DIVERTICULITIS

Summary

The Veteran, a Marine Corps Veteran who served from December 1971 to August 1980, appeals the denial of service connection for diverticulitis as secondary to his service-connected irritable bowel syndrome (IBS). The Veteran was diagnosed with diverticulitis in 2019, and the Agency of Original Jurisdiction (AOJ) conceded this diagnosis. The Veteran has been service-connected for IBS since August 2019. The primary issue is whether the diverticulitis is proximately due to or the result of the service-connected IBS. A VA examination in May 2021 concluded that diverticulosis (a precursor to diverticulitis) is not clearly linked to IBS, and that diverticulosis leads to IBS, not vice versa, and is less likely due to GERD. However, the Veteran's treating physician of over 20 years provided a letter in March 2021, stating that the diverticulitis was at least as likely as not caused by the service-connected IBS, reviewing the Veteran's service treatment records. The Board found the Veteran's statements plausible and the treating physician's opinion more persuasive than the VA examiner's, noting the VA examiner's opinion was unclear and contradicted by the treating physician. The Board found the evidence in equipoise, applying the benefit of the doubt doctrine in the Veteran's favor. Service connection for diverticulitis as secondary to IBS was granted.

Rationale

Treating physician opinion found diverticulitis at least as likely as not caused by IBS; VA examiner opinion was unclear and contradicted by treating physician; Evidence found in equipoise, applying benefit of doubt

Full Decision Text

Citation Nr: A26032207
Decision Date: 04/08/26	Archive Date: 04/08/26

DOCKET NO. 210604-164878
DATE: April 8, 2026

ORDER

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

FINDING OF FACT

The Veteran's diverticulitis is due to his service-connected IBS.

CONCLUSION OF LAW

The criteria for service connection for diverticulitis as secondary to service-connected IBS are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the Marine Corps from December 1971 to August 1980.  The Board recognizes the Veteran's service to our country, and the sacrifices it necessarily entailed.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2021 rating decision issued by the Agency of Original Jurisdiction (AOJ), Department of Veterans Affairs (VA) Regional Office (RO), which denied entitlement to service connection for diverticulitis.  

In June 2021, VA received the Veteran's VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), in which he timely appealed the May 2021 rating decision to the Board and selected the Board Hearing Lane under the Appeals Modernization Act (AMA) review system.

In March 2025, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ).  The transcript is of record.  As explained on the VA Form 10182, under the AMA, the Board hearing option entails review of the evidence of record of the time of the decision on appeal, in this case the May 2021 rating decision as well as evidence submitted at the March 2025 hearing and within 90 days after the Board hearing.  38 U.S.C. § 7113(b).   

If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(a), 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[s], considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service.  See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

Service connection may also be granted on a secondary basis for disability which is proximately due to or the result of service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability.  38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

To establish entitlement to service connection on a secondary basis, there must be (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical evidence establishing a nexus between the service-connected disability and the current disability.  Wallin v. West, 11 Vet. App. 509 (1998).

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

The Veteran has asserted that his diverticulitis is secondary to his IBS.  See e.g., Hearing Transcript, March 2025. 

Regarding the first element of secondary service connection, evidence of a current disability, the Veteran was diagnosed with diverticulitis in 2019.
 connection on a secondary basis, there must be (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical evidence establishing a nexus between the service-connected disability and the current disability.  Wallin v. West, 11 Vet. App. 509 (1998).

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

The Veteran has asserted that his diverticulitis is secondary to his IBS.  See e.g., Hearing Transcript, March 2025. 

Regarding the first element of secondary service connection, evidence of a current disability, the Veteran was diagnosed with diverticulitis in 2019.  See VA Examination, March 2021, C&P Exam, May 2021.  The AOJ has additionally conceded that the Veteran has been diagnosed with diverticulitis.  See Rating Decision - Narrative, May 2021. 

Regarding the second element of secondary service connection, evidence of a service-connected disability, the Veteran has been service connected for gastroesophageal reflux disease (GERD) and irritable bowel syndrome from August 29, 2019.  See Rating Decision - Codesheet, March 2026.

Regarding the third element of secondary service connection, medical evidence establishing a nexus between the service-connected disability and the current disability, the Veteran was afforded a VA examination for diverticulitis in May 2021.  In the opinion section of the examination, the examiner stated,

No documentation of acute abdominal pain or diverticulitis.  Based on his recent report of watery stools and based on report of constipation in 2019 it is likely that he has alternating diarrhea and constipation.  Diverticulosis is the condition of having multiple pouches (diverticula) in the colon that are not inflamed.  The causes diverticulosis is not known.  It is thought that low fiber diet could cause diverticulosis.  However it is not clear that alternating diarrhea and constipation which is a symptoms of IBS could cause diverticulosis.  Letter from the treating doctor indicate that diverticulosis lead to IBS and not vice versa.  Based on the current documentation his diverticulosis is less likely due to service related IBS.  GERD is due to relaxation of the gastroesophageal spincter [sic] resulting in reflux of acidic gastric content into the lower esophagus.  The pathology is in proximal intestinal tract.  His diverticulosis of the sigmoid colon which is in the distal gastrointestinal tract is less likely due to GERD.  See C&P Exam, May 2021.

In March 2021, the Veteran's treating physician of over 20 years conducted an assessment of the Veteran and wrote a letter in support of his condition.  The physician stated that the Veteran's diverticulitis was at least as likely as not caused by his service connected IBS.  The physician reviewed the Veteran's service treatment records in making their assessment.  See Medical Treatment Record - Non-Government Facility, March 2021. 

The Veteran's statements of his in-service symptoms and post-service symptoms are plausible and reliable.  Additionally, a positive nexus opinion and negative nexus opinion was obtained.  The opinions appears to be based upon a detailed review of the Veteran's medical history and consideration of pertinent medical literature.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion"); see also Bloom v. West, 12 Vet. App. 185, 187 (1999) (the probative value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion").  The medical opinions also considered the Veteran's lay statements concerning the onset and duration of his diverticulitis.  See Miller v. Wilkie, 32 Vet. App. 249, 260 (2020) ("The examiner must address the Veteran's lay statements to provide the Board with an adequate medical opinion.")

The evidence must be persuasively against the Veteran's claim to warrant a denial and that is not the case here; the negative evidence is not more persuasive or of greater evidentiary weight.  Accordingly, the Board finds that the evidence is at least in equipoise as to whether the Veteran's diagnosed diverticulitis was due to his service connected IBS.  The benefit-of-the-doubt rule is therefore for application.  See 38 U.S.C. § 5107;
 his diverticulitis.  See Miller v. Wilkie, 32 Vet. App. 249, 260 (2020) ("The examiner must address the Veteran's lay statements to provide the Board with an adequate medical opinion.")

The evidence must be persuasively against the Veteran's claim to warrant a denial and that is not the case here; the negative evidence is not more persuasive or of greater evidentiary weight.  Accordingly, the Board finds that the evidence is at least in equipoise as to whether the Veteran's diagnosed diverticulitis was due to his service connected IBS.  The benefit-of-the-doubt rule is therefore for application.  See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.  The Board will resolve reasonable doubt in the Veteran's favor and find that the evidence supports the grant of service connection.  See 38 U.S.C. § 5107.

 

 

Frederic P. Gallun

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Axelrad, E

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.