Citation Nr: 18145213 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 17-38 128 DATE: October 26, 2018 ORDER Entitlement to service connection for ulcerative colitis is granted. Entitlement to service connection for pancreatitis, to include as secondary to ulcerative colitis, is granted. Entitlement to service connection for type II diabetes mellitus, to include as secondary to pancreatitis, is granted. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. Veteran’s ulcerative colitis had its onset during service. 2. The Veteran’s pancreatitis is proximately due to medication taken for his ulcerative colitis. 3. The Veteran’s type II diabetes mellitus is proximately due to his pancreatitis. CONCLUSIONS OF LAW 1. The criteria for service connection for ulcerative colitis have been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for service connection for pancreatitis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for type II diabetes mellitus have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Introduction The Veteran served on active duty in the United States Navy from January 1967 to February 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a May 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In October 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. The Board observes that in April 2018 correspondence, the Veteran requested a Motion to Advance his appeal on the Board’s docket due to serious illness, and submitted substantial medical evidence to confirm a serious illness. While there is no AOD ruling letter, the undersigned Veterans Law Judge has found sufficient evidence to grant the motion to Advance on the Docket. Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection may be established on a secondary basis for a disability that is proximately due to or that has been aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence to show that (1) a current disability exists and (2) the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995) (en banc) (additional disability resulting from aggravation of a nonservice-connected disorder by a service-connected disorder is also compensable under 38 C.F.R. §3.310). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Background and Analysis The record shows that the Veteran was diagnosed with ulcerative colitis in 1968, during service, and that he received a medical discharge related to the condition. Specifically, treatment records from September 1968 show the Veteran was admitted to a U.S. Naval Hospital with symptoms including diarrhea, tenesmus, and lower abdominal cramping. He reported he had no prior history of gastrointestinal disorders and had enjoyed excellent health prior to the onset of his symptoms approximately nine months prior. Following laboratory tests, a sigmoidoscopy, and biopsies, the Veteran was diagnosed with ulcerative colitis. Post-service medical records show the Veteran remains diagnosed with ulcerative colitis. The record, to include the Veteran’s credible testimony during his October 2018 Travel Board hearing, shows he has suffered from the condition, to varying degrees of severity, intermittently since service. Upon review, there is no medical or other evidence indicating the Veteran’s ulcerative colitis pre-existed service. Instead, the evidence shows the condition had its onset during service and has persisted to the present day. Accordingly, granting of service connection for ulcerative colitis is warranted. Service connection for pancreatitis and type II diabetes mellitus The record shows the Veteran has been diagnosed with pancreatitis on several occasions, as well as type II diabetes mellitus. He has contended his pancreatitis is secondary to medication taken for his ulcerative colitis. Additionally, he has contended his type II diabetes mellitus is secondary to medication taken for his ulcerative colitis and/or secondary to his pancreatitis. In a July 2015 letter, Dr. L.G., a specialist in gastroenterology, stated that when he cared for the Veteran, the Veteran was placed on medication for his ulcerative colitis. During that time, Dr. L.G. stated, the Veteran developed abdominal pain and had elevations of amylase and lipase until he had several episodes of acute pancreatitis. Dr. L.G. determined that the Veteran’s pancreatitis was very likely secondary to the medication he was taking for his ulcerative colitis. Dr. L.G. further stated that it was very likely that some of the consequences of the Veteran’s acute pancreatic inflammation over time may have contributed to several of the Veteran’s issues, to include his diabetes. In a separate March 2016 letter, Dr. E.R. noted the Veteran had a long history of ulcerative colitis for which he was placed on medication, but that unfortunately, he developed severe pancreatitis as a result of this medication. Upon a review of the foregoing and of the entire record, the Board first notes there is no medical or other evidence to contradict the findings of Dr. L.G. and Dr. E.R. with respect to the etiologies of the Veteran’s pancreatitis and diabetes. Regarding pancreatitis, the Board notes that the two physicians in question were treating the Veteran at the time he developed pancreatitis, and thus, were in the best possible position to determine the etiology of the pancreatitis. Both Dr. L.G. and Dr. E.R. attributed the condition to medication taken for the Veteran’s ulcerative colitis, which, as noted above, the Board has determined is subject to service connection. Based on the foregoing, the Board finds the evidence is at least in equipoise as to whether the Veteran’s pancreatitis is proximately due to his ulcerative colitis. Therefore, granting of service connection for pancreatitis is in order. Regarding diabetes, the most probative medical evidence of record which addresses the etiologies of the Veteran’s condition’s is the July 2015 letter by Dr. L.G., which attributed the condition, at least in part, to the Veteran’s pancreatitis. In the absence of any medical evidence contradicting Dr. L.G.’s findings, the Board finds the evidence is at least in equipoise as to whether the Veteran’s diabetes is proximately due to his pancreatitis. Because, as noted above, the Board has determined the Veteran’s pancreatitis is subject to service connection, granting of service connection for type II diabetes mellitus is also in order. REMAND The Veteran filed a claim for a TDIU in November 2014. A review of the record shows, however, that no VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, has been filed in this case. The Veteran has not otherwise provided any information regarding his work history or current employment status. Under these circumstances, the Board finds a remand is warranted to solicit a completed VA Form 21-8940 from the Veteran, so that he may provide up-to-date information regarding his employment history and current employment status. The matter is REMANDED for the following actions: 1. Provide and request the Veteran complete and return an updated VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, detailing his work history and current employment status. 2. Undertake any other development determined to be warranted. 3. Then, readjudicate the issue on appeal. If the benefit sought on appeal is not granted to the Veteran’s satisfaction, the Veteran and his representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs