Citation Nr: 18153406 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 07-07 571 DATE: November 27, 2018 ORDER Entitlement to service connection for gastrointestinal disorder to include colitis and rectal bleeding is denied. Entitlement to service connection for idiothrombocytopenic purpura (ITP), to include as due to exposure to herbicide agents, chemicals, and as secondary to gastrointestinal disorder is denied. FINDINGS OF FACT 1. The Veteran’s gastrointestinal disorder did not have its clinical onset in service and there is no evidence to show that it is otherwise related to service. 2. ITP did not have its onset in service and there is no evidence to show that it is otherwise related to service or service connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a gastrointestinal disorder have not been met. 38 U.S.C. §§ 1110, 1117, 5107; 38 C.F.R. §§ 3.303, 3.317. 2. The criteria for service connection for ITP have not been met. 38 U.S.C. §§ 1110, 1117, 5107; 38 C.F.R. §§ 3.303, 3.307,3.309 3.310, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from April 1966 to February 1970. These matters are on appeal from a March 2009 rating decision and were previously remand via February 2013, September 2013, and July 2017 Board remands. The Board notes that the Veteran initially presented a claim of entitlement to service connection for rectal bleeding, but that issue was recharacterized by the Board as a petition to reopen a claim for entitlement to service connection for gastrointestinal disorder, to include rectal bleeding and colitis. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence 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, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Disabilities diagnosed after discharge may still be service-connected if all the evidence, including pertinent service records, establishes that the disorder was incurred in service. 38 C.F.R. § 3.303(d). Under the relevant laws and regulations, presumptive service connection can be granted for certain diseases due to herbicide exposure, and it is presumed that a Veteran who served in Vietnam during the Vietnam Era, such as this Veteran, was exposed to Agent Orange/herbicides in service. 38 C.F.R. §§ 3.307, 3.309. Additionally, service connection may be granted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). The Veteran has not alleged, and his service records do not suggest, that he had service in Vietnam. He claims he served in Okinawa, and his service records confirm his service in Okinawa in 1969. Because he lacks the requisite service in Vietnam or in another location where herbicides are acknowledged by VA to have been sprayed, the presumptive disability provisions do not apply. 38 C.F.R. § 3.307(a)(6)(iii). In various written statements, the Veteran asserts that he was stationed in Okinawa and exposed to jet and aircraft engine fuel emissions, aircraft lubricants, chemical dioxins and toxins, outgoing airborne transportation of chemical dioxins and toxins or herbicide agents in support of the Vietnam conflict. Most recently he contends that he was exposed to high levels of fluoride and lead in service. See Medical Treatment Record Non-Government Facility received July 2016 and August 2018 at 1; see also correspondence received August 2018 at 2. 1. Gastrointestinal Disability The Veteran contends that his current colitis diagnosis is related to active duty service, specifically to the gastrointestinal problems he experienced during service. Alternatively he contends that prolonged chemical exposure, (fluoride and lead), during active duty service is the cause of his current gastrointestinal disorder. Evidence of record shows a diagnosis of colitis See CAPRI received July 2018 at 47 and 121. The first requirement of service connection, a current diagnosis, is therefore established. Service treatment records show that in February 1967, the Veteran received treatment for vomiting and reddish colored sputum. In January 1970, he was treated for gastroenteritis During his separation exam later that month, the Veteran reported mild indigestion about twice a year, but the examiner noted no gastrointestinal issues and no issues with the anus, rectum, abdomen, or viscera. See STRs received July 2015 at 14-16. Based upon the reports of in-service injuries, the second element of service connection is also established. Thus, the crux of this issue is the final element of service connection, a nexus, which requires the showing of a causal relationship between the present disability and the injury incurred during service. Based on the record, the Board finds that service connection for a gastrointestinal disability is not warranted. There are several opinions of record that address the question of whether this disorder is related to the Veteran’ service. It is the responsibility of the Board to assess the credibility and weight to be given to evidence. Owens v. Brown, 7 Vet. App. 429, 433 (1995) (citing Wood v. Derwinski, 1 Vet. App. 190, 192 (1991)). The Board is permitted to favor one opinion over another provided that it gives an adequate statement of its reasons and bases for doing so. Simon v. Derwinski, 2 Vet. App. 621, 623 (1992). As indicated above, there are two conflicting medical opinions of record, one is a private opinion from Dr. R. L. J., who provides a positive nexus opinion. See Medical Treatment Record Non-Government Facility received July 2016 and August 2018. The other is a negative nexus opinion provided by a VA examiner in October 2016, December 2017 and June 2018. The Veteran submitted the private opinion letter from Dr. R. L. J in February 2016. Dr. R. L. J. opined that he believes that all of the Veteran’s current disabilities are likely related to exposure to hazardous chemicals. Further, Dr. R. L. J. alleged that “it was concluded by all the specialists [the Veteran] has seen since 1997 that the progressively disabling nature of his illness had to be related to prolonged exposure to toxic substances especially fluoride and lead throughout his military service.” See Medical Treatment Record Non-Government Facility received July 2016 and August 2018. However, opposing the positive nexus opinion is a negative nexus opinion provided by a VA examiner. The Veteran was examined at a VA medical facility in October 2016. In addition to examining the Veteran in person, the VA examiner also reviewed the claim file. The October 2016 examiner determined that it is less likely than not that the Veteran’s current gastrointestinal disorder was incurred in service or caused by his in-service ailments. In coming to this conclusion, the examiner noted that symptoms of mild indigestion and vomiting red sputum are not consistent with ulcerative colitis and there is no evidence to support a connection between those symptoms and ulcerative colitis that was not diagnosed until 2002. Furthermore, the gap of treatment for gastrointestinal issues indicates that the acute symptoms during service are not related to the 2002 diagnosis. In a June 2018 addendum opinion the same examiner specifically addressed the private opinion that the gastrointestinal disability was caused by prolonged lead and fluoride exposure during military service. After conducting an extensive review of the literature, he found no correlation between fluoride and lead exposure and the development of ulcerative colitis. He stated that the cause of ulcerative colitis is unknown. See C&P exam received June 2018 at 4. He provided the opinion that is less likely as not that the Veteran’s ulcerative colitis was related in any way to the claimed in-service chemical exposure. Id. He stated that current medical literature does not support a relationship between fluoride, increased lead levels and the development of ulcerative colitis. Id. First, the Board finds that the private physician’s opinion has relatively little probative value. Specifically, no review of the claims file was conducted, which is important in this case because the history provided by the Veteran varies from the history shown in the claims file. While a review of the medical records is not necessary in every case, see Snuffer v. Gober, 10 Vet. App. 400, 404 (1997) (stating that “the Court has never decided that in every case, a medical examiner must review all prior medical records before issuing a medical opinion or diagnosis”), in this instance, the history provided by the Veteran to the private physician is incomplete. Specifically, STRs and other post treatment records do not show that the Veteran was exposed to high levels of lead and fluoride during   service. Furthermore, the February 2016 letter from Dr. R. L. J. reports that high levels of lead and fluoride was discovered in the Veteran’s blood in 2014 which was many years most service. While it is claimed to be the result of military service there is no evidence of record to indicate such exposure during military service. In fact, the Veteran’s separation exam showed no ailments. The private examiner did cite literature, nonetheless in-service exposure to such chemicals as lead and fluoride has not been established and the VA examiner’s literature review greatly contradicts that of the private examiner. In this case the Board affords the private opinion relatively little probative value. The remaining relevant opinion of record is that from the Veteran and the VA examiner. While laypersons are sometimes competent to provide opinions regarding medical matters such as etiology and diagnosis, see Davidson v. Shinseki, 581 F.3d at 1315-16 (Fed.Cir.2009), the Board finds that the opinions provided by the VA examiners are more probative than the Veteran’s lay assertions. The VA examiners are medical professionals who possess training, expertise, and experience that the Veteran is not shown to have. The VA examiner’s opinions are predicated on a detailed review of the Veteran’s history, as set out in his service records and in records of post-service examination and treatment, and contains clear conclusions with supporting data and rationale. As such, the Board accords greater probative weight to the VA physicians’ opinions than to that of the Veteran. Therefore, the October 2016 and June 2018 VA examination reports are the most probative evidence of record with regard to whether the Veteran has a gastrointestinal disorder that is related to service. The evidence against the Veteran’s claim outweighs the evidence in its favor. For the foregoing reasons, it is the Board’s conclusion that the criteria for service connection for a gastrointestinal disability has not been met. In reaching this conclusion, the Board has considered   the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 2. ITP The Veteran contends that his ITP diagnosis is secondary to his ulcerative colitis; similarly, like his ulcerative colitis diagnosis, he also contends that his ITP is due to prolonged fluoride and lead exposure during military service. As service connection for a gastrointestinal disability, specifically the ulcerative colitis diagnosis has not been established, service connection for ITP on a secondary basis must be denied. As indicated above, Dr. R. L. J. opined that he believes that all the Veteran’s current disabilities are likely related to exposure to hazardous chemicals. Further, Dr. R. L. J. alleged that “it was concluded by all the specialists [the Veteran] has seen since 1997 that the progressively disabling nature of his illness had to be related to prolonged exposure to toxic substances especially fluoride and lead throughout his military service.” See Medical Treatment Record Non-Government Facility received July 2016 and August 2018. However, the June 2018 addendum opinion provided by the VA examiner found no correlation between fluoride and lead exposure and the development of ITP. Also, the record fails to show that the Veteran was in fact exposed to high levels of lead and fluoride during service. As there is no probative positive nexus linking the Veteran’s current ITP diagnosis to service, service connection for ITP must be denied.   In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Davis, Associate Counsel