IRRITABLE COLON SYNDROME (SPASTIC COLITIS MUCOUS COLITIS)

Summary

The veteran, who served from November 1967 to November 1971, including service in the Republic of Vietnam, appeals the denial of service connection for a gastrointestinal disorder, specifically irritable bowel syndrome (IBS) and diverticulitis. The veteran claimed the condition was due to herbicide agent exposure during service, which is presumed due to his Vietnam service. However, the Board noted that gastrointestinal disorders are not among the diseases presumptively linked to herbicide exposure under VA regulations. The veteran's service treatment records (STRs) showed no gastrointestinal complaints or diagnoses at separation. While the veteran later sought treatment for vomiting, diarrhea, and was diagnosed with IBS and diverticulosis years after service, the Board found no competent, credible evidence linking these post-service conditions to any in-service event or exposure. A December 2021 VA opinion was discounted for lack of rationale. Subsequent VA opinions in February 2022 and August 2022 concluded that the Veteran's IBS and diverticulosis were less likely than not related to service, citing the absence of in-service complaints and the conditions' later onset and age-related nature. The Board found these latter opinions more persuasive. Service connection for the gastrointestinal disorder was denied.

Rationale

No in-service complaints or diagnosis documented; Conditions diagnosed years after service; VA opinions found less likely than not related to service

Full Decision Text

Citation Nr: 22055368
Decision Date: 09/28/22	Archive Date: 09/28/22

DOCKET NO. 17-17 919
DATE: September 28, 2022

ORDER

Service connection for a gastrointestinal disorder, to include irritable bowel syndrome (IBS) and diverticulitis, is denied.

FINDING OF FACT

The Veteran's gastrointestinal disorder was not manifested during his active service or for many years thereafter and is not shown to be etiologically related to his active service.

CONCLUSION OF LAW

The criteria for service connection for a gastrointestinal disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from November 1967 to November 1971, to include service in the Republic of Vietnam.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO).

In March 2017, the Veteran requested a Board hearing.  In July 2021, the Veteran requested to withdraw his request for a hearing.  As such, the Veteran's hearing request is considered to have been withdrawn.  See 38 C.F.R. § 20.704.

In September 2021 and May 2022, the Board remanded the matter for additional development. 

Service Connection

The Veteran asserted that he had a gastrointestinal disorder due to exposure to herbicide agents during his active service.  As the Veteran had service in the Republic of Vietnam, he is presumed to have herbicide agent exposure.

Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 

To substantiate a claim of service connection, there must be evidence of a present disability; incurrence or aggravation of a disease or injury in service; and a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a).

A veteran is entitled to a presumption of service connection if he is diagnosed with certain diseases associated with exposure to certain herbicide agents, he served in the Republic of Vietnam or another prescribed area during a prescribed period, and the provisions of 38 C.F.R. § 3.307(a)(6) and (d) are met. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309. A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii). "Service in the Republic of Vietnam" includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 C.F.R.§ 3.313(a); see also Haas v. Peake, 525 F.3d 1168, 1197 (Fed. Cir. 2008).

A gastrointestinal disorder is not one of the diseases associated with exposure to certain herbicide agents, as listed in 38 C.F.R. § 3.309(e), to which the presumption of service connection applies. Thus, the Veteran is not entitled to service connection on a presumptive basis based on his herbicide agent exposure.

The question for the Board is whether the Veteran has a gastrointestinal disorder, to include IBS and/or diverticulitis that began during service or is related to an in-service injury, event, or disease, including in-service herbicide agent exposure.

The Veteran's service treatment records (STR
. Peake, 525 F.3d 1168, 1197 (Fed. Cir. 2008).

A gastrointestinal disorder is not one of the diseases associated with exposure to certain herbicide agents, as listed in 38 C.F.R. § 3.309(e), to which the presumption of service connection applies. Thus, the Veteran is not entitled to service connection on a presumptive basis based on his herbicide agent exposure.

The question for the Board is whether the Veteran has a gastrointestinal disorder, to include IBS and/or diverticulitis that began during service or is related to an in-service injury, event, or disease, including in-service herbicide agent exposure.

The Veteran's service treatment records (STRs) do not reflect any diagnosis or complaints related to a gastrointestinal disorder during his active service.  At his November 1971 separation physical, he had a normal examination with no gastrointestinal symptoms noted.

The Veteran's STRs from his reserve service show that he first treated for vomiting and diarrhea in August 1979 and was diagnosed with gastroenteritis.

The medical evidence of record shows no chronic disorder of the lower intestine in service or soon after service.  The Veteran's gastrointestinal symptoms first reported years after his separation from active service have not been linked to any in-service injury or disease by competent, credible evidence.

The Veteran's post-service medical records show that he was diagnosed with IBS in January 2015, and diagnosed with diverticulosis in July 2021.  However, a July 2021 medical record shows there was no evidence of colitis.

A December 2021 VA examiner opined that the Veteran's IBS was at least as likely as not related to the Veteran's active service; however, the examiner did not provide any rationale for his opinion and apparently bases his opinion on the Veteran's lay statements and not on any objective medical evidence.  Accordingly, this opinion is given no probative value.

In a February 2022 addendum opinion, a VA examiner opined that the Veteran's IBS was less likely than not due to the Veteran's active service.  The examiner reported that the Veteran's STRs did not show any intestinal conditions during his active service.  The examiner also reported that IBS was not a condition that was caused by herbicide agent exposure.  The examiner reported the Veteran was not diagnosed with IBS until 2015, many years after his separation from active service and unrelated to any environmental exposures.

In August 2022, a VA examiner reviewed the Veteran's claims file.  The examiner opined that the Veteran's IBS and diverticulosis were less likely due to his active service, to include herbicide agent exposure.  The examiner explained that IBS was not a condition related to herbicide agent exposure.  The examiner reported that the Veteran was diagnosed with diverticulosis, which was age-related.  The examiner reported that there was no evidence of IBS during the Veteran's active service.  The examiner agreed with the February 2022 VA examiner's opinion and reported that the December 2021 VA examiner's opinion was incorrect.

The Veteran has not submitted any medical evidence supporting his assertion that he had a gastrointestinal disorder due to or the result of his active service.  VA obtained medical opinions in an effort to support the Veteran in establishing his claim.  The February 2022 and August 2022 VA examiners opined that the Veteran's gastrointestinal disorder was less likely than not due to his active service, to include any herbicide agent exposure.  Moreover, the VA medical opinion was accompanied by a detailed explanation of how the examiner reached the conclusion.

Therefore, after weighing all the evidence, the Board finds the greatest probative value in the February 2022 and August 2022 VA examiners' opinion, but also notes that the entirety of the medical evidence weighs against the conclusion that any gastrointestinal disorder either began during or was otherwise caused by his active service.  Thus, the evidence fails to establish service connection for the Veteran's gastrointestinal disorder.

Consideration has been given to the Veteran's assertions that has a gastrointestinal disorder due to his active service, to include his presumed herbicide agent exposure.  He is clearly competent to report the symptoms of this condition.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  However, while he may describe symptoms, he lacks the medical training or qualification either to diagnose a gastrointestinal disorder or to relate this condition to any in-service event.  Id. 

The record does not contain evidence of a diagnosis of an ongoing gastrointestinal disorder related to his active service, as the evidence of any complaints do not appear until at least seven years after his separation from active service.  Furthermore, his STRs do not document any gastrointestinal complaints, symptoms, or diagnosis.  As such, the Board does
 his presumed herbicide agent exposure.  He is clearly competent to report the symptoms of this condition.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  However, while he may describe symptoms, he lacks the medical training or qualification either to diagnose a gastrointestinal disorder or to relate this condition to any in-service event.  Id. 

The record does not contain evidence of a diagnosis of an ongoing gastrointestinal disorder related to his active service, as the evidence of any complaints do not appear until at least seven years after his separation from active service.  Furthermore, his STRs do not document any gastrointestinal complaints, symptoms, or diagnosis.  As such, the Board does not find that the evidence of record shows continuous symptoms.

Accordingly, the criteria for service connection have not been met for a gastrointestinal disorder, and the claim is denied. 

 

 

Timothy Berryman

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Hemphill, Athena

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.