IRRITABLE COLON SYNDROME (SPASTIC COLITIS MUCOUS COLITIS)

Summary

The veteran, who served in the U.S. Army from May 2002 to October 2007, appeals the denial of service connection for irritable bowel syndrome (IBS) and the remand of service connection for obstructive sleep apnea (OSA). The veteran claimed IBS as secondary to his service-connected PTSD, asserting that stress and nightmares from PTSD triggered his IBS symptoms, causing functional impairment. However, the Board found no current diagnosis of IBS in the record and no objective evidence of digestive symptoms during the VA examination. The Board deemed the veteran's self-reported symptoms not credible due to the lack of objective findings and the absence of treatment sought for such severe, recurring symptoms. Consequently, the evidence persuasively weighed against a current disability, and service connection for IBS was denied. The Board also addressed the OSA claim, finding the July 2024 VA medical opinion insufficient. The examiner opined that OSA was less likely than not caused by PTSD, citing a lack of pathophysiological link and noting the veteran's obesity as a factor. The Board remanded the OSA claim for a new opinion to determine if PTSD aggravated the veteran's obesity, and if that aggravation substantially contributed to the OSA, or if the OSA would not have occurred but for the aggravated obesity.

Rationale

No current diagnosis of IBS; No objective evidence of digestive symptoms; Veteran's self-reported symptoms not credible due to lack of objective findings and treatment; Evidence persuasively weighs against service connection

Full Decision Text

Citation Nr: A26032101
Decision Date: 04/08/26	Archive Date: 04/08/26

DOCKET NO. 250703-561177
DATE: April 8, 2026

ORDER

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

REMANDED

Entitlement to service connection for obstructive sleep apnea (OSA) is remanded.

FINDING OF FACT

The most probative evidence of record shows that the Veteran's claimed IBS is not related to military service because there is no diagnosis of IBS and it is less likely than not that the Veteran had an undiagnosed illness that caused a functional impairment.

CONCLUSION OF LAW

The criteria for service connection for IBS have not been met. 38 U.S.C. §§ 1101, 1110, 1117, 1119, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.317.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from May 2002 to October 2007.

In the July 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 December 2024 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review 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 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.

However, because the Board is remanding the claim of entitlement to service connection for OSA, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection may be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated by a service-connected disability. To prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing that the service-connected disability caused or aggravated the nonservice-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995).

Further, special presumptive service connection rules exist for Gulf War Veterans. 38 U.S.C. §§ 1117, 1119, 1120; 38 C.F.R. §§ 3.317, 3.320. The Southwest Asia (SWA) theater of operations includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317(e)(2).

Service connection may be granted on a presumptive basis for certain diseases associated with exposure to contaminants from burn pits and fine particulate matter with SWA service. 38 U.S.C. §§ 501(a), 1119, 1120; 38 C.F.R. § 3.320. Service connection may be granted on a presumptive basis for chronic asthma, chronic rhinitis, chronic sinusitis, multiple myelomas including monoclonal gammopathy of undetermined significance (MGUS), Myelodysplastic Syndromes (MDS), Myelofibrosis and a number of cancers, including rare cancers, bladder cancer, ureter cancer, and leukemias. 38 C.F.R. §§ 3.320, 3.320a
 for certain diseases associated with exposure to contaminants from burn pits and fine particulate matter with SWA service. 38 U.S.C. §§ 501(a), 1119, 1120; 38 C.F.R. § 3.320. Service connection may be granted on a presumptive basis for chronic asthma, chronic rhinitis, chronic sinusitis, multiple myelomas including monoclonal gammopathy of undetermined significance (MGUS), Myelodysplastic Syndromes (MDS), Myelofibrosis and a number of cancers, including rare cancers, bladder cancer, ureter cancer, and leukemias. 38 C.F.R. §§ 3.320, 3.320a, 3.320b.

Under 38 C.F.R. § 3.317, aside from disabilities deemed as per-se presumptive with SWA service, there are two types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a diagnosed medically unexplained chronic multi-symptom illness (MUCMI) that is defined by a cluster of signs or symptoms such as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding gastrointestinal diseases). For disability due to undiagnosed illness and medically unexplained chronic multi-symptom illness, the disability must have been manifest either during active military service in the SWA theater of operations or to a degree of 10 percent or more and must manifest by December 31, 2026. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1).

If the claimed condition is not one of the enumerated diseases presumptively associated with exposure to burn pits or fine particulate matter and also does not meet the definition of an undiagnosed illness or a MUCMI, there is a further requirement to evaluate whether there is entitlement under the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (the PACT Act). Pub. L. No. 117-168, 136 Stat. 1759, implemented in 38 U.S.C. § 1168. That is, the Board must consider whether the cumulative effect of the toxic exposure risk activities (TERAs) caused the claimed condition.

VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay testimony is competent to prove that a claimant exhibited certain lay-observable symptoms and the time that those symptoms appeared. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence cannot be determined to lack credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006).

The Board is responsible for determining whether the evidence persuasively supports the claim or is in approximate balance, with the Veteran prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

IBS

The Veteran asserts that his IBS is secondary to his service-connected PTSD. See June 2024 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits (526) and Veteran's statement.

The Board is required to consider all theories of entitlement to service connection reasonably raised. See Szemraj v. Principi, 357 F.3d 1370, 1371 (Fed. Cir. 2004), and Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir. 2001) (explaining that the Board must consider all potential theories of entitlement raised by the evidence).

For the reasons discussed below, service connection cannot be established for IBS, on a secondary basis to the PTSD, presumptively from exposure to burn pits, as an undiagnosed illness, as a MUCMI, or due to TERAs. The most probative evidence of record shows that the Veteran does not have a current diagnosis of IBS or symptoms of an undiagnosed illness causing functional impairment.

The Veteran provided a June 2024 statement in which he reported,

"I am applying for IBS because I have IBS symptoms every other day. I have rotating constipation and diarrhea that is triggered by my stress and nightmares from my PTSD.
aining that the Board must consider all potential theories of entitlement raised by the evidence).

For the reasons discussed below, service connection cannot be established for IBS, on a secondary basis to the PTSD, presumptively from exposure to burn pits, as an undiagnosed illness, as a MUCMI, or due to TERAs. The most probative evidence of record shows that the Veteran does not have a current diagnosis of IBS or symptoms of an undiagnosed illness causing functional impairment.

The Veteran provided a June 2024 statement in which he reported,

"I am applying for IBS because I have IBS symptoms every other day. I have rotating constipation and diarrhea that is triggered by my stress and nightmares from my PTSD. It is almost like my body is put off by the stress and the triggers. This has been going on for a while. I have actually had to call out of work for the IBS symptoms. They can really disrupt my life. It's exhausting because I have to constantly be planning ahead to make sure a bathroom is accessible."

The Veteran was provided a July 2024 VA examination, at which examiner E.S. properly considered the Veteran's June 2024 statement and determined that there was not a diagnosis of IBS or any other digestive disorder. Examiner E.S. indicated that there was no objective evidence of any symptoms of a digestive disorder to include diarrhea or constipation on examination or in the medical record. The examiner considered the Veteran's report of symptoms to be subjective only and insufficient to establish a diagnosis or to consider the Veteran to have an undiagnosed illness.

A review of the record shows that there is no indication of complaints of, treatment for, or diagnosis of any kind of digestive symptoms or disability in the VA Medical Center (VAMC) treatment records, in private treatment records, or in the service treatment records (STRs).

All the above theories of service connection turn on the first element, that is, whether there is a current disability.

Disability evaluations are based on functional impairment and the loss of earning capacity caused by that impairment. Saunders v. Wilkie, 886 F.3d 1356, 1362-63 (2018). A diagnosis by a medical provider can show a current disability, but symptoms of an undiagnosed condition causing functional impairment can also show a disability. Id. at 1364 (pain is an impairment insofar as it "it diminishes the body's ability to function" and results in an impairment in earning capacity.) And specifically for service connection as an undiagnosed illness, there must still be symptoms which cause functional impairment to establish a disability.

There is no diagnosis of IBS anywhere in the record, thus the analysis proceeds to whether there are symptoms of an undiagnosed condition causing functional impairment. There is both evidence for and against such symptoms.

In his June 2024 statement, the Veteran reported symptoms of diarrhea and constipation which he indicated occurred every other day and caused a functional impairment, causing him to call out of work and requiring him to plan in advance for access to a bathroom.

The Board may draw inferences against a claimant from a lack of documentation if it lays a proper foundation. Horn v. Shinseki, 25 Vet. App. 231, 239 (2012); Fountain v. McDonald, 27 Vet. App. 258, 272 (2015). If that inquiry concerns a lack of medical documentation, the Board must discuss whether the condition was of such severity that it would have been reasonable to expect the appellant to seek treatment. 

Here, the Veteran reported frequently reoccurring and severe symptoms that interfered with his work and required regular planning to accommodate. The Board therefore finds it reasonable to expect the Veteran to have reported and sought treatment for his symptoms, or for his symptoms to have been severe enough that some objective evidence would have been present at the VA examination, for example, tenderness to the abdomen or hyperactive bowel sounds. The medical record is silent, and the VA examiner found no objective evidence of a digestive condition. Therefore, the Board does not find the Veteran's report of the digestive symptoms to be credible when weighed against the contemporaneous records.

The Board finds that the competent evidence persuasively weighs against finding that the Veteran has a current disability. As the evidence of record persuasively weighs against service connection, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

REASONS FOR REMAND

Under the Appeals Modernization Act (AMA), remands are limited to pre-decisional duty to assist errors and "correction of any other error by
 credible when weighed against the contemporaneous records.

The Board finds that the competent evidence persuasively weighs against finding that the Veteran has a current disability. As the evidence of record persuasively weighs against service connection, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

REASONS FOR REMAND

Under the Appeals Modernization Act (AMA), remands are limited to pre-decisional duty to assist errors and "correction of any other error by the agency of original jurisdiction in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating the appellant's claim." 38 C.F.R. § 20.802(a).

When there is a duty to assist to provide an examination and opinion, that examination and opinion must be sufficient. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).

OSA

The Veteran contends that he is entitled to service connection for OSA as secondary to his service-connected PTSD. See June 2024 526.

Here, for the reasons discussed below, the Board must remand the issue to correct a pre-decisional duty-to-assist error, specifically, failure to order a sufficient medical opinion.

In his June 2024 statement, the Veteran specifically claimed that he believed his OSA was secondary to PTSD because the PTSD caused his weight gain.

The Veteran was provided with a July 2024 VA medical opinion at which examiner E.S. opined that the OSA was less likely than not caused by the PTSD and provided this rationale:

"Although there is a strong correlation between PTSD and OSA occurring within the same individual, there is no literature showing a pathophysiological link or cause for PTSD to lead to OSA. OSA often occurs secondary to obesity around the neck which impact breathing. The veterans BMI at the time of the sleep study was 35.44, obesity range."

Obesity, while not considered a disability by the VA, can be an intermediate step linking together a secondary condition and a service-connected condition. See VAOPGPREC 1-2017. Both aggravation and causation, should be considered in a secondary service connection claim with the intermediate step of obesity, that is, whether a service-connected disability caused or aggravated a Veteran's obesity. Walsh v. Wilkie, 32 Vet. App. 300, 306-307 (2020). To demonstrate secondary service connection with obesity as an intermediate step requires determining (1) whether the PTSD aggravated the Veteran's obesity; (2) if so, whether the aggravation of obesity because of service-connected disability was a substantial factor in causing OSA; and (3) whether the OSA would not have occurred but for obesity aggravated by the PTSD. See Walsh v. Wilkie, 32 Vet. App. at 307.

In this case, the July 2024 medical opinion did not adequately answer the question of whether the OSA was caused or aggravated by the PTSD through the intermediate step of obesity as explicitly claimed by the Veteran and thus the issue must be remanded for a new medical opinion.

The matter is REMANDED for the following action:

Make reasonable efforts to obtain medical opinions from an appropriate clinician to determine the nature and etiology of the Veteran's obstructive sleep apnea (OSA). The examiner must review the electronic claims file and provide medical opinions on the following:

(a) Whether the service-connected posttraumatic stress disorder (PTSD) caused the Veteran's obesity.

(b) Whether the service-connected PTSD aggravated the Veteran's obesity.

(c) Whether the aggravation of obesity because of service-connected PTSD was a substantial factor in causing OSA.

(d) Whether the OSA would not have occurred but for obesity aggravated by the PTSD.

In providing the requested opinions, consider the Veteran's description of in-service events and symptoms as well as his post-service symptoms. The Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptoms during and after service. If there is a medical basis to support or doubt the history provided by the Veteran, the clinician should provide a fully reasoned explanation.

The examiner must provide a clear, understandable and complete rationale for all conclusions reached and any opinions rendered above.

 

 

JOHN Z. JONES

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Schneider, Joan 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