Citation Nr: 21003813 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 18-20 017 DATE: January 22, 2021 ORDER Service connection for a digestive disability, diagnosed as irritable bowel syndrome (IBS), is granted. FINDING OF FACT The Veteran’s IBS is a chronic disability resulting from a medically unexplained chronic multisymptom illness that became manifest to a compensable degree within the prescribed presumptive period since his active service in the Southwest Asia theater of operations during the Persian Gulf War. CONCLUSION OF LAW The criteria for service connection for a digestive disability, diagnosed as IBS, have been met. 38 U.S.C. §§ 1110, 1117, 1118, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1985 to July 1992. The record reflects that he had service in the Southwest Asia theater of operations during the Persian Gulf War. In July 2019, the Board issued a decision by another Veterans Law Judge that (in pertinent part) denied service connection for a digestive disability also claimed as IBS. The Veteran appealed that portion of the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). In June 2020, the Court issued a Mandate that (in pertinent part) vacated the July 2019 Board decision with regard to that issue and remanded the matter for readjudication consistent with instructions outlined in its June 2020 Memorandum Decision. Entitlement to service connection for a digestive disability (to include IBS). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). In addition, service connection is granted for Persian Gulf Veterans suffering from a chronic disability resulting from an undiagnosed illness or medically unexplained chronic multisymptom illness that became manifest during active duty in the Southwest Asia theater of operations or became manifest to a compensable degree within the prescribed presumptive period (currently, by December 31, 2021). 38 U.S.C. §§ 1117, 1118; 38 C.F.R. § 3.317. To determine whether a qualifying chronic disability became manifest to a compensable degree, the condition must be rated by analogy to a disease or injury in which the functions affected, anatomical location, or symptomatology are similar. See 38 C.F.R. § 3.317(a)(5); see also Stankevich v. Nicholson, 19 Vet. App. 470, 472 (2006). The Board must explain its selection of an analogous Diagnostic Code. Id. at 472. The Veteran contends that he currently has a digestive disability (to include IBS) as a result of his active service in the Southwest Asia theater of operations during the Persian Gulf War. The Veteran’s service treatment records (STRs) include the following pertinent findings. In August 1990, he reported having diarrhea for two days, and he was assessed with diarrhea. In January 1991, he reporting feeling nauseous and dizzy and having abdominal cramps (but denied diarrhea), and he was assessed with gastroenteritis. Post-service, a June 2015 VA treatment record noted the Veteran’s report of “still having constipation with current bowel regimen” and typically having one bowel movement every three to four days. It was noted at that time in June 2015 and also in a May 2016 VA treatment record that his active VA medications included docusate (for softening stools) and that his active non-VA medications included milk of magnesia. At a November 2016 VA intestinal examination, the Veteran was diagnosed with IBS. He reported having infrequent bowel movements (every four days) and abdominal cramping beginning one and a half to two years ago, and that he now had a bowel movement every day to every other day with associated abdominal cramps on docusate stool softener and milk of magnesia every three days. In an accompanying November 2016 medical opinion, the VA examiner opined that the Veteran’s IBS was less likely than not proximately due to or the result of his service-connected GERD, noting in the rationale that IBS “is characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause.” Thereafter, VA treatment records dating from December 2017 through May 2019 noted that the Veteran’s active non-VA medications continued to include milk of magnesia. In its June 2020 Memorandum Decision, the Court determined that the Board did not adequately discuss why the November 2016 VA intestinal examination and the Veteran’s IBS diagnosis at that time were insufficient for the Board to determine whether the Veteran’s IBS was compensable pursuant to 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. Diagnostic Code 7319, for irritable colon syndrome (spastic colitis, mucous colitis, etc.), provides for an evaluation of 10 percent for moderate symptoms, with frequent episodes of bowel disturbance with abdominal distress. 38 C.F.R. § 4.114, Diagnostic Code 7319. As noted above, the Veteran is a Persian Gulf Veteran. See 38 C.F.R. § 3.317(e)(1). In addition, the Veteran has been diagnosed with IBS, a qualifying chronic disability resulting from a medically unexplained chronic multisymptom illness. See 38 C.F.R. § 3.317(a)(2)(i)(B)(3). Furthermore, the Board finds that the Veteran’s IBS became manifest to a compensable degree within the prescribed presumptive period, as his IBS symptoms (i.e., having a bowel movement every day to every other day with associated abdominal cramps) at least nearly approximate an evaluation of 10 percent under Diagnostic Code 7319 (for moderate symptoms manifested by frequent episodes of bowel disturbance with abdominal distress). See 38 C.F.R. § 3.317(a)(1)(i); see also 38 C.F.R. § 4.114, Diagnostic Code 7319. In light of the foregoing, and after resolving all doubt in the Veteran’s favor, the Board concludes that service connection for a digestive disability, diagnosed as IBS, is warranted on a presumptive basis in accordance with the provisions of 38 U.S.C. § 1117 and 38 C.F.R. § 3.317.   [The Board finds that the instant decision applies to – and resolves – all pending claims of service connection for a digestive disability, however diagnosed. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009).] M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. B. Yantz, 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.