IRRITABLE COLON SYNDROME (SPASTIC COLITIS MUCOUS COLITIS)

S. KIM · 2026 · Case ID: A26040152

MIXED

Summary

The veteran, who served from December 1993 to December 1997, appeals the denial of service connection for irritable bowel syndrome (IBS), sleep apnea, post-traumatic stress disorder (PTSD), and urinary frequency. The Board found that the evidence persuasively weighed against service connection for IBS, sleep apnea, and urinary frequency, as there was no competent medical evidence diagnosing these conditions or linking them to service. For IBS, the Board noted the lack of a diagnosis and the complexity of its diagnosis, and that the veteran's lay statements were insufficient to establish a link to service or TERA. For sleep apnea, the Board found no diagnosis or description of symptoms, and the veteran lacked the expertise to diagnose it. For urinary frequency, the Board found no evidence of a current diagnosis, and thus the duty to assist in obtaining an examination was not triggered. For PTSD, the Board found no competent evidence linking a current psychiatric disorder to an in-service stressor, as the private mental health nurse practitioner's opinion was not probative regarding etiology. The Board denied all four claims. The claim for tinnitus was remanded due to a duty to assist error, as the VA examiner failed to address whether tinnitus was related to in-service TERAs, despite evidence of both tinnitus and TERA exposure.

Rationale

No established diagnosis of IBS or functional gastrointestinal disorder.; Veteran lacks expertise to diagnose IBS.; Service treatment records silent for IBS complaints/diagnosis.; Evidence weighs against current diagnosis or link to service/TERA.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251215-631101

Full Decision Text

Citation Nr: A26040152
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 251215-631101
DATE: April 29, 2026

ORDER

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

Entitlement to service connection for sleep apnea is denied.

Entitlement to service connection for post-traumatic stress disorder (PTSD) is denied.

Entitlement to service connection for urinary frequency is denied.

REMANDED

Entitlement to service connection for tinnitus is remanded.

FINDINGS OF FACT

1. The competent and credible evidence of record persuasively weighs against finding a current diagnosis of IBS or a functional gastrointestinal disorder, or that a gastrointestinal disorder is related to an in-service illness or injury, to include a toxic exposure risk activity (TERA). The evidence is not in approximate balance.

2. The competent and credible evidence of record persuasively weighs against finding a current sleep apnea. The evidence is not in approximate balance.

3. The competent and credible evidence of record persuasively weighs against finding an acquired psychiatric disorder, to include PTSD is related to an in-service illness, event or injury. The evidence is not in approximate balance.

4. The competent and credible evidence of record persuasively weighs against finding a current urinary frequency. The evidence is not in approximate balance.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for IBS are not met. 38 U.S.C. §§ 1110, 1117, 5107; 38 C.F.R. §§ 3.303, 3.317, 3.655.

2. The criteria for entitlement to service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.655.

3. The criteria for entitlement to service connection for PTSD are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.655, 4.125.

4. The criteria for entitlement to service connection for urinary frequency are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.159, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 1993 to December 1997.

These matters are before the?Board of Veterans' Appeals?(Board) on appeal of December 2024 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In the December 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 on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 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 claims, 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 claims of entitlement to service connection for tinnitus, 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).

In his December 2025 VA Form 10182, the Veteran also identified the issues of entitlement to service connection for an anxiety condition to include sleep disturbances, and back and right ankle disorders, adjudicated in a March 2023 rating decision. These attempted appeals were not timely, as the December 2025 VA Form 10182 was received more than one year following the March 2023 rating decision. There is no more recent rating decision adjudicating those issues within one year prior to the December 2025 VA Form 10182. Accordingly, the issues of entitlement to service connection for an anxiety condition to include sleep disturbances, and back and right ankle disorders are not part of this appeal.

Service Connection

2)(ii).

Service Connection

Service connection is established on a direct basis when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d).

VA regulation states that when a claimant, without good cause, fails to report for an examination scheduled in conjunction with the original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655 (a), (b).

"When a veteran misses a scheduled VA examination, the Board must consider (1) whether the examination was necessary to establish entitlement to the benefit sought, and (2) whether the veteran lacked good cause to miss the scheduled examination. See 38 C.F.R. § 3.655 (a)." Turk, 21 Vet. App. at 569. VA's duty to assist is not a "one-way street" Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996). "If a [Veteran] wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991).

If the positive and negative evidence is in approximate balance, the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

As a preliminary matter, the Board will address whether remand is required to provide the Veteran another opportunity to attend VA examinations for his claims for IBS, PTSD and sleep apnea. In this case, the Veteran was scheduled for VA examinations in connection with his claims for IBS, PTSD and sleep apnea on November 8, 2024, but he did not appear for those examinations. Later that month, VA sent the Veteran a letter asking him to contact VA if he wished to reschedule the examinations, but there is no documented response.

In a December 2024 38 U.S.C. §5103 Notice Response, the Veteran checked the box indicating "I have enclosed all the remaining information or evidence that will support my claim, or I have no other information or evidence to give VA to support my claim. Please decide my claim as soon as possible."

In his December 2024 Notice of Disagreement, the Veteran stated that he "never had any medical evaluations done" and that on the day of his appointments "my mother died, I asked for resch[eduling], never got one."

At the time of the December 2024 rating decision on appeal, there was no evidence that the Veteran had provided any explanation for failing to appear for the examinations, or that he had requested new examinations. In fact, in his 38 U.S.C. §5103 Notice Response, the Veteran explicitly requested that the AOJ proceed with his appeal. He has not argued that he was not notified of the date and time of the examination. Rather, after the rating decision on appeal, the Veteran first informed VA of the reasons for missing the November 8, 2024 examination in his December 2025 notice of disagreement. As the Veteran did not provide the reason for missing the examination or request a new examination prior to the December 2024 rating decision, the Board cannot find any duty to assist error in the AOJ's decision not to provide another examination. Accordingly, the Board will proceed to adjudicate the claims for service connection for IBS, PTSD and sleep apnea based on the evidence of record.

The Board notes that, with regard to IBS, PTSD and sleep apnea, the December 2024 rating decision states "if you wish to
of the examination. Rather, after the rating decision on appeal, the Veteran first informed VA of the reasons for missing the November 8, 2024 examination in his December 2025 notice of disagreement. As the Veteran did not provide the reason for missing the examination or request a new examination prior to the December 2024 rating decision, the Board cannot find any duty to assist error in the AOJ's decision not to provide another examination. Accordingly, the Board will proceed to adjudicate the claims for service connection for IBS, PTSD and sleep apnea based on the evidence of record.

The Board notes that, with regard to IBS, PTSD and sleep apnea, the December 2024 rating decision states "if you wish to pursue this [claim] you can file a VA Form [20]-0995 and request this claim to be reopened and an exam will be scheduled at that time." Therefore, if he desires additional examinations the Veteran may pursue this option.

1. Entitlement to service connection for IBS is denied.

The Veteran contends that he has IBS which is related to his active-duty service.

Service connection can be established for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability that by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1).

A "qualifying chronic disability" means a chronic disability resulting from any of the following (or any combination of the following): (A) an undiagnosed illness; or (B) a medically unexplained chronic multisymptom illness (MUCMI) that is defined by a cluster of signs or symptoms such as: (1) chronic fatigue syndrome; (2) fibromyalgia; or (3) functional gastrointestinal disorders (excluding structural gastrointestinal diseases). 38 C.F.R. § 3.317(a)(2).

The service treatment records are silent for complaints or diagnosis of IBS. On reports of medical history in January 1993, March 1994, September 1995 and October 1997, the Veteran reported no past or current history of frequent indigestion, or stomach, liver or intestinal trouble.

In an August 2024 statement, the Veteran reported symptoms of cramping, abdominal pain, bloating, gas, and alternating diarrhea and constipation which he believed were manifestations of IBS. He stated that these symptoms began "around 1996 during my active-duty military service" and had continued "from my service time to this day."

An October 2024 TERA Memorandum found that the Veteran had service in the Southwest Asia theater of operations, as well as exposure to noise, fuel products such as diesel, JP8, JP-4, industrial solvents used in cleaning, degreasing, paint fumes, benzene, monoammonium phosphate, risk of electrical burns and fatal electrical shock, toxic welding fumes and possible lead and asbestos dust.

The evidence weighs persuasively against the claim for service connection for IBS. First, IBS is a MUCMI which may be presumptively service-connected based on service in the Southwest Asia theater of operations pursuant to 38 C.F.R. § 3.317. However, in this case, there is no established diagnosis of IBS, or any other functional gastrointestinal disorder. While the Veteran believes that he has IBS, he is not shown to have the relevant training or education to diagnose IBS or a functional gastrointestinal disorder. The diagnosis of IBS is complex as it requires specialized education and knowledge of complex diagnostic instruments. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). There is thus no competent evidence diagnosing IBS or any other functional gastrointestinal disorder. Accordingly, service connection is not warranted on a presumptive basis under 38 C.F.R. § 3.317.

Next, the evidence also weighs persuasively against finding that any gastrointestinal disorder is related to an in-service injury or illness, to include a TERA. While the Veteran is competent to describe gastrointestinal symptoms since service, he is not shown to have the relevant training or education to offer a medical opinion relating any current gastrointestinal symptoms to an in-service injury or illness. The etiology of a gastrointestinal disorder is complex as it has multiple possible etiologies. Jandreau, 492 F.3d at 1377, 1377 n.4. There is thus no competent evidence relating current gastrointestinal symptoms to an in-service injury or illness, to include a TERA.

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether service connection for a gastrointestinal disorder is warranted. Rather, the evidence
or illness, to include a TERA. While the Veteran is competent to describe gastrointestinal symptoms since service, he is not shown to have the relevant training or education to offer a medical opinion relating any current gastrointestinal symptoms to an in-service injury or illness. The etiology of a gastrointestinal disorder is complex as it has multiple possible etiologies. Jandreau, 492 F.3d at 1377, 1377 n.4. There is thus no competent evidence relating current gastrointestinal symptoms to an in-service injury or illness, to include a TERA.

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether service connection for a gastrointestinal disorder is warranted. Rather, the evidence persuasively weighs against finding any current diagnosed IBS or functional gastrointestinal disorder, or that a gastrointestinal disorder is related to an in-service injury or illness. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107 (b), Lynch, 21 F.4th 776. The claim is denied.

2. Entitlement to service connection for sleep apnea and is denied.

The Veteran contends that he has sleep apnea which is related to his active-duty service.

The service treatment records are silent for complaints or diagnosis of sleep apnea.

The evidence weighs persuasively against finding any current diagnosis of sleep apnea. In this regard, there is no evidence of record of any diagnosed sleep apnea, nor has the Veteran specifically described any symptoms of sleep apnea. To the extent that the Veteran believes that he has sleep apnea, he is not shown to have the relevant training or education to offer a medical opinion diagnosing any such disorder. The diagnosis of sleep apnea is complex as it requires specialized education and knowledge of complex diagnostic instruments. See Jandreau, 492 F.3d 1377 n.4. There is thus no competent evidence diagnosing any sleep apnea.

As the evidence of record weighs persuasively against finding any sleep apnea for which service connection may be granted, service connection is not warranted. Brammer v. Brown, 3 Vet. App. 223 (1992).

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether service connection for sleep apnea is warranted. Rather, the evidence weighs persuasively against finding any current sleep apnea. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107 (b), Lynch, 21 F.4th 776. The claim is denied.

3. Entitlement to service connection for PTSD is denied.

The Veteran contends that he has PTSD which is related to his active-duty service.

Service connection for PTSD requires medical evidence establishing a diagnosis of the condition in accordance with 38 C.F.R. § 4.125 (a); a link, established by medical evidence, between current symptomatology and an in-service stressor; and credible supporting evidence that the claimed in-service stressor actually occurred. See Moreau v. Brown, 9 Vet. App. 389, 396 (1996).

The service treatment records are silent for complaints or diagnosis related to PTSD.

In an August 2024 statement, the Veteran described a stressful incident in service. He stated that on August 6, 1997 in Guam, he volunteered to assist at a Naval hospital following a civilian airliner crash. He stated that he had ongoing psychiatric symptoms related to that incident.

In an August 2024 statement, M.K., a private mental health nurse practitioner reported that the Veteran's responses to a screening tool indicated a result which was "probable for PTSD." M.K. noted the Veteran's description of an in-service incident. M.K. opined that the Veteran "suffers from severe occupational and social impairment consistent with a compensable mental health disorder." M.K. did not provide an explicit medical opinion regarding the etiology of a mental health disorder.

The evidence weighs persuasively against finding that any acquired psychiatric disorder is related to an in-service injury or illness, to include the reported in-service stressor. The Veteran is not shown to have the relevant training or education to offer a medical opinion relating any current psychiatric disorder to an in-service injury or illness. The etiology of an acquired psychiatric disorder is complex as it has multiple possible etiologies. Jandreau, 492 F.3d at 1377, 1377 n.4. There is thus no competent evidence relating a current acquired psychiatric disorder to an in-service injury or illness, to include the in-service stressor.

While Dr. M.K. indicated that the Veteran had a current acquired psychiatric disorder, she did not provide any explicit medical opinion linking the current disorder to an in-service event, injury or illness. Thus, the opinion of
reported in-service stressor. The Veteran is not shown to have the relevant training or education to offer a medical opinion relating any current psychiatric disorder to an in-service injury or illness. The etiology of an acquired psychiatric disorder is complex as it has multiple possible etiologies. Jandreau, 492 F.3d at 1377, 1377 n.4. There is thus no competent evidence relating a current acquired psychiatric disorder to an in-service injury or illness, to include the in-service stressor.

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether service connection for an acquired psychiatric disorder is warranted. Rather, the evidence persuasively weighs against finding any current diagnosed acquired psychiatric disorder, to include PTSD is related to an in-service injury or illness. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107 (b), Lynch, 21 F.4th 776. The claim is denied.

4. Entitlement to service connection for urinary frequency is denied.

The Veteran contends that he has urinary frequency which is related to his active-duty service.

The service treatment records are silent for complaints or diagnosis of urinary frequency.

The evidence weighs persuasively against finding any current diagnosis of urinary frequency. In this regard, there is no evidence of record of any urinary frequency, nor has the Veteran specifically described any current symptoms of urinary frequency. There is thus no evidence of any current urinary frequency.

As the evidence of record weighs persuasively against finding any urinary frequency for which service connection may be granted, service connection is not warranted. Brammer v. Brown, 3 Vet. App. 223 (1992).

The record indicates that the Veteran has not been provided a VA examination to consider the nature and etiology of his claimed urinary frequency, and the AOJ did not undertake to provide any such examination. VA's duty to assist includes providing a medical examination when necessary to make a decision on a claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4). Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) establishes that the veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology).

Here, at the time of the rating decision on appeal, the record contained no evidence of any current urinary frequency. Accordingly, even the low threshold under McLendon was not met and VA's duty to provide a VA examination was not triggered. See 38 U.S.C. § 5103A; 38 C.F.R. §§ 3.159 (c), 3.326; Bardwell v. Shinseki, 24 Vet. App. 36, 39 (2010); Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010). Therefore, there is no pre-decisional duty-to-assist error in the choice not to provide an examination for this claim.

38 U.S.C. § 1168 (a) requires a medical nexus opinion and examination if a Veteran submits a claim for compensation for a service-connected disability under section 1110 with evidence of a disability and evidence of participation in a TERA during service, and such evidence is not sufficient to establish a service connection for the disability. However, again, there is no evidence of any current urinary frequency. Therefore, in the absence of evidence of a disability, a TERA examination was not required.

As the evidence of record weighs persuasively against finding any urinary frequency for which service connection may be granted, service connection is not warranted. Brammer
cisional duty-to-assist error in the choice not to provide an examination for this claim.

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether service connection for urinary frequency is warranted. Rather, the evidence weighs persuasively against finding any current urinary frequency. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107 (b), Lynch, 21 F.4th 776. The claim is denied.

REASONS FOR REMAND

5. Entitlement to service connection for tinnitus is remanded.

The Veteran was provided a VA examination to consider the etiology of his claimed tinnitus in November 2024. At that time, the examiner diagnosed tinnitus and opined that tinnitus was unlikely related to in-service noise exposure. However, the examiner did not address whether tinnitus was related to an in-service TERA. Here, there is evidence of tinnitus and evidence of participation in a TERA during service, as documented by the October 2024 TERA Memorandum. Accordingly, 38 U.S.C. § 1168 (a) requires that a medical opinion be obtained to address whether tinnitus is related to the in-service TERAs. Failure to obtain a medical opinion addressing this question was a duty to assist error requiring remand.

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The matters are REMANDED for the following action:

Request a medical opinion from an appropriate clinician to determine the etiology of tinnitus. The examiner should answer the following questions:

(a.) Is tinnitus at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) related to in-service TERAs?

The examiner must expressly consider both the total potential exposure through all applicable military deployments and synergistic, combined effect of all TERAs?

S. Kim

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Bametzreider, Paul

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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