Citation Nr: 21063136 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 17-64 222 DATE: October 13, 2021 ORDER Service connection for irritable bowel syndrome (IBS) is granted. FINDING OF FACT The Veteran had qualifying service in Southwest Asia and his IBS has persisted for at least six months at a degree of 10 percent or more. CONCLUSION OF LAW The criteria for entitlement to service connection for IBS on a presumptive basis due to exposure to environmental hazards in Southwest Asia are met. 38 U.S.C. §§ 1110, 1117; 38 C.F.R. §§ 3.317, 4.114, Diagnostic Code 7319. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1989 to January 1993, to include service in Southwest Asia. His decorations include the Combat Action Ribbon. The Veteran testified before the undersigned Veterans Law Judge during an October 2021 Board hearing. Service Connection Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called nexus requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection also may be warranted for a Persian Gulf War 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, or to a degree of 10 percent or more not later than not later than December 31, 2021. 38 C.F.R. § 3.317(a). For purposes of 38 C.F.R. § 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multisymptom illness (MUCMI); and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. An undiagnosed illness is defined as a condition that by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. 38 C.F.R. § 3.317(a)(1)(ii). A MUCMI is defined by a cluster of signs or symptoms, and specifically includes chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome. 38 C.F.R. § 3.317(a)(2)(ii). It means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. MUCMIs of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). Signs or symptoms that may be a manifestation of an undiagnosed illness or a MUCMI include, but are not limited to the following: fatigue; signs or symptoms involving the skin; headache; muscle pain; joint pain; neurologic signs or symptoms; neuropsychological signs or symptoms; signs or symptoms involving the respiratory system (upper or lower); sleep disturbances; gastrointestinal signs or symptoms; cardiovascular signs or symptoms; abnormal weight loss; and menstrual disorders. 38 C.F.R. § 3.317(b). The Veteran asserts that he has a gastrointestinal disorder related to service, to include service in the Southwest Asia Theater of Operations. The Board agrees. There is no dispute that the Veteran had service in Southwest Asia during the Gulf War. The Veteran's service personnel records indicate his combat history and expeditions included participation in Operation Desert Shield/Storm while deployed aboard the USS Okinawa in the North Arabian Sea and the Persian Gulf and amphibious operations in Kuwait. Accordingly, he qualifies as a Persian Gulf veteran. 38 C.F.R. § 3.317(e). Further, there is no dispute that the Veteran has a diagnosis of IBS. See June 2017 Nexus Statement from the Veteran's private physician, September 2017 VA Intestinal Conditions examination report and VA treatment records showing treatment for IBS. Although the September 2017 VA examination report includes an opinion that the Veteran's IBS is not related to service (and an April 2017 VA examination report includes the opinion that the Veteran did not have a GI condition), as discussed above, IBS is specifically listed as one of the illnesses that may be presumed to be related to service in the Southwest Asia Theater of Operations. During the September 2017 VA examination, the Veteran reported abdominal pain and diarrhea alternating with constipation. He reported vomiting (last episode one year previously) and taking Imodium as needed. Diagnostic Code 7319, applicable to IBS, provides for a 10 percent rating for moderate symptoms, including frequent episodes of bowel disturbance with abdominal distress. 38 C.F.R. § 4.114, Diagnostic Code 7319. The Veteran's symptoms of IBS described above may appropriately be characterized as at least moderate and involve abdominal distress. The evidence above also shows that such symptoms persisted for more than six months. Based on the foregoing, the Board finds that service connection is warranted for the Veteran's IBS as due to his service in Southwest Asia. As service connection is granted on a presumptive basis, consideration of the Veteran's claim on the basis of his secondary service connection theory of entitlement (gastrointestinal disability secondary to service connected posttraumatic stress disorder) raised in his June 2018 VA Form 21-526EZ, Fully Developed Claim, is not necessary. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K Hughes 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.