Citation Nr: 21001297 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 17-10 926A DATE: January 7, 2021 ORDER Entitlement to service connection for bowel disease, specifically to include diverticulosis and Crohn's disease (claimed as gastrointestional (GI) condition) due to environmental exposures during service in Southwest Asia during the Persian Gulf War, is denied. FINDING OF FACT The evidence fails to establish that the Veteran’s current bowel disease to include diverticulosis and Crohn’s disease was incurred in, or is otherwise etiologically related to, the Veteran’s active duty service. CONCLUSION OF LAW The criteria for service connection for bowel disease, specifically to include diverticulosis and Crohn’s disease, have not been met. 38 U.S.C. §§ 1101, 1110, 1117, 1131; 38 C.F.R. §§ 3.303, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1991 to April 1991, with additional service in the reserves. This case comes before the Board of Veterans’ Appeals (Board) on appeal of a November 2015 rating decision by the Department of a Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The Veteran testified at a November 2019 Travel Board hearing held before the undersigned Veterans Law Judge. The matter was before the Board in February 2020 when it was remanded for further development to include obtaining any and all of the Veteran’s VA and private treatment records for the period from 2015 to present, specifically for the Veteran’s Crohn’s disease or GI issues. Following this remand, VA treatment records dated March 2015 through February 2020 were added to the claims file in March 2020. In addition, VA contacted the Veteran by a March 2020 letter, pursuant to 38 C.F.R. § 3.159(c), and requested authorization to obtain any outstanding private treatment records pertinent to this claim including previously identified records, and attached blank VA Forms 21-4142 and 21-4142a, General Medical Release Forms, for the Veteran to complete and return. The letter also contained a blank VA 21-4138 Statement in support of claim in case the Veteran wanted to submit any additional information. Following a thorough review of the record, the Board is unable to identify a response from the Veteran to the March 2020 letter. The Board notes that VA's duty to assist in the development of a claim is not “a one-way street.” Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Rather, the Veteran also has an obligation to assist in the adjudication of her claim. Due to the Veteran’s failure to provide the requested information or return executed medical release forms authorizing VA to obtain the medical records, there is no further duty to make further attempts to locate private treatment records relating to this case. Wood at 193. Thus, the Board will decide the claim without the benefit of the private treatment records. The Veteran contends that her bowel disease to include diverticulitis and Crohn’s disease was caused by or incurred during her active service. See November 2015 Notice of Disagreement (NOD). After reviewing the evidence of record, the Board finds that service connection for a bowel disease to include diverticulitis and Crohn’s disease due to environmental exposures during service in Southwest Asia during the Persian Gulf War is not warranted. Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C. §§ 1110, 1131. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, 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 (Fed. Cir. 2004). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Aside from the general statutes and regulations, service connection may also be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia Theater of operations during the Persian Gulf War. For disability due to undiagnosed illness and medically unexplained chronic multi-symptom illness, the disability must have been manifest either during active military service in the Southwest Asia Theater of operations or to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317. The Board acknowledges the Veteran has current diagnoses of diverticulitis and Crohn’s disease from 2008. See October 2015 VA intestinal conditions (other than surgical or infectious), including irritable bowel syndrome, Crohn’s disease, ulcerative colitis and diverticulitis examination; November 2008 private treatment record noting a diagnosis of mild Crohn’s disease. Therefore, the law and regulations including the Gulf War presumption pertaining to undiagnosed illness incurred due to service in the Persian Gulf are not applicable. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. The only question for the Board is whether there is a nexus between the current disabilities and active service. The Veteran’s service treatment records (STRs) include December 1986, August 1987, June 1988, June 1990, March 1991, July 1992, June 1994, and March 1995 Reports of Medical Examination (RMEs) that are silent for GI issues. STRs also include December 1986, July 1992, April 1995 Reports of Medical History (RMHs), wherein the Veteran denied intestinal trouble. A July 1988 sick call record wherein the Veteran complained about diarrhea for the past three days and was prescribed Pepto-Bismol. A March 1991 sick call record noted the Veteran complained about swelling of the legs and feet. The same record noted the Veteran has no history of GI issues. The Board also observes a March 1994 hospital discharge summary record that noted a diagnosis of pelvic inflammatory disease; a colonoscopy performed during the hospital admission showed a mild degree of inflammation, but the record does not confirm a diagnosis of any bowel disease. A June 1998 aeromedical history record noted the Veteran underwent a hysterectomy following a history of pelvic and abdominal pain. The Board is unable to identify any other STRs specifically addressing the Veteran’s diagnosed bowel diseases. The claims file includes an October 2015 VA intestinal examination that was part of a Gulf War general medical examination. The examiner confirmed diagnoses of diverticulitis and Cohn’s disease from 2008. The medical history section noted the Veteran reported that after service in the Southwest Asia Theater of operations during the Persian Gulf War she was diagnosed with diverticulitis. The Veteran also reported her symptoms worsened during the following years to include bloating and belching, bouts of diarrhea, and frequent and increased bowel movements before she was diagnosed with Crohn’s disease in 2013 or 2014. The examination report indicated the Veteran experienced frequent episodes of bowel disturbance with abdominal distress, approximately three times per week, with 7 or more exacerbations/attacks within the past 12 months. The examiner opined that it is not at least as likely as not that the Veteran’s GI condition is related to her active service in the Persian Gulf. As a rationale, the examiner noted that the Veteran’s intestinal diagnosis is diverticulosis and Crohn's Disease, both conditions with a clear and specific etiology and diagnosis. The Veteran testified during a November 2019 Travel Board hearing that she began to experience abdominal discomfort and swelling of extremities during active service. The Veteran described her stomach issue as pressure that she either tolerated or treated with over-the-counter medication including Tylenol and GasX. She testified that the pain worsened to the point that she eventually went to the emergency room. The Board acknowledges that the Veteran is competent to relate symptoms within the realm of her personal knowledge including abdominal pain. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, the diagnosis of bowel disease including diverticulitis and Crohn’s disease are medically complex, as it requires knowledge of specialized medical education and interpretation of complicated diagnostic medical testing. While the Veteran’s Air Force specialty code was flight nurse, the record does not establish that she has the medical training or credentials necessary to provide a diagnosis or etiology opinion regarding the bowel disease to include diverticulitis and Crohn’s disease. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board also considered direct connection for the Veteran’s diverticulitis and Crohn’s disease. However, as noted above, the STRs are silent as to any complaints of, treatment for, or diagnoses of bowel disease including diverticulitis or Crohn’s disease. The Board notes that the Veteran indicated during the November 2019 hearing that she started to feel discomfort during deployment, she just did not talk about it. A thorough review of the Veteran’s STRs and post service treatment records in the claims file does not reveal complaints of, treatment for, or a diagnosis of diverticulitis or Crohn’s disease within one year of separation from active service. The Veteran was not diagnosed with diverticulitis or Crohn’s disease until 2008, more than 15 years after separation from active service. The Veteran has not provided sufficient evidence, such as private opinions and/or medical evidence, to establish a nexus between her diverticulitis and Crohn’s disease and her active service. Again, while the Veteran was a flight nurse, the record does not establish that she possesses the medical training or credentials to competently link abdominal pressure to active service. In the total absence of supportive competent evidence, the Board finds no basis for a remand for a VA examination because there is no reasonable likelihood of favorable findings from such examination. See 38 C.F.R. § 3.159(c)(4). As the competent evidence of record does not establish a nexus between the Veteran’s service and the claimed disabilities, direct service connection must be denied. The Board finds that the preponderance of the evidence is against a finding that the Veteran’s currently diagnosed bowel disease including diverticulitis and Crohn’s disease manifested as a result of active service. In short, the preponderance of the evidence is against the Veteran’s claim, and the claim must be denied. In reaching the above conclusion, the Board has considered 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 in the instant appeal. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Banks, 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.