Citation Nr: 20006294 Decision Date: 01/24/20 Archive Date: 01/24/20 DOCKET NO. 17-07 403 DATE: January 24, 2020 ORDER Service connection for ulcerative colitis status post ileostomy is granted. FINDINGS OF FACT 1. The Veteran is diagnosed with ulcerative colitis status post ileostomy (ulcerative colitis). 2. The current ulcerative colitis began during service. CONCLUSION OF LAW Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for ulcerative colitis are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran, who is the appellant, had active service from March 1965 to June 1968. The case stems from an August 2014 Department of Veterans Affairs (VA) Regional Office (RO) rating decision that denied service connection for ulcerative colitis. The Veteran testified at a teleconference hearing before the Board of Veterans’ Appeals (Board) in April 2019. The transcript has been associated with the record. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326 (2018). The Board finds that the duties to notify and assist have been met. Additionally, this decision is a full grant of the benefits sought on appeal, so no additional discussion of the duties to notify and assist is warranted. Service Connection Legal Authority Service connection can be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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. 38 C.F.R. § 3.303(d). Service Connection for Ulcerative Colitis Beginning with the current diagnosis, the record reflects that the Veteran has a diagnosis of ulcerative colitis. The Veteran testified to the diagnosis at the April 2019 Board hearing, which included that his ulcerative colitis had worsened to the point that he required removal of the entire large intestine. Medical records include those dated June 22, 2017, November 28, 2017, and July 17, 2018. Additionally, a gastroenterology consultation note dated July 28, 2015 stated that the Veteran was stable with respect to the ulcerative colitis and that he was doing an excellent job with care of the ileostomy. Accordingly, the present disability requirement is met. After a review of all the lay and medical evidence of record, the Board finds that the evidence is at least in equipoise on the question of whether there was an onset of symptoms in service that were later diagnosed as ulcerative colitis, that is, whether the later diagnosed ulcerative colitis was directly “incurred in” service. See 38 C.F.R. § 3.303(d). While there is no treatment or diagnosis specifically for a gastrointestinal condition during service, the Veteran testified at the April 2019 Board hearing that he first experienced bloody stools during the second month in Vietnam, that he was told that he should wait and see what happened, and the bloody stools went away on their own. The Veteran shared in the VA Form 9 that the symptoms of bloody stools, irritable bowel, and diarrhea were persistent during service. Giving the Veteran the benefit of the doubt, the Board finds that there was an in-service incurrence of gastrointestinal symptoms. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. While ulcerative colitis is not a chronic disease, the Board has nonetheless found the evidence at least in equipoise on the question of whether the Veteran had gastrointestinal symptoms that began during service and continued since service separation, which symptoms were later diagnosed as ulcerative colitis, thus showing direct service onset or direct incurrence during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(d). The Veteran testified that, although the in-service symptoms resolved on their own, he had to get treatment when similar symptoms arose very shortly after service separation, that that a doctor mistakenly thought he was experiencing hemorrhoids, so that delayed proper treatment for a while. The Veteran stated that eventually he located a physician who provided the correct diagnosis. The finding, as supported by the medical records, that the Veteran has had ulcerative colitis symptoms since service and eventually requiring surgery is supportive of the overall direct service connection claim because it tends to show that the symptoms that began in service were the basis for the later diagnosed ulcerative colitis. See Horowitz v. Brown, 5 Vet. App. 217, 221-22 (1993) (lay statements related to dizziness and loss of balance are competent on in-service and post-service symptoms that were later diagnosed as Meniere’s disease). As noted, the Veteran explained that he sought medical care for a significant period of time, but that it took a while to receive the diagnosis of ulcerative colitis. The diagnosis covered was based on the reports of in-service symptomatology as well. Service-related symptoms are the only known cause of his gastrointestinal symptomatology indicated in the evidence, as there were no gastrointestinal symptoms prior to service; rather, the symptoms began when under stress in Vietnam. The Veteran has credibly testified that gastrointestinal symptoms have remained since their in-service onset. The Veteran was told that the symptoms can come and go and that, at their mildest stage, they can go away on their own, which explained why the in-service symptoms did not require immediate medical care but still caused pain. The Veteran secured a treatment record from a VA gastroenterologist that explained this nature of the illness and who explained that the early symptoms during service are consistent with the beginning of ulcerative colitis. Resolving reasonable doubt in favor of the Veteran and in consideration of the consistent progression of symptoms since service, the Board finds that all elements of direct service connection for ulcerative colitis have been met. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Smith, 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.