Citation NR: 9614021 Decision Date: 05/17/96 Archive Date: 05/28/96 DOCKET NO. 93-11 415 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUE Entitlement to service connection for bowel disease. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD C. R. Olson, Counsel INTRODUCTION The veteran served on active duty from June 1990 to September 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 1992 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon, which denied service connection for a bowel disorder. The case was previously before the Board in January 1995, when it was remanded for medical records, examination of the veteran and medical opinions. The requested development has been completed. The Board now proceeds with its review of the appeal. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his gastrointestinal disorder, most recently diagnosed as ulcerative colitis and primary sclerosing cholangitis, had its onset during his active service. He asserts that the disabilities were not manifested by the gastrointestinal discomfort experienced prior to service. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1995), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence supports service connection for ulcerative colitis and primary sclerosing cholangitis. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for an equitable disposition of the veteran's appeal. 2. The veteran's ulcerative colitis and primary sclerosing cholangitis are the result of disease during his active wartime service. CONCLUSION OF LAW Ulcerative colitis and primary sclerosing cholangitis were incurred in active wartime service. 38 U.S.C.A. §§ 101(16), 1110, 1111 (West 1991); 38 C.F.R. § 3.1(m) (1995). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, he has presented a claim which is plausible. All relevant facts have been properly developed and no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Service connection may be granted for a disability resulting injury suffered or disease contracted in line of duty or for aggravation of a preexisting injury suffered or disease contracted in line of duty. 38 U.S.C.A. §§ 101(16), 1110, 1131 (West 1991). The United States Court of Veterans Appeals notes that 38 C.F.R. § 3.1(m) provides in pertinent part as follows: In line of duty means an injury or disease incurred or aggravated during a period of active military, naval, or air service unless such injury or disease was the result of the veteran's own willful misconduct. A service department finding that injury, disease or death occurred in line of duty will be binding on the Department of Veterans Affairs unless it is patently inconsistent with the requirements of laws administered by the Department of Veterans Affairs. Kinnaman v. Principi, 4 Vet.App. 20, 27 (1993). Preservice medical records show treatment at Kaiser Permanente from December 1988 to January 1990. There was an undiagnosed complaint of diarrhea in November 1989. The subsequent notes, including those for January 1990, did not indicate any gastrointestinal complaints or findings. The veteran was examined for service in January 1990. He reported that he did not have frequent indigestion or stomach, liver, or intestinal trouble. The examiner indicated the veteran's abdomen and viscera to be normal. A record from the Portland Clinic, dated June 11, 1990, shows that the veteran had a 2 year history of abdominal discomfort and loose stools. Examination of the abdomen disclosed normoactive bowel sounds without masses, hepatosplenomegaly or pain. The assessment was probable irritable bowel syndrome. It was noted that the possibility of colitis needed to be ruled out. A note on the entrance examination report is dated June 25, 1990. It reflects that the veteran went to the Portland Clinic for stomach upset and was told that he was allergic to milk and ice cream. A February 1991 service department clinical record indicates that the veteran had anemia and that further testing was required. The veteran had consultations and tests. These included an April 1991 endoscopy which was interpreted as showing probable ulcerative colitis versus Crohn's disease. A medical board report was prepared by a physician. It reviewed the history and findings and reported a diagnosis of idiopathic inflammatory bowel disease, pancolitis. The physician expressed the opinion that the condition did not exist before service and that it occurred while the veteran was on active service. The veteran has stated that all of his treatment since service has been at VA facilities. Those records have been obtained. They contain various possible diagnoses as well as reports of numerous tests. Pursuant to the Remand of this Board, the files were reviewed by a physician. It is noted that the physician is a gastroenterologist and is familiar with the veteran's case. In a report and a letter dated in August 1995, the specialist stated that the veteran has a diagnosis of ulcerative colitis. She could not determine when it began but noted that it was first diagnosed in April 1991 (while the veteran was on active service). She also noted that she usually dated the onset of the disease to the time of the diagnosis. Another diagnosis was primary sclerosing cholangitis. The physician was of the opinion that the cholangitis was definitely an extraintestinal manifestation of the veteran's ulcerative colitis. In denying the veteran's claim, the RO took the position that the disability existed before service and was not aggravated by service. There were some gastrointestinal complaints before service which certainly raise a possibility that the colitis existed before service. However, in a case such as this where the disability was not noted when the veteran was examined for service, the burden is on VA to show by clear and unmistakable evidence that the disease existed before acceptance and enrollment and was not aggravated by service. 38 U.S.C.A. § 1111 (West 1991). The Board's search of the record does not disclosed any such clear and unmistakable evidence that the colitis existed before service. No physician reported any manifestations specific to colitis prior to service. There are no definite diagnoses of colitis before service. No physician has expressed an opinion linking the preservice gastrointestinal symptoms to the veteran's current colitis. The weight of the evidence supports the veteran's claim. Colitis was first diagnosed in service and the service department physician expressed an opinion that the colitis began in service. The service department made a formal determination that the condition was in line of duty and granted severance pay. 38 C.F.R. § 3.1(m); Kinnaman v. Principi, 4 Vet.App. 20, 28 (1993). The VA physician noted that the ulcerative colitis was first diagnosed in service and expressed the opinion she dated the onset to the time of diagnosis. This medical evidence supports the conclusion that the ulcerative colitis and primary sclerosing cholangitis are the result of disease which began in service. Consequently, the Board finds that the evidence supports service connection for ulcerative colitis and primary sclerosing cholangitis. ORDER Service connection for ulcerative colitis and primary sclerosing cholangitis is granted. H. N. SCHWARTZ Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741 (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1995), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. - 2 -