Citation Nr: 0810760 Decision Date: 04/01/08 Archive Date: 04/14/08 DOCKET NO. 03-33 370 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Salt Lake City, Utah THE ISSUE Entitlement to service connection for a psychogenic gastrointestinal disorder, to include as secondary to schizophrenia. REPRESENTATION Appellant represented by: American Red Cross ATTORNEY FOR THE BOARD Heather M. Gogola, Associate Counsel INTRODUCTION The veteran served on active duty from July 1977 to August 1977. This matter is before the Board of Veterans'' Appeals (Board) on appeal from a September 2003 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah. The Board notes that the veteran's original claim was previously remanded to the RO via the Appeals Management Center (AMC) for further development per Board decisions dated March 2005 and August 2007. FINDING OF FACT The veteran does not have a psychogenic gastrointestinal disorder that is related to his service-connected schizophrenia, or any other aspect of his active service. CONCLUSION OF LAW A psychogenic gastrointestinal disorder was not incurred in, or the result of, any incidence of service, and is not proximately due to or the result of a service-connected disability. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSION The requirements of the Veterans Claims Assistance Act of 2000 (VCAA) have been met. There is no issue as to providing an appropriate form or completeness of the application. VA notified the veteran in August 2005 and March 2006 of the information and evidence needed to substantiate and complete a claim, to include notice of what part of that evidence is to be provided by the claimant and notice of what part the VA will attempt to obtain. VA has fulfilled its duty to assist the claimant in obtaining identified and available evidence needed to substantiate a claim, and as warranted by law, affording VA examination. VA informed the claimant of the need to submit all pertinent evidence in their possession, and provided adequate notice of how disability ratings and effective dates are assigned. While the appellant may not have received full notice prior to the initial decision, after notice was provided the claimant was afforded a meaningful opportunity to participate in the adjudication of the claims, and the claim was readjudicated. The claimant was provided the opportunity to present pertinent evidence and testimony. In sum, there is no evidence of any VA error in notifying or assisting the appellant that reasonably affects the fairness of this adjudication. Analysis The veteran contends that he has a psychogenic gastrointestinal disorder that is the result of his active service. Alternatively, the veteran asserts that he has a psychogenic gastrointestinal disorder that is due to his service-connected schizophrenia. Service connection may be established where the evidence demonstrates that an injury or disease resulting in disability was contracted in the line of duty coincident with military service, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303. To establish service connection, there must be: (1) a medical diagnosis of a current disability; (2) medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd 78 F.3d 604 (Fed. Cir. 1996). Service connection may be granted for a disability that is proximately due to, or the result of, a service-connected disability. 38 U.S.C.A. § 3.310 (2007). To establish entitlement to service connection on a secondary basis, there must be competent medical evidence of record establishing that a current disability is proximately due to, or the result of, a service-connected disability. See Lantham v. Brown, 7 Vet. App. 359, 365 (1995). The veteran's service medical records revealed complaints of vomiting, spitting up blood, diarrhea, and pain in the mid- epigastric area soon after he began his military service in July 1977. The veteran was provided with a diagnosis of active peptic ulcer disease, hemodynamically stable. A Medical Board examination report indicated a diagnosis of psychophysiologic gastrointestinal dysfunction, and discharge was recommended. An April 1998 emergency room report indicated complaints of abdominal pain, nausea and vomiting. Examination revealed a somewhat distended abdomen with rather generalized tenderness, no guarding, no rebound, no masses or oganomegaly and diminished bowel sounds. A MRI of the same dated noted findings suggesting a small bowel obstruction with maybe incomplete or early complete. A diagnosis of acute abdominal pain of questionable etiology, possible diverticulitis was provided. A May 1998 discharge summary noted a diagnosis of acute diverticulitis. The veteran was provided with a VA examination in March 2005. The veteran reported being diagnosed with psychophysiological gastrointestinal dysfunction in 1977 while in the military, and that he was better after discharge, but that symptoms would return about once every three months. Symptoms included stomach ache, nausea, bloating, black tarry bowel movements, and vomiting. Upon examination, abdomen was soft, bowel sounds were normoactive, and there was diffuse tenderness in the lower quadrant bilaterally. The examiner stated that the veteran's symptoms were consistent with diverticulitis, and that it was probable that the veteran had a psychosomatic component to his gastrointestinal symptoms. The examiner further stated that it is not at least as likely as not or less than 50 percent probability that the current gastrointestinal disability is the same as the disability mentioned in service, noting that the veteran was eventually diagnosed with psychophysiological gastrointestinal dysfunction. In September 2007, the veteran was afforded another VA examination. The veteran reported that over the past several years, he had pain on the left that varied from mild to severe, once or twice a week. He also reported occasional diarrhea, with four or five episodes in the last few years. He also stated that about four or five years ago he was sick for three days with bloating and abdominal pain. The veteran further stated that he did not normally have nausea or vomiting but does have some trouble with acid reflux. He denied dysphagia, epigastric pain, hematemesis, melena, or any symptoms above the belly button. Examination revealed a nontender abdomen with normal bowel sounds and no masses. There was some periumbilical erythema and some irritation at the umbilicus but no cellulitis. The examiner provided a diagnosis of gastroesophageal reflux and a history of diverticulitis, but noted that the veteran never had a colonoscopy to confirm the diagnosis of diverticulitis. Further, the examiner opined that schizophrenia does not, in and of itself cause either gastroesophageal reflux disease or diverticulitis, nor does his medication of Porlixin cause the conditions. Thus, the examiner stated that is was not at least as likely as not that his current gastrointestinal disorders were caused by or the result of his schizophrenia. The examiner also opined that the veteran did not currently have any psychogenic gastrointestinal disorder. While the veteran was treated for gastrointestinal complaints and provided with a diagnosis of psychogenic gastrointestinal disorder during service, there is no objective medical evidence that the veteran's complaints during service are related to his current gastrointestinal disorders. The Board notes that a previous Board decision dated August 2007 denied service connection for diverticulitis. While the March 2005 VA examiner stated it was probable that the veteran had a psychosomatic component to his gastrointestinal symptoms, the September 2007 VA examiner specifically stated that the veteran's schizophrenia, including medication taken to treat the condition, does not cause gastroesophageal reflux or diverticulitis. More importantly, the September 2007 VA examiner stated that the veteran did not have any current psychogenic gastrointestinal disorder. Thus, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, the evidence of record does not show that the veteran has a psychogenic gastrointestinal disorder that is due to service, or is proximately due to or the result of a service-connected disability. As there is not an approximate balance of positive and negative evidence regarding the merits of the appellant's claim that would give rise to a reasonable doubt in favor of the appellant, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). ORDER Service connection for a psychogenic gastrointestinal disorder is denied. ____________________________________________ K. J. ALIBRANDO Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs