated with the claims file.

2. Obtain an opinion from an appropriate clinician on the etiology of the Veteran's lumbosacral strain. If an examination is deemed necessary to respond to the questions posed, one should be scheduled. The clinician is asked to address the following after reviewing the claims file:

Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the lumbosacral strain arose during or within a year of service, or is otherwise related to an in-service injury, event, or illness? Please explain why or why not, specifically considering and discussing (1) the Veteran's MOS duties as cannon crewmember; and 2) his lay statements regarding repetitive heavy lifting while performing his MOS duties.

Please include a complete rationale for the opinion provided. If you cannot provide the requested opinion without resorting to speculation, please expressly indicate this and state why it is so.

L. STEPANICK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Hampl, Samantha

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.

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