Citation Nr: 21004102 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 12-16 388 DATE: January 26, 2021 ORDER Entitlement to service connection for irritable bowel syndrome (IBS) is granted. FINDING OF FACT The probative medical evidence of record is in equipoise as to the etiology of the Veteran’s current IBS. CONCLUSION OF LAW The criteria for service connection for IBS are met. 38 U.S.C. §§ 1110, 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1987 to September 1990. In December 2017, the Veteran testified at a videoconference hearing before a Veterans Law Judge (VLJ). A written transcript of the hearing is of record. In January 2021, the Board informed the Veteran that the VLJ who held the hearing was no longer employed by the Board. He was informed that he could testify at another hearing. He was advised that if he did not respond to the letter within 30 days, the Board would assume that he did not want another hearing, and would proceed accordingly. The Veteran did not respond to the letter. The Board will proceed to adjudicate his claim. This matter was previously before the Board in August 2018 but was remanded for additional development. Specifically, the Agency of Original Jurisdiction (AOJ) was directed to schedule the Veteran for a VA examination to determine the nature and etiology of all GI disorders that have been present during the period of the claim. The required examination were and addendum medical opinion were completed and associated with the record in June 2020. Accordingly, the Board finds there has been substantial compliance with the remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence in light of the entirety of the record. Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). 1. Entitlement to service connection for IBS Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. In order to prevail on the issue of service connection there must be competent evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Veteran’s diagnosis of IBS was confirmed at a June 2020 Intestinal Conditions examination. At issue in the present case is whether the Veteran’s current IBS was incurred during or caused by his period of active service. The Veteran’s August 1986 report of medical examination and report of medical history at enlistment do not note a diagnosis of IBS. Reports of medical examination completed in August 1988 and April 1993 are also silent for complaints or diagnosis of IBS. A service treatment record from January 1990 notes the Veteran had blood in his stool during his period of active service. A November 2009 VA internal medicine examination states that the Veteran reports he was diagnosed with IBS in 1995, five years after completing active service. The Veteran contends that his current IBS was incurred during, and worsened, during his period of active service. At a December 2017 hearing, the Veteran testified that he began experiencing symptoms of IBS during his period of active service, and that those symptoms continued and worsened after completing active service. The Veteran testified to continuing symptoms of IBS in 1991 and late 1992. Lay persons are competent to provide opinions on some medical issues. Kahana, 24 Vet. App. at 435. The Board finds the Veteran’s statements to be competent and credible. Additionally, in January 2018, the Veteran submitted a private medical opinion from his treating physician noting a diagnosis of IBS. The physician opined that following a review of the Veteran’s medical history and VA treatment records that it was highly likely that the Veteran’s IBS began in January 1990, during active duty service, and was exacerbated throughout the years, leading to the current chronic IBS. The Board finds that the Veteran’s treating physician’s opinion is probative evidence in favor of the Veteran’s claim for service connection. Conversely, following a June 2020 intestinal conditions examination, an addendum medical opinion against service connection was associated with the record. The opinion states it is less likely than not that the Veteran’s current IBS was incurred during or caused by his period of active service. The opinion notes that the Veteran’s medical records do not report a formal diagnosis of IBS until 2001, more than a decade after the Veteran completed his active service, thus it is unlikely that the Veteran’s January 1990 in-service treatment for bloody stool is related to his current IBS. The examiner’s opinion was authored following a review of the Veteran’s service treatment records and medical history, and in-person examination of the Veteran. The Board finds the June 2020 opinion to be probative evidence against the Veteran’s claim for service connection. The Board finds that the probative medical evidence of record regarding the etiology the Veteran’s current IBS is in equipoise. A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. Entitlement need not be established beyond a reasonable doubt, by clear and convincing evidence, or by a fair preponderance of the evidence. When the evidence is in “relative equipoise, the law dictates that the Veteran prevails.” Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, the Board finds that entitlement to service connection for IBS is warranted. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Riordan, 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.