Citation Nr: 18145872 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 15-00 816 DATE: October 30, 2018 ORDER Entitlement to service connection for irritable bowel syndrome is granted. FINDING OF FACT The evidence is in equipoise as to whether the Veteran’s irritable bowel syndrome had its onset in active service. CONCLUSION OF LAW The criteria for entitlement to service connection for irritable bowel syndrome have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1966 to May 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of an April 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. In the April 2014 rating decision, the RO denied, in part, entitlement to service connection for fungal infections of hand and feet. The Veteran indicated his disagreement with this decision in the June 2014 notice of disagreement and a statement of the case was issued as to the issue in October 2014. The Veteran did not, however, file a timely VA Form 9 or its equivalent as to the issue. See Archbold v. Brown, 9 Vet. App. 124, 130 (1996) (pursuant to 38 U.S.C. § 7105 (a), the filing of a notice of disagreement initiates appellate review in the VA administrative adjudication process, and the request for appellate review is completed by the claimant’s filing of a substantive appeal after a statement of the case is issued by VA). This issue is therefore not in appellate status and is not before the Board. 1. Entitlement to Service Connection for Irritable Bowel Syndrome The Veteran contends that he has irritable bowel syndrome that had its onset during his active military service. Specifically, the Veteran’s wife stated that upon returning home from Vietnam, the Veteran suffered from stomach distress and abdominal pain with alternating diarrhea and constipation. See Statement, received June 2014. To establish service connection for a disability on a direct-incurrent basis, the Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004). See also 38 C.F.R. § 3.303. The evidence of record shows that the Veteran has a current diagnosis of irritable bowel syndrome. See, e.g., Private treatment record dated March 2000. Therefore, there is evidence of a current disability. As to an in-service event, injury or disease the Veteran’s service treatment records do not reflect complaints related to irritable bowel syndrome. However, in the June 2014 correspondence, the Veteran’s wife, a registered nurse for 42 years, stated that the Veteran began to complain about stomach distress shortly after returning from Vietnam. In addition, the Veteran’s wife stated that the Veteran suffered from abdominal pain with alternating diarrhea and constipation. The Veteran’s wife is competent to report the Veteran’s symptoms she observed, such as abdominal pain, alternating diarrhea and constipation, and stomach distress, that she witnessed. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). As such, the Board finds there is evidence of an in-service injury of gastrointestinal distress and abdominal pain. Therefore, the question remaining for consideration is whether there is a causal relationship between the in-service gastrointestinal distress and abdominal pain and the Veteran’s current irritable bowel syndrome. Concerning element (3), the Board recognizes that the evidence regarding a nexus relationship between the Veteran’s current irritable bowel syndrome and his active service is limited. However, the Board finds that the Veteran has provided competent and credible evidence regarding the onset and persistent nature of his irritable bowel syndrome. As mentioned above, the Veteran’s wife stated that she has been a registered nurse for 42 years and has experience evaluating medical problems. She stated that when the Veteran returned home from Vietnam he complained of gastrointestinal distress and abdominal pain that did not exist prior to his service in Vietnam. Additionally, the Veteran’s spouse provided receipts for medication that the Veteran took related to his irritable bowel syndrome starting in 1978, four years after the Veteran’s separation from active service. In addition, the medical treatment records support the Veteran’s statements regarding the chronic nature of his irritable bowel syndrome. A May 2014 private treatment record reflects that the Veteran was treated for recurrent and persistent alternating diarrhea and constipation with abdominal discomfort from 1980 through 1999. Additionally, medical records from the Mayo Clinic reflect that the Veteran complained of and was treated for irritable bowel syndrome in 2000. Furthermore, the provisions of 38 C.F.R. § 3.303 (d) direct that service connection may 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. The Board acknowledges that the Veteran was provided a VA review of available medical records examination in January 2016. The VA examiner reviewed the Veteran’s records and opined that his irritable bowel syndrome was less likely than not incurred in or caused by the claimed in-service injury, event or illness. As rationale, the VA examiner stated that the Veteran’s service treatment records do not reflect objective complaints of recurrent bowel issues while on active duty. The examiner further stated that private medical records do not indicate a diagnosis of irritable bowel syndrome in service or within one year of separation from active service. However, the VA examiner did not address the Veteran’s wife’s competent and credible statements that the Veteran suffered from stomach distress and abdominal pain with alternating diarrhea and constipation shortly after returning from Vietnam. Since the January 2016 VA examiner did not examine the Veteran or address his wife’s competent and credible statements, the Board affords relatively little probative weight to the January 2016 opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In this case, the Board finds that the evidence, including the evidence pertinent to service, is in relative balance as to whether the Veteran’s current disability is related to active service. As the evidence is in relative balance as to whether the Veteran’s current irritable bowel syndrome is related to service, the benefit-of-the-doubt is resolved in favor of the Veteran. Service connection for irritable bowel syndrome is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102 (2017).   VA’s Duty to Notify and Assist With respect to the Veteran’s claim herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (2012); 38 C.F.R. §§ 3.102, 3.156 (a), 3.159, 3.326 (2017); see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. G. LeMoine, Associate Counsel