ANKYLOSING SPONDYLITIS

Summary

The Veteran served from June 2002 to September 2006. This case involves appeals for service connection for ankylosing spondylitis (AS) and Crohn's disease with diverticulitis. The Veteran argued that his AS was incurred during service and his Crohn's disease is secondary to his AS. The Board found that VA had already conceded current diagnoses of AS and Crohn's disease, and that documented in-service treatment for foot and ankle pain constituted a qualifying in-service event for AS. The Board relied on a positive opinion from the Veteran's treating physician, Dr. C.K., who opined that the in-service ankle pain was more likely than not the beginning of the Veteran's AS, reasoning that atraumatic joint pain is a common sign of AS. A negative VA opinion was given less weight as it did not consider the in-service foot and ankle pain. The Board found the evidence favored a nexus for AS. Since AS was granted, the Board then granted Crohn's disease as secondary, relying on a February 2025 VA examiner's opinion that the condition was at least as likely as not due to AS, with no contradictory evidence presented. Service connection for AS and Crohn's disease with diverticulitis was granted.

Rationale

Conceded current diagnosis of AS; Conceded in-service foot and ankle pain as qualifying event; Positive treating physician opinion linking in-service pain to AS; VA opinion less probative as it did not consider in-service pain

Full Decision Text

Citation Nr: A26040757
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 260217-643713
DATE: April 30, 2026

ORDER

Entitlement to service connection for ankylosing spondylitis (AS) is granted.

Entitlement to service connection for Crohn's disease with diverticulitis is granted.

FINDINGS OF FACT

1. It is at least as likely as not that the Veteran's AS was incurred during his active service.

2. It is at least as likely as not that the Veteran's Crohn's disease is due to or the result of his service-connected AS.

CONCLUSIONS OF LAW

1. The criteria for service connection for AS are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for Crohn's disease with diverticulitis as secondary to AS are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from June 2002 to September 2006.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision by a Department of Veterans Affairs (VA) regional office (RO). The Veteran timely appealed by submitting a February 2026 VA Form 10182 and requested the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the March 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted after the AOJ decision on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

1. Entitlement to service connection for ankylosing spondylitis (AS) and Crohn's disease with diverticulitis.

The Veteran asserts he is entitled to service connection for his AS and Crohn's disease with diverticulitis. Specifically, he argues that his AS was incurred during his active service and his Crohn's disease is secondary to his AS. 

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be granted on a secondary basis for a disability which is proximately due to, or the result of, an already service-connected disability. 38 CFR § 3.310. Establishing secondary service connection requires evidence of: (1) a current disability (for which secondary service connection is sought); (2) an already service-connected disability; and (3) that the claimed disability was either caused or aggravated by the already service-connected disability. 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

Here, VA has already conceded the Veteran has current diagnoses of AS and Crohn's disease with diverticulitis. Under the Appeals Modernization Act (AMA), the Board is bound by favorable findings unless they are rebutted by clear and unmistakable evidence. 38?C.F.R. §§?3.104(c); 20.801(a). After a thorough review of the Veteran's electronic claim file, the Board concludes that such clear and unmistakable evidence does not exist. Therefore, the current disability requirement is met for both claims. 

Regarding the AS claim, the Board has also conceded that documented in-service treatment for foot and ankle pain constitutes a qualifying in-service event or injury. A review of the record did not produce clear and unmistakable evidence to rebut this favorable finding, therefore, the in-service event or injury requirement is met for the AS claim. 

Turning to the question of a nexus, the Veteran submitted a positive opinion by Dr. C.K., the Veteran's treating physician for his in-service foot and ankle pain in October 2003. See Email Correspondence received October 
 After a thorough review of the Veteran's electronic claim file, the Board concludes that such clear and unmistakable evidence does not exist. Therefore, the current disability requirement is met for both claims. 

Regarding the AS claim, the Board has also conceded that documented in-service treatment for foot and ankle pain constitutes a qualifying in-service event or injury. A review of the record did not produce clear and unmistakable evidence to rebut this favorable finding, therefore, the in-service event or injury requirement is met for the AS claim. 

Turning to the question of a nexus, the Veteran submitted a positive opinion by Dr. C.K., the Veteran's treating physician for his in-service foot and ankle pain in October 2003. See Email Correspondence received October 2024; STR received October 2024. C.K. opined that he believed the in-service acute ankle pain that he treated the Veteran for in 2003 was more likely than not the beginning of the Veteran's AS. He reasoned that atraumatic joint pain is one of the common signs of AS. 

The Board notes there is a negative August 2023 VA opinion. See August 2023 C&P Exam. However, this opinion did not consider the Veteran's in-service foot and ankle pain, which evidence of record identifies as a possible symptoms of AS. See October 2024 Web / HTML Documents. Therefore, the Board assigns the negative August 2023 VA opinion less probative weight than the C.K. opinion. Therefore, the weight of the probative evidence is in favor of a nexus finding. Consequently, all the elements for service connection are met for the AS claim and service connection must be granted. 

Since service connection for AS has been granted, service connection for the Veteran's Crohn's disease may now be granted as secondary to his AS. In February 2025, a VA examiner opined that the Veteran's Crohn's disease is at least as likely as not due to or a result of his AS. See February 2025 C&P Exam. There is no contradictory evidence to be weighed against this opinion, therefore, the evidence supports a secondary nexus. Consequently, all of the elements for service connection for Crohn's disease with diverticulitis as secondary to AS have been met and service connection must be granted.

 

 

CHRISTOPHER A. WENDELL

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	E. J.

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.