Citation Nr: 1001074 Decision Date: 01/07/10 Archive Date: 01/15/10 DOCKET NO. 08-39 589 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Buffalo, New York THE ISSUES 1. Entitlement to service connection for celiac disease. 2. Entitlement to service connection for a bone disorder, claimed as secondary to celiac disease. REPRESENTATION Veteran represented by: The American Legion WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD N. L. Northcutt, Associate Counsel INTRODUCTION The Veteran served on active duty from October 1982 to October 1992 and from March 2003 to February 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York. The Veteran testified at a hearing before the undersigned Veterans Law Judge in October 2009. A transcript of those proceedings has been associated with the Veteran's claims file. FINDINGS OF FACT 1. The Veteran reports the onset of the symptoms of his currently-diagnosed celiac disease during his second period of active service, and treatment records months after his discharge from his second period of service reflect his reports of diarrhea. 2. A VA medical opinion finds it at least as likely as not that the Veteran's celiac disease began during the Veteran's second period of service. 3. The Veteran's treatment records reference diagnoses of both osteopenia and osteoporosis, and the Veteran's treating VA physician stated that osteoporosis is a known complication of celiac disease. CONCLUSIONS OF LAW 1. The criteria for service connection for celiac disease have been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002 & Supp. 2009); 38 C.F.R. § 3.303 (2009). 2. The criteria for service connection for a bone disorder, secondary to celiac disease, have been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.310 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist Under applicable criteria, VA has certain notice and assistance obligations to claimants. See 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). In the instant case, the Board is granting the Veteran's service connection claims; thus, the Board is granting the benefits sought on appeal. Accordingly, assuming, without deciding, that any error was committed with respect to either the duty to notify or the duty to assist, such error was harmless and will not be further considered. II. Service Connection Through his submitted statements and Board hearing testimony, the Veteran contends that his currently-diagnosed celiac disease had its onset during his second period of active service and that his currently-diagnosed bone disorder is secondary to his celiac disease, thereby entitling him to service connection for both diseases. In seeking VA disability compensation, a veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131. "Service connection" basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303 (2009). Establishing direct service connection generally requires (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a) (2008). Secondary service connection may be granted for a disability which is proximately due to, or the result of, a service- connected disorder. 38 C.F.R. § 3.310(a) (2009). Turning first to the Veteran's celiac disease service connection claim, the Board notes that the Veteran is currently diagnosed with celiac disease, as reflected in his medical treatment of record. Thus, the relevant inquiry is whether the Veteran's celiac disease had its onset in service or is otherwise related to service. In that regard, the Board notes that the Veteran's service records do not reflect that he was diagnosed with celiac disease nor do they reflect any related symptoms during his second period of active service. Nevertheless, the Veteran is competent to report experiencing the symptoms of his celiac disease in service, namely diarrhea and abdominal cramping. (The Veteran's service treatment records from his first ten-year period of service reflect three instances of gastrointestinal complaints, but the records reflect that these were assessed as acute and viral in nature.) See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required). The Veteran also reports continuity of his celiac disease symptomatology since service, and his reports are corroborated by the medical evidence of record. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) (holding that a Veteran is competent to report continuity of symptomatology). Specifically, a May 2004 private treatment record reflects that the Veteran's intermittent diarrhea was diagnosed as irritable bowel syndrome at the time, and July 2004 VA treatment records also reference the Veteran's intermittent diarrhea. Moreover, the VA treatment records reflect that when the Veteran sought treatment for his gastrointestinal symptoms in August 2007, at which time clinical tests were performed that affirmatively diagnosed the Veteran with celiac disease. At that time, the Veteran reported the onset of his gastrointestinal symptoms after being deployed in 2003. It is notable that the Veteran had not yet filed the instant service connection claim at the time of this treatment, thereby lending more credibility to his report. Furthermore, a January 2008 letter from the Veteran's VA gastroenterologist reflects the physician's opinion that the Veteran's currently-diagnosed celiac disease is as likely as not due to the Veteran's second period of active duty. The physician stated that he had reviewed the Veteran's medical record and stated that the Veteran had experienced chronic diarrhea and malaise since his overseas deployment to Saudi Arabia and Kuwait. The physician therefore opined that it was clear that the Veteran's celiac condition began when he was exposed to the difficult and extreme conditions of his service in Saudi Arabia and Kuwait. Therefore, given the Veteran's competent reports of experiencing the symptoms of his celiac disease during his second period of service (as corroborated by his treatment records reflecting his reports of diarrhea very soon after his discharge from this period of service) and the Veteran's treating VA gastroenterologist's opinion that the extreme conditions of the Veteran's deployment triggered the onset of his celiac disease in service, the Board finds that a basis for granting service connection for celiac disease has been presented. With regard to the Veteran's service connection claim for a bone disorder, the Veteran contends that his recently- diagnosed bone disorder is secondary to his celiac disease, which began in service, as bone loss in men of his age (45- years old at the time of his diagnosis) is rare, absent a medical complication. The Veteran's medical records reflect that he has been diagnosed with osteopenia (the predecessor to osteoporosis) of the lumbar spine and femoral neck based on the results of a January 2008 VA bone density scan. Corresponding January 2008 VA treatment records reflect the treating physician's notation that the Veteran was obviously having osteoporosis, which is a known complication of celiac disease. Subsequent treatment records include a medical history of "osteoporosis/osteopenia." Accordingly, given this evidence of a currently-diagnosed bone disorder, referred to as osteopenia and osteoporosis, and the VA physician's medical opinion that these bone disorders are known complications of the Veteran's celiac disease, the Board finds that a basis for granting service connection as secondary to service-connected celiac disease has been presented, as well. ORDER Service connection for celiac disease is granted, subject to the laws and regulations governing the award of monetary benefits. Service connection for a bone disorder as secondary to celiac disease is granted, subject to the laws and regulations governing the award of monetary benefits. ____________________________________________ MICHAEL E. KILCOYNE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs