AVITAMINOSIS

Summary

The Veteran, a Navy veteran who served from June 1988 to July 1995, appeals the denial of service connection for vitamin D deficiency, initially denied in January 2016. After a remand in February 2019 for further examination and opinion, the Board granted service connection for vitamin D deficiency in July 2020, assigning a 10 percent rating. The Veteran sought an increased rating, contending his condition was more severe than the current 10 percent evaluation. The Board reviewed the evidence, including a February 2020 VA examination which confirmed the diagnosis but found no associated symptoms, and a December 2014 VA treatment record noting liquid stools and abdominal discomfort. The Veteran also testified at a September 2024 hearing about experiencing periodic diarrhea since service. The Board found the Veteran credible regarding his symptoms, noting the recurrent diarrhea and abdominal pain, supported by the treatment record and his testimony. These symptoms align with the criteria for a 20 percent rating under DC 6313. The Board found no evidence of other symptoms associated with vitamin D deficiency, such as stomatitis or dermatitis. Therefore, the Board granted an initial 20 percent rating for vitamin D deficiency, finding it most closely approximated the 20 percent criteria.

Rationale

Veteran's vitamin D deficiency diagnosed; Recurrent abdominal pain and diarrhea supported by medical records and testimony; Symptoms approximate 20 percent rating criteria under DC 6313

Full Decision Text

Citation Nr: A26040182
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 210810-178477
DATE: April 29, 2026

ORDER

Entitlement to an initial 20 percent rating, but no higher, for service-connected vitamin D deficiency is granted.

FINDING OF FACT

The Veteran's vitamin D deficiency manifests recurrent abdominal pain and diarrhea.

CONCLUSION OF LAW

The criteria for a 20 percent rating, but no higher, for service-connected vitamin D deficiency are met. 38 U.S.C. §?1155;?38 C.F.R. §§ 4.1-4.3, 4.6, 4.7, 4.14, 4.88b, Diagnostic Code (DC) 6313.

PROCEDURAL HISTORY

The Veteran served on active duty in the United States Navy from June 1988 until honorable discharge in July 1995.

In March 2015, under the "Legacy" adjudication process, the precursor to the current Appeals Modernization Act (AMA) process, the Veteran filed a VA Form 21-526Z, seeking service connection for multiple issues, including vitamin D deficiency. In a January 2016 rating decision, the Department of Veterans Affairs (VA) Regional Office (RO) denied the claim.

In January 2017, the Veteran filed a Notice of Disagreement (NOD) concerning the January 2016 rating decision. In May 2017, the RO issued a Statement of the Case (SOC) that continued the previous denial of service connection for vitamin D deficiency.

In July 2017, the Veteran filed VA Form 9, Appeal to Board of Veterans' Appeals (Board), concerning the May 2017 SOC. The Veteran elected a videoconference hearing. In October 2018, the Board conducted the requested hearing, and in a February 2019 decision, the Board remanded the claim of service connection for a vitamin D deficiency. Specifically, the Board directed the RO to obtain a new VA medical examination and new VA medical opinion(s) concerning the Veteran's vitamin D deficiency.

After completing the directed development, in March 2020, the RO issued a Supplemental Statement of the Case (SSOC) that continued the previous denial of service connection for vitamin D deficiency. The case was returned to the Board, and in a July 2020 decision, the Board granted service connection for a vitamin D deficiency. In a July 2020 rating decision, the RO, acting as the agency of original jurisdiction (AOJ) implemented the Board's decision, assigning a 10 percent evaluation, effective March 24, 2014. The AOJ notified the Veteran of this decision in correspondence dated August 11, 2020. The AMA automatically applies to all claims and requests for reopening of finally adjudicated claims for which VA issues notice of an initial decision on or after February 19, 2019. See 38?C.F.R. §?3.2400(a)(1). The July 2020 rating decision is an initial decision and the AMA applies. 

On August 10, 2021, the Veteran filed VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)), appealing the July 2020 rating decision to the Board. The Veteran elected to place this appeal on the Hearing docket. A Board hearing was conducted on September 26, 2024. As a valid and timely 10182 was received, the case is properly before the Board.

The Board may only consider the evidence of record at the time of the July 2020 AOJ decision on appeal, as well as any evidence submitted by the Veteran, or 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 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.

REASONS AND BASES FOR FINDING AND CONCLUSION

Increased Rating


 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.

REASONS AND BASES FOR FINDING AND CONCLUSION

Increased Rating

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10.? 

When a question arises as to which of two ratings applies under a particular Code, the higher rating is assigned if the disability more nearly approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3.

Entitlement to an initial 20 percent rating, but no higher, for service-connected vitamin D deficiency is granted.

The Veteran contends that his service-connected vitamin D deficiency is more severe that the current 10 percent evaluation. Hearing Transcript, September 2024.

The Veteran was granted service connection for his vitamin D deficiency in the July 2020 Board decision. The July 2020 AOJ rating decision assigned a 10 percent rating, effective March 24, 2014. The Veteran's vitamin D deficiency is currently rated under Diagnostic Code (DC) 6313, "Avitaminosis." 38 C.F.R. § 4.88b.

Diagnostic Code 6313 provides: a 10 percent rating is warranted for a confirmed diagnosis with nonspecific symptoms such as, decreased appetite, weight loss, abdominal discomfort, weakness, inability to concentrate, and irritability; a 20 percent rating is warranted with stomatitis, or achlorhydria, or diarrhea; a 40 percent rating is warranted with stomatitis, diarrhea, and symmetrical dermatitis; a 60 percent rating is warranted with all of the symptoms contained in the 40 percent rating, plus mental symptoms and impaired bodily vigor, and; a 100 percent, or total disability rating is warranted with marked mental changes, moist dermatitis, inability to retain adequate nourishment, exhaustion, and cachexia. 38 C.F.R. § 4.88b, DC 6313.

The Veteran underwent a VA medical examination in February 2020 concerning his vitamin D deficiency. The VA examiner confirmed that the Veteran had a diagnosed vitamin D deficiency, however the examiner stated that the Veteran had no symptoms associated with said deficiency. VA Medical Examination, February 2020.

At the time of the February 2020 examination, the Veteran was seeking service connection for additional conditions, including Irritable Bowel Syndrome (IBS). While the Veteran was not awarded service connection for IBS, and while this issue is not before the Board, the Veteran did undergo a VA medical examination for "Stomach and Duodenal Conditions," in February 2020. This examination was conducted on the same day, by the same examiner, as the aforementioned vitamin D deficiency examination. In the stomach condition examination, the examiner stated that the Veteran experiences, "recurrent non-severe periodic episodes of abdominal pain occurring monthly and are unrelieved by standard ulcer therapy." VA Medical Examination, February 2020.

In a VA treatment record, documenting an emergency department visit that took place in December 2014, the provider notes that the Veteran reported that he "has not had fully formed [bowel movement] in about a week. States intermittent episodes of small liquid stools. States discomfort in abdomen." VA Treatment Record, December 2014.

Finally, in the September 2024 hearing, the Veteran testified that he has experienced occasional, periodic diarrhea since his active-duty service. Hearing Transcript, September 2024. The Veteran specifically stated that since he left active duty service, he has never gone six months or more without an episode of diarrhea. Id.

The Veteran is credible and competent to provide evidence of his lived experience, and to provide evidence of symptoms that are capable of lay observation. See
 emergency department visit that took place in December 2014, the provider notes that the Veteran reported that he "has not had fully formed [bowel movement] in about a week. States intermittent episodes of small liquid stools. States discomfort in abdomen." VA Treatment Record, December 2014.

Finally, in the September 2024 hearing, the Veteran testified that he has experienced occasional, periodic diarrhea since his active-duty service. Hearing Transcript, September 2024. The Veteran specifically stated that since he left active duty service, he has never gone six months or more without an episode of diarrhea. Id.

The Veteran is credible and competent to provide evidence of his lived experience, and to provide evidence of symptoms that are capable of lay observation. See Jandreau v. Nicholson, 492 F.3d 1372 (2007). The Veteran is competent to report experiencing episodes of diarrhea, including the duration and frequency of said episodes. Thus, the evidence of record indicates that the Veteran has experienced recurrent, periodic episodes of diarrhea since active duty service. This finding is supported by the December 2014 VA treatment record documenting his "liquid stool." Moreover, while the February 2020 VA examiner indicated that the Veteran had no symptoms associated with his vitamin D deficiency, the examiner did find that the Veteran experienced monthly abdominal pain. It appears that the examiner attributed these symptoms to the IBS claim, rather than the vitamin D deficiency claim, but the symptoms were nonetheless present. This further supports the Veteran's assertion that he has experienced his diarrhea symptoms throughout the period on appeal.

Regarding the remaining symptoms associated with DC 6313, neither the Veteran nor his representative have ever asserted that the Veteran has experienced stomatitis, achlorhydria, symmetrical dermatitis, any mental symptoms associated with vitamin D deficiency, impaired bodily vigor, moist dermatitis, an inability to retain adequate nourishment, exhaustion, or cachexia. There is no medical evidence within the record before the Board that indicates that Veteran has experienced any such symptoms associated with his vitamin D deficiency.

The medical and lay evidence of record establishes that the Veteran has experienced recurrent abdominal pain and diarrhea throughout the period on appeal. There is no evidence before the Board that the Veteran has experienced any other symptoms associated with his vitamin D deficiency. This symptomatology most closely approximates the rating criteria of a 20 percent rating. Accordingly, entitlement to an initial 20 percent rating, but no higher, for service-connected vitamin D deficiency is granted.

 

 

Danette Mincey

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. T. Holtsclaw

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.