Citation Nr: 19153003 Decision Date: 07/09/19 Archive Date: 07/09/19 DOCKET NO. 09-30 461 DATE: July 9, 2019 ORDER Service connection for ulcerative colitis is granted. FINDING OF FACT The evidence is in relative equipoise regarding whether the Veteran demonstrated the onset of ulcerative colitis in service or whether the Veteran’s PTSD disability aggravates his ulcerative colitis disability. CONCLUSION OF LAW The criteria to establish service connection for ulcerative colitis have been satisfied. 38 U.S.C. §§ 1110, 5107 (b) (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1969 to May 1971. Pursuant to a joint motion for remand (JMR) filed by VA and the Veteran, in February 2017 the Court of Appeals for Veterans Claims (CAVC) vacated the Board’s May 2016 decision and remanded it to the Board for compliance with its instructions. Before the CAVC, the parties agreed that the Board did not obtain an adequate medical opinion to fully address all the Veteran’s contentions. The Board has since requested 2 additional medical opinions to determine the etiology of the Veteran’s ulcerative colitis disability and its relationship to the Veteran’s service and his service-connected disabilities. All actions ordered by the remand have been accomplished and the Board grants the claim. Entitlement to service connection for ulcerative colitis Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Additional disability resulting from the aggravation of a nonservice-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310 (b). See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination about the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104 (a). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran contends that his in-service viral infection led to his subsequent ulcerative colitis diagnosis. Alternatively, the Veteran contends his current PTSD disability aggravates his ulcerative colitis symptoms. VA treatment records indicate the Veteran reported the onset of ulcerative colitis in 1973. April 1971 service treatment records (STRs) indicate the Veteran reported a headache, chills, fever, nausea, aching joints and general malaise for several days. The examiner noted the Veteran stopped taking the military-issued malaria pills 12 months earlier because they gave him headaches. The Veteran tested negative for malaria and was treated for an unknown viral infection with bed rest, fluids and pain relief medication. At his May 1971 report of medical examination at discharge, the Veteran’s overall clinical evaluation was normal, and he reported he was in good health. At the October 2015 VA medical examination, the examiner noted the Veteran was diagnosed with ulcerative colitis in 1975, although the Veteran reported that symptoms began in 1973. The examiner noted the Veteran had a total colectomy with rectal anastomosis in 2003, and that the Veteran did not currently demonstrate significant gastrointestinal (GI) symptoms, although the Veteran reported 5 to 10 bowel movements daily. The examiner opined the Veteran’s current ulcerative colitis disability was not incurred in service because the Veteran did not demonstrate GI symptoms such as diarrhea or rectal bleeding during service. The examiner noted that although the Veteran demonstrated a viral infection of unknown origin, the infection did not demonstrate with lower GI symptoms and that ulcerative colitis did not demonstrate with stomach pains or upper GI symptoms. In a July 2017 addendum opinion, the same October 2015 VA examiner further explained that medical literature did not support the contention that ulcerative colitis was caused by herbicide exposure and that as an autoimmune disorder, ulcerative colitis was not caused by the claimed physical injury of falling out of a helicopter. In a June 2018 VA opinion, a gastroenterologist reviewed the Veteran’s claims file and opined that ulcerative colitis was not “connected” to physical injury, herbicide exposure or a non-GI viral infection. In an April 2019 addendum VA opinion, a different VA examiner noted that although the Veteran’s in-service physical injury and presumed herbicide exposure did not cause the Veteran’s ulcerative colitis disability, the Veteran’s in-service viral infection may have increased the Veteran’s risk factor for developing ulcerative colitis soon after discharge. The examiner noted that studies have suggested a relationship between acute gastroenteritis and the development of inflammatory bowel disease (IBD) and that given the findings of these studies, it was possible that the Veteran’s in-service viral infection “may have played a small role” in putting the Veteran at risk for developing ulcerative colitis. In addition, the examiner noted that although there were no definitive studies that examined the relationship between psychological factors and the risk of developing ulcerative colitis, stress “may have a role” in exacerbating ulcerative colitis symptoms and thus the Veteran’s PTSD “may have aggravated” the disability and played a role in precipitating flare-ups. The medical evidence is in relative equipoise regarding whether the Veteran demonstrated the onset of ulcerative colitis in service or whether the Veteran’s PTSD disability aggravates his ulcerative colitis disability. Affording the Veteran the benefit of the doubt, the claim for service connection is granted. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Anwar, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.