Citation NR: 9802529 Decision Date: 01/29/98 Archive Date: 02/03/98 DOCKET NO. 95-27 507 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to service connection on a secondary basis for gastrointestinal disability. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Thomas H. O'Shay, Associate Counsel INTRODUCTION The veteran had active military service from August 1969 to August 1971. This matter comes before the Board of Veterans’ Appeals (Board) from a May 1995 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The Board notes that the veteran submitted duplicate copies of private medical records of his hospitalization in February 1995, in which he highlighted a diagnosis of depression he received. The veteran has also submitted excerpts from a drug reference publication which lists depression as a major side effect of Ibuprofen. The Board finds that the veteran has reasonably raised the issue of service connection on a secondary basis for depression. This matter is therefore referred to the RO for appropriate consideration. CONTENTIONS OF APPELLANT ON APPEAL The veteran essentially claims that the RO erred in not granting the benefit sought on appeal. He maintains, in substance, that he was prescribed Motrin, a common brand name for Ibuprofen, over an extended period of time by VA physicians for the alleviation of symptoms associated with his service-connected right knee disability. He asserts that the prescribed Motrin caused his gastrointestinal disability, and that compensation for that disability is therefore warranted. Thus, a favorable determination is requested. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1997), 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 preponderance of the evidence supports the veteran’s claim for service connection on a secondary basis for gastrointestinal disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. The veteran’s gastrointestinal disorder was caused or chronically worsened by service-connected disability. CONCLUSION OF LAW Gastrointestinal disability is proximately due to or the result of service-connected disability. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 3.310(a) (1997). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds that the veteran’s claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a), in that it is plausible. Further, the Board is satisfied that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with 38 U.S.C.A. § 5107(a). The veteran contends, in essence, that he was prescribed Ibuprofen, including under the brand name Motrin, for the relief of symptoms associated with his service-connected right knee, and that this medication caused his gastrointestinal disability. The record reflects that the RO adjudicated the veteran’s claim as one for compensation under the auspices of 38 U.S.C.A. § 1151, regarding disability resulting from an injury incurred as the result of medical treatment at a VA facility. Although there is arguably a basis for consideration of the provisions of 38 U.S.C.A. § 1151, since Motrin was prescribed in several instances to relieve symptoms associated with several nonservice-connected disabilities, the Board nevertheless concludes, on the basis of medical evidence, discussed below, clearly showing that Motrin was used in the treatment of the veteran’s right knee, that the issue should be characterized as one involving application of 38 C.F.R. § 3.310(a) (1997). Under that regulation, disability which is proximately due to or the result of a service-connected disability shall be service connected. The Board will therefore proceed to adjudicate the veteran’s claim on the basis specified on the title page of this decision. Review of the record reflects that the veteran is service connected for right knee disability, with a history of arthralgia and synovitis, currently evaluated as 20 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5257 (1997). Of record are VA outpatient treatment reports for the period from May 1991 to March 1995. The reports disclose several occasions, beginning in 1991, on which the veteran presented with complaints of right knee pain, for which Motrin was prescribed. In several instances in which the veteran complained of right knee pain, he also complained of pain from several other nonservice-connected disabilities. Also of record are private medical reports from Cox Medical Centers for February 1995. These reports indicate that the veteran was hospitalized that month with complaints of upper gastrointestinal bleeding. The veteran gave a history of nonsteroidal anti-inflammatory drug (NSAID) use, although he apparently reported that he used such medications for a variety of disabilities, including for his right knee. A gastric ulcer was identified on esophagogastroduodenoscopic examination and was described as involving hemorrhaging. The veteran’s treating physicians indicated that the veteran was suffering adverse effects from his therapeutic use of NSAIDs, and diagnosed him with upper gastrointestinal bleeding and azotemia, both probably induced by NSAIDs. One examiner specifically opined that the cause of the veteran’s bleeding was probably related to Ibuprofen or ulcer disease. In support of his claim, the veteran has submitted a computerized list, allegedly from a VA outpatient pharmacy, detailing his prescription history. This list indicates that he was prescribed Ibuprofen by a VA physician from October 1992 to November 1994; he was instructed to consume 800 milligram tablets four times daily with food. The veteran has also submitted copies of excerpts from two drug reference publications. Collectively, the excerpts indicate that major side effects of Ibuprofen, a nonsteroidal anti-inflammatory drug, include bleeding and ulcers. The publications also indicate that Motrin is a commonly used brand name for Ibuprofen. The record clearly indicates that the veteran was prescribed Ibuprofen, including under the brand name Motrin, by VA physicians several times between 1991 and 1994. While the Motrin apparently alleviated complaints associated with several nonservice-connected disabilities in addition to his right knee disability, the Board finds that Motrin was prescribed as part of the therapy associated with treatment of the veteran’s right knee disability. The veteran was hospitalized in 1995 and diagnosed with upper gastrointestinal bleeding, which was effectively related by medical opinion to his use of NSAIDs in general, and to Ibuprofen in particular. As the medical evidence of record confirms that the veteran’s current gastrointestinal disorder was caused or aggravated by medications prescribed to treat symptoms associated with his service-connected right knee disability, it follows that the preponderance of the evidence warrants service connection for gastrointestinal disability. 38 C.F.R. § 3.310(a). In reaching this determination, the Board recognizes that the issue is being disposed of in a manner that differs from that used by the RO, that is, on the basis of 38 C.F.R. 3.310(a) rather than § 38 U.S.C.A. § 1151. The Board has, therefore, considered whether the veteran has been given adequate notice to respond, and if not, whether he has been prejudiced thereby. Bernard v. Brown, 4 Vet. App. 384, 394 (1993). As the decision of the Board is favorable to the veteran, and since a claim granted under 38 C.F.R. § 3.310(a) entitles the veteran to no fewer benefits than those allowed a claim which is granted based on 38 U.S.C.A. § 1151, the Board concludes that the veteran has not been prejudiced by this approach. ORDER Entitlement to service connection on a secondary basis for gastrointestinal disability is granted. SHANE A. DURKIN Member, Board of Veterans' Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1997), 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 -