Citation Nr: 18142418 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 14-39 524 DATE: October 15, 2018 ORDER Entitlement to service connection for a gastrointestinal disability is denied. FINDING OF FACT The preponderance of the evidence is against finding that a current chronic gastrointestinal disability, to include irritable bowel syndrome, was incurred in service or is otherwise related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a gastrointestinal disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (West 2012); 38 C.F.R. § 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1979 to March 1984. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The claims file was subsequently transferred to the RO in Cleveland, Ohio. This claim was previously before the Board in May 2018, at which time it remanded the issue decided herein in order to obtain additional VA treatment records as well as provide the Veteran with a new VA examination to determine the likely nature and etiology of his claimed gastrointestinal disability. Additional VA treatment records were added to the claims file in July 2018, and the Veteran was provided with a relevant VA examination in June 2018. Thus, the Board finds that there has been substantial compliance with its previous remand directives. See Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request, is required); Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that there was no Stegall violation when the examiner made the ultimate determination required by the Board's remand, because such determination more than substantially complied with the Board's remand order). The Board notes that its May 2018 Remand also addressed the issues of entitlement to service connection for a right shoulder disability and a low back disability. However, in a June 2018 Rating Decision, the RO granted entitlement to service connection for right shoulder rotator cuff tendonitis, status post rotator cuff repair, as well as lumbar degenerative arthritis. As this constitutes complete grants of the benefits sought on appeal with respect to these issues, they are no longer before the Board. Pursuant to the Veterans Claims Assistance Act of 2000 (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2014); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a); see also Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Here, VA correspondence dated July 2012 satisfied the duty to notify provisions with respect to service connection and notified the Veteran of the regulations pertinent to the establishment of an effective date and disability rating. Additionally, the claims file contains the Veteran’s service treatment records, VA treatment records, private treatment records, and lay evidence. Relevant VA examinations were conducted in March 2012 and June 2018. Review of the most recent VA examination report reflects that it is adequate for the purpose of adjudicating the claim. Specifically, the examination report reflected that diagnoses and opinions which are congruent with the other evidence of record were rendered following a physical examination of the Veteran and a review of the record. All offered opinions are accompanied by a complete rationale. 38 C.F.R. § 3.159 (c) (4) (2016); Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). In light of above, the Board finds that all necessary development has been accomplished and therefore appellate review may proceed without prejudice to the Veteran. See generally 38 C.F.R. § 3.159 (c). Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. § 1110 (West 2014); 38 C.F.R. §§ 3.303, 3.304 (2017). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish service connection for a disability resulting from a disease or injury incurred in service, or to establish service connection based on aggravation in service of a disease or injury which preexisted service, there must be (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of incurrence or aggravation of a disease or injury in active service; and (3) competent evidence of a nexus or connection between the current disability and the disease or injury incurred or aggravated in service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In many cases, medical evidence is required to meet the requirement that the evidence be "competent". However, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Here, the Veteran seeks entitlement to service connection for a gastrointestinal disability. Specifically, the Veteran maintained that he started having problems with his stomach in 1979, could not hold his food down, and experienced diarrhea, abdominal pain, nausea, and vomiting. He testified that he was placed on a special diet as a result of his gastrointestinal disability, and that he experiences the same gastrointestinal symptoms now that he experienced in service. A review of the Veteran’s service treatment records reveals treatment for severe abdominal pain and distension, etiology undetermined, later diagnosed as severe gastroenteritis, on several occasions in May 1980. He was later diagnosed as having gastritis in May 1983 after seeking treatment for stomach cramping. Significantly, however, the Veteran’s January 1984 Report of Medical Examination at separation indicated that his abdomen, viscera, anus, and rectum were within normal limits. Similarly, on his corresponding January 1984 Report of Medical History at separation, the Veteran indicated that he never suffered from indigestion, piles, rectal disease, or stomach, liver, or intestinal trouble. A review of the Veteran’s post-service VA treatment records show that he was prescribed simethicone for excessive gas. The Veteran was provided with a VA examination in March 2012, at which time the examiner acknowledged the Veteran’s history of in-service gastrointestinal symptomatology. However, the VA examiner found that the Veteran did not have current symptoms compatible with gastritis or any specific abdominal diagnosis; additionally, the examiner opined that the documented in-service gastrointestinal symptoms were acute and had since resolved. The Veteran was provided with another VA examination in June 2018, at which time the examiner concluded that the Veteran did not have and never had any chronic stomach or duodenum condition other than generalized irritable bowel syndrome. The VA examiner opined that any current abdominal problems were less likely as not a continuation of the complaints shown while on active duty. In support of this conclusion, the examiner explained that, although the Veteran used simethicone as needed for gas and bloating, he did not exhibit symptoms compatible with gastritis or any specific abdominal diagnosis; rather, he reported non-specific symptoms with diffuse lower abdominal pain. The examiner opined that the Veteran’s problems documented in service were acute, had since resolved, and were unlikely related to any symptoms described upon current examination. The examiner emphasized that the Veteran’s in-service complaints and diagnoses of gastroenteritis resolved with treatment, and that his separation examination reported “NO” for any stomach, liver or intestinal problems. Additionally, the VA examiner indicated that recent tests since 2012 had been normal, with no other complaints seen since then. The Board finds that the VA examiners’ medical opinions to be highly probative. The VA examiners’ opinions were based on a thorough review of the claims file, including the service treatment records and examination of the Veteran, and the opinions are consistent with other evidence of record. Moreover, the examiners provided adequate rationale for the opinions provided and cited to the medical evidence in support of the opinions. Accordingly, the VA examiners’ opinions are entitled to great probative weight. See Nieves-Rodriguez, 22 Vet. App. at 304. To the extent the Veteran believes that he currently suffers from a gastrointestinal disability that is related to service, as a lay person, he does not have the specialized training sufficient to render such an opinion. See Jandreau, 492 F.3d at 1377, n. 4. Thus, the Veteran's own opinion regarding the etiology of the claimed gastrointestinal disability is not a competent medical opinion. Moreover, the most probative and persuasive evidence is against a finding that his claimed gastrointestinal disability is related to service. Significantly, there is no competent medical evidence that supports the claim. Accordingly, the preponderance of the evidence is against the claim, and service connection is denied. In sum, the most probative evidence of record does not support a finding that it is at least as likely as not that any gastrointestinal disability diagnosed during the period on appeal, to include irritable bowel syndrome, is related to the Veteran’s period of active duty service. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim for service connection for a gastrointestinal disability. As such, that doctrine is not applicable in the instant appeal, and the claim must be denied. See 38 U.S.C. § 5107 (b) (West 2014); Ortiz, supra; Gilbert, supra. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Anthony M. Flamini, Counsel