IRRITABLE COLON SYNDROME

M. C. GRAHAM · 2026 · Case ID: A26039808

MIXED

Summary

The Veteran, a Marine Corps and Army National Guard Veteran who served from May 1985 to May 1989, appeals the denial of an increased rating for his gastrointestinal conditions and the service connection for a scar. The Veteran sought an initial disability rating exceeding 30 percent for irritable bowel syndrome (IBS), hepatic steatosis, pancreatitis, GERD with Barrett's esophagus, gastroenteritis, and hiatal hernia. The Board reviewed medical evidence from the appeal period, including VA treatment records and a VA examination report. The Veteran's gastrointestinal disability primarily manifested as frequent diarrhea, intermittent abdominal pain, and occasional acute pancreatitis attacks, with the Board assigning greater weight to contemporaneous evidence showing less frequent exacerbations during the appeal period. The Board found the evidence did not support a severe impairment of health required for higher ratings, nor did it demonstrate the specific symptom combinations for higher evaluations under the applicable diagnostic codes. Service connection for a scar on the lower right quadrant of the abdomen was granted, as it was found to be secondary to his service-connected gastrointestinal disability and the evidence was in approximate balance. The issue of service connection for kidney stones was remanded due to duty-to-assist errors, including failure to obtain relevant treatment records and an inadequate medical opinion that relied on inaccurate factual bases regarding the onset of kidney stones.

Rationale

Veteran's gastrointestinal disability primarily manifested by frequent diarrhea and intermittent abdominal pain.; Evidence did not show severe impairment of health required for 60% rating.; Board assigns greater weight to contemporaneous evidence showing less frequent pancreatitis exacerbations during appeal period.

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7347

Docket No.

210803-176520

Full Decision Text

Citation Nr: A26039808
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 210803-176520
DATE: April 28, 2026

ORDER

Entitlement to an initial disability rating in excess of 30 percent for irritable bowel syndrome (IBS), hepatic steatosis, pancreatitis, gastroesophageal reflux disease (GERD) with Barrett's esophagus, gastroenteritis, and hiatal hernia, is denied.

Entitlement to service connection for a scar, lower right quadrant of abdomen, is granted.

REMANDED

Entitlement to service connection for kidney stones is remanded.

FINDINGS OF FACT

1. During the period on appeal, the Veteran's gastrointestinal disability did not manifest by symptom combinations productive of severe impairment of health; nor by frequently recurrent disabling attacks of abdominal pain with few pain free intermissions and with steatorrhea, malabsorption, diarrhea, and severe malnutrition; nor by frequent attacks of abdominal pain, loss of normal body weight and other findings showing continuing pancreatic insufficiency between acute attacks.

2. During the pendency of the claim, the Veteran had a scar of the lower right quadrant abdomen secondary to his service-connected gastrointestinal disability.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an initial disability rating in excess of 30 percent for IBS, hepatic steatosis, pancreatitis, GERD with Barrett's esophagus, gastroenteritis, and hiatal hernia, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.21, 4.3, 4.7, 4.114, Diagnostic Code 7347-7319

2. The criteria for entitlement to service connection for scar, lower right quadrant of abdomen, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Marine Corps from May 1985 to May 1989, with additional periods of service in the Army National Guard. The Board thanks the Veteran for his service.

In September 2020, the appellant submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of an August 2020 rating decision.

In February 2021, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the August 2020 rating decision.

In the August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on November 14, 2024 before the undersigned Veterans Law Judge, and a transcript has been added to the claims file.

Therefore, the Board may only consider the evidence of record at the time of the August 27, 2020 AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review 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, 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 kidney stones, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

The issue of service connection for kidney stones was subject to a prior Board remand in June 2020. A hearing was held before a different VLJ in February 2020, and a transcript has
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.

The issue of service connection for kidney stones was subject to a prior Board remand in June 2020. A hearing was held before a different VLJ in February 2020, and a transcript has been added to the record.

In the June 2020 Board decision, service connection for IBS, hepatic steatosis, and pancreatitis were granted. In the August 2020 AOJ decision, service connection for GERD with Barrett's esophagus and gastroenteritis was established and these disabilities were evaluated together with IBS, hepatic steatosis, and pancreatitis. Service connection for hiatal hernia was granted in a later July 2021 AOJ decision.

Therefore, the appeal period runs from June 5, 2014, the effective date of service connection for the Veteran's gastrointestinal disability, to August 28, 2020, the notification date of the rating decision subsequently subject to higher-level review.

1. Entitlement to an initial disability rating in excess of 30 percent for IBS, hepatic steatosis, pancreatitis, GERD with Barrett's esophagus, gastroenteritis, and hiatal hernia.

The Veteran contends that he is entitled to an initial disability rating in excess of 30 percent for his service-connected IBS, hepatic steatosis, pancreatitis, gastroesophageal reflux disease with Barrett's esophagus, gastroenteritis, and hiatal hernia (gastrointestinal disability).

Disability ratings are based on average impairment in earning capacity resulting from a particular disability and are determined by comparing symptoms shown with criteria in VA's Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities.

Where there is a question as to which of two ratings apply, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. An exception to this rule occurs when the rating criteria are successive. In such a case, all the requirements of the lower levels must be met before a higher level is awarded, so 38 C.F.R. §§ 4.7 and 4.21 do not apply. Johnson v. Wilkie, 30 Vet. App. 245 (2018).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant; however, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

With a claim for an increased initial rating, separate staged ratings may be assigned based on facts found. Fenderson v. West, 12 Vet. App. 119 (1999). In a claim for increase in a previously established rating, the present level of disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the evidence contains factual findings that demonstrate distinct time periods when the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, staged ratings are to be considered. See Hart v. Mansfield, 21 Vet. App. 505 (2007).

When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event, or whether the evidence weighs persuasively against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).

The Veteran's statements describing symptoms and conditions are competent evidence to the extent that one can describe one's own experiences. However, these statements must be viewed in conjunction with the medical evidence and the pertinent rating criteria. Lay evidence is not competent evidence concerning complex medical questions requiring specialized
considered. See Hart v. Mansfield, 21 Vet. App. 505 (2007).

The Veteran's statements describing symptoms and conditions are competent evidence to the extent that one can describe one's own experiences. However, these statements must be viewed in conjunction with the medical evidence and the pertinent rating criteria. Lay evidence is not competent evidence concerning complex medical questions requiring specialized training or expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

In May 2013, the Veteran was hospitalized for acute pancreatitis, characterized as non-severe.

According to a March 2014 VA nursing note, the Veteran complained of "off and on" mid-upper abdominal pain since May 2013, lasting from a few days to one week. He denied vomiting, constipation, and weight loss.

According to an April 2014 VA primary care note, the Veteran reported normal bowel movements except for occasional diarrhea.

According to an August 2014 VA gastroenterology consult, the Veteran complained of chronic abdominal pain and daily diarrhea. He reported epigastric pain occurring every 6-8 weeks and lasting for a week before resolving.

According to a May 2015 VA gastroenterology note, the Veteran reported daily diarrhea, feeling bloated, and excessive flatulence. He reported experiencing a weight gain over the prior year. He had Barrett's esophagus, for which he was not taking a PPI medication, with really bad" GERD symptoms.

A January 2016 gastroenterology note indicates that he had not had any pancreatitis episodes in over two years.

According to an April 2016 primary care note, the Veteran complained of "off and on" diarrhea without bloody stool. He denied abdominal pain.

In July 2017, the Veteran was hospitalized at a VA facility for one day for dry heaves and abdominal/chest pain, diagnosed as acute pancreatitis.

According to an August 2017 VA gastroenterology note, the Veteran had non-bloody diarrhea with no weight loss, with bowel movements occurring 2-6 times per day.

According to a January 2018 VA gastroenterology note, the Veteran complained of a cramp-like right upper quadrant pain he experienced the week prior that had been the "worst pain" of his life. According to a March 2018 VA gastroenterology note, the Veteran's transient right upper quadrant abdominal pain was suspected to have a musculoskeletal rather than a luminal cause.

According to an August 2019 VA gastroenterology note, the Veteran reported an increase in heartburn and indigestion since he stopped using a PPI. He denied dysphagia and had no melena or bleeding.

According to a February 2020 VA gastroenterology note, the Veteran reported bothersome heartburn 3 to 4 times per week that awakens him from sleep. He had gained 8 pounds between September and November of the previous year. He was without pain or acute pancreatitis symptoms and reported going a year or more between exacerbations, the most recent having occurred in July 2017.

According to a June 2020 VA stomach and duodenal conditions examination report, the Veteran held a diagnosis of recurrent gastroenteritis with symptoms including intermittent nausea, vomiting, diarrhea and abdominal pain. Treatment included Esomeprazole.

According to a June 2020 VA esophageal conditions examination report, the Veteran held a diagnosis of GERD and Barrett's esophagus, with symptoms of reflux, regurgitation, substernal pain, sleep disturbance caused by esophageal reflux, nausea, and vomiting. The examiner indicated that the Veteran's esophageal disability did not result in a considerable or severe impairment of health.

At the November 2024 Board hearing, the Veteran reported pancreatitis attacks at least twice per year lasting up to two weeks. He also reported esophageal symptoms of burning/pain and sleep disruption every three or four months, lasting up to one week.

The Veteran is in receipt of a 30 percent rating under DC 7347-7319 for the entire period on appeal.

Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the assigned rating; the additional code is shown after the hyphen. Here, the hyphenated diagnostic code indicates that the Veteran's gastrointestinal disability is
disability did not result in a considerable or severe impairment of health.

The Veteran is in receipt of a 30 percent rating under DC 7347-7319 for the entire period on appeal.

Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the assigned rating; the additional code is shown after the hyphen. Here, the hyphenated diagnostic code indicates that the Veteran's gastrointestinal disability is being rated under the criteria for irritable colon syndrome. 38 C.F.R. § 4.20.

While amendments were made to the schedule of ratings for the digestive system in March 2024, these only became effective on May 19, 2024. As such, the Board will apply the version of 38 C.F.R. § 4.114 in effect during the period on appeal. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003) (VA may not apply a current statute or regulation prior to its effective date, unless it explicitly provides otherwise).

The Veteran is in receipt of the maximum 30 percent schedular rating under DC 7319 for the entire period on appeal.

In accordance with 38 C.F.R. § 4.114, ratings under DCs 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.

The Board has considered whether an evaluation under a different diagnostic code of the digestive system would result in a more favorable outcome for the Veteran.

Under DC 7346 for hiatal hernia, a 10 percent disability rating is warranted for two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent evaluation is warranted for persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A maximum 60 percent evaluation is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. 38 C.F.R. § 4.114 (2020).

The terms "severe impairment of health" and "considerable impairment of health" are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. The Board notes the term "considerable" is defined by the dictionary as "large in extent or degree," and "severe" is defined as "very painful or harmful." Merriam-Webster's Collegiate Dictionary 267, 1140 (11th ed. 2012).

The record shows that the Veteran's gastrointestinal disability manifested primarily by frequent diarrhea as well as intermittent abdominal pain, vomiting, heartburn, indigestion, and substernal pain. He also suffered from more severe attacks of acute pancreatitis at a frequency of less than once per year. While at the November 2024 Board hearing he reported pancreatitis attacks of up to four per year, the Board assigns greater probative weight to the contemporaneous medical evidence from the appeal period showing that the Veteran went one year or longer between exacerbations during this time.

The Board finds this symptom combination was not productive of the severe impairment of health required for a 60 percent rating. Throughout the appeal period, Veteran's only daily symptom was diarrhea and the record does not show that his less frequent/intermittent symptoms resulted in an overall severe impairment of health so as to warrant a 60 percent rating. In this regard, the Board also attaches probative weight to the June 2020 VA examiner's finding that the Veteran's esophageal symptoms were not productive of a considerable impairment of health, let alone a severe impairment.

A rating in excess of 30 percent under DC 7347 for pancreatitis is similarly not warranted. Under DC 7347, a 10 percent rating is warranted for at least one recurring attack of typical severe abdominal pain in the past year. A 30 percent evaluation is warranted for at least 4-7 typical attacks of abdominal pain per year with good remission between attacks. A 60 percent evaluation is
ent symptoms resulted in an overall severe impairment of health so as to warrant a 60 percent rating. In this regard, the Board also attaches probative weight to the June 2020 VA examiner's finding that the Veteran's esophageal symptoms were not productive of a considerable impairment of health, let alone a severe impairment.

A rating in excess of 30 percent under DC 7347 for pancreatitis is similarly not warranted. Under DC 7347, a 10 percent rating is warranted for at least one recurring attack of typical severe abdominal pain in the past year. A 30 percent evaluation is warranted for at least 4-7 typical attacks of abdominal pain per year with good remission between attacks. A 60 percent evaluation is warranted for frequent attacks of abdominal pain, loss of normal body weight and other findings showing continuing pancreatic insufficiency between acute attacks. A 100 percent evaluation is warranted for frequently recurrent disabling attacks of abdominal pain with few pain free intermissions and with steatorrhea, malabsorption, diarrhea and severe malnutrition. 38 C.F.R. § 4.114 (2020).

Here, the record weighs persuasively against a finding that the Veteran's gastrointestinal disability manifested by a loss of normal body weight (60 percent), or by steatorrhea, malabsorption, or severe malnutrition (100 percent). As noted above, the record does not show a loss of normal body weight or malnutrition attributable to the Veteran's gastrointestinal disability, and at times a weight gain was noted.

In so finding, the Board has not considered the ameliorative effects of medication the Veteran took for his disability, including esomeprazole, a protein pump inhibitor (PPI). See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). Throughout the appeal period, the Veteran frequently reported that he was not taking any PPI due to side effects he experienced, but his disability picture nonetheless did not more nearly approximate a rating in excess of 30 percent under DC 7346 or 7347. See, e.g., May 2015 and August 2019 VA treatment records.

As the record weighs persuasively against the assignment of an initial disability rating in excess of 30 percent for the Veteran's gastrointestinal disability, the benefit-of-the-doubt doctrine is not applicable and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

The Board acknowledges that the issue of service connection for kidney stones is being remanded to obtain records of urologic treatment at a non-VA facility authorized by VA. While there is no relevancy standard for obtaining such records under § 3.159(c)(3), remand of this issue is nonetheless not warranted as the Board finds that there is no reasonable possibility that urologic treatment records would substantiate the claim for an increased rating for a gastrointestinal disability. 38 C.F.R. § 3.159(d).

Neither the Veteran nor his representative has raised any other issues in connection with the issue on appeal, beyond what is addressed in this decision, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

2. Entitlement to service connection for scar, lower right quadrant of abdomen.

VA is required to develop and adjudicate all claims for secondary service connection reasonably raised by claims for an increased rating. Bailey v. Wilkie, 22 Vet. App. 188, 203 (2021).

Secondary service connection can be established when a disability is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. To be awarded secondary service connection, there must be evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). To be service connected on a secondary basis under a causation theory, the primary disability need not be service-connected, or even diagnosed, at the time the secondary condition is incurred. Frost v. Shulkin, 29 Vet. App. 131, 138 (2017) (holding that there was not a temporal requirement inherent in 38 C.F.R. § 3.310 (a) for claims for service connection on a secondary basis). A service-connected disability need only be a contributing cause, not the sole contributing cause,
) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). To be service connected on a secondary basis under a causation theory, the primary disability need not be service-connected, or even diagnosed, at the time the secondary condition is incurred. Frost v. Shulkin, 29 Vet. App. 131, 138 (2017) (holding that there was not a temporal requirement inherent in 38 C.F.R. § 3.310 (a) for claims for service connection on a secondary basis). A service-connected disability need only be a contributing cause, not the sole contributing cause, to establish secondary service connection. See Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (holding that 38 U.S.C. § 1110 employs only but-for causation in direct and secondary service connection claims, not proximate causation).

Here, the Veteran reported that he underwent a surgery in 1994 for pain due to "extreme inflammation in the GI tract." See May 2016 statement in support of claim.

An August 2014 VA treatment record notes the presence of a surgical scar in the on the Veteran's "lower belly."

In an August 2022 rating decision, service connection for a right lower quadrant scar was granted as secondary to the Veteran's gastrointestinal disability. The Board is bound by this favorable finding absent a showing of clear and unmistakable evidence to the contrary, which is not shown here. 38 C.F.R. § 3.104(c).

While service connection for this disability is already established, a grant in connection with the current appeal may entitle the Veteran to an earlier effective date. As effectual relief is still available, the issue is not moot. See Green v. McDonough, 37 Vet. App. 127, 136-48 (2024); see also Warren v. McDonald, 28 Vet. App. 214, 221 (2016).

As the evidence is in at least approximate balance as to whether the Veteran suffered from an abdomen scar during the pendency of the appeal, the benefit-of-the-doubt doctrine is applicable and the claim is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Entitlement to service connection for kidney stones.

A March 2007 ultrasound from Norton Suburban Hospital shows the presence of left kidney stones. According to VA treatment records, the Veteran received VA-authorized treatment for his kidney stones at non-VA facilities. See December 2018 statement in support of claim (noting that VA "outsourced" two kidney stones); July 2018 VA correspondence (noting urology appointment scheduled at Appalachian Regional Healthcare hospital on August 7, 2018). Records of non-VA urology treatment have also been scanned into VA imaging systems. See January 2019 VA treatment record (noting that a community care urology note had been scanned into VistA).

The AOJ should have requested the Veteran to provide a release to obtain records of this relevant private treatment. 38 C.F.R. § 3.159(e)(2). It should have also associated with the claims file the records that were already in VA custody. 38 C.F.R. § 3.159(e)(2)

Lastly, the June 2020 Board remand directed the AOJ to obtain an opinion addressing whether the Veteran's kidney stone disability was related to the Veteran's acknowledged exposure to Camp Lejeune contaminated water (CLCW). In a June 2020 VA medical opinion, the examiner found it to be less likely than not that the Veteran's disability was related to CLCW, relying in part on the fact that his kidney stones "commenced in 2014," 27 years after exposure. However, as noted above, the record shows that the Veteran was treated for kidney stones as early as March 2007. The Board therefore finds the opinion to be based on inaccurate factual basis and thus inadequate for adjudicative purposes. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993).

Remand is necessary to correct these pre-decisional duty-to-assist errors. 38 C.F.R. § 20.802(a).

The Board intimates no credibility findings as to any of the Veteran's lay statements at this time.

The matters are REMANDED for the following action:

1. Please print and upload into the virtual benefits file a community care urology note dated November 16, 2018 (noted in a January 12, 2019
2007. The Board therefore finds the opinion to be based on inaccurate factual basis and thus inadequate for adjudicative purposes. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993).

Remand is necessary to correct these pre-decisional duty-to-assist errors. 38 C.F.R. § 20.802(a).

The Board intimates no credibility findings as to any of the Veteran's lay statements at this time.

The matters are REMANDED for the following action:

1. Please print and upload into the virtual benefits file a community care urology note dated November 16, 2018 (noted in a January 12, 2019 VA treatment record).

2. After receiving necessary authorization from the Veteran, make reasonable efforts to obtain records of non-VA treatment the Veteran has received for his kidney stones, to include from the following providers:

(a.) Norton Suburban Hospital in March 2007.

(b.) Appalachian Regional Healthcare Hospital in Whitesburg, KY in August 2018.

3. After the development requested in paragraphs 1 and 2 is complete, refer the claim to an appropriate clinician to provide an addendum opinion on the etiology of the Veteran's kidney stones. The opinion should be responsive to the following:

Is it at least as likely as not (i.e., evidence in approximate balance or greater) that the Veteran's kidney stone disability is related to his acknowledged exposure to contaminated water at Camp Lejeune? Please explain. The examiner should take as fact that the Veteran was treated for kidney stones as early as March 2007.

M. C. GRAHAM

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Alvarez, D.A.

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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