Citation Nr: 21063155 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 17-26 426 DATE: October 13, 2021 ORDER Entitlement to service connection for ulcerative colitis is granted. REMANDED Entitlement to an initial compensable disability evaluation for hemorrhoids prior to April 28, 2013, and in excess of 10 percent from July 22, 2020, is remanded. FINDING OF FACT The Veteran's current ulcerative colitis is of service origin. CONCLUSION OF LAW The criteria for service connection for ulcerative colitis have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant, had active service from June 2012 to April 2013. The Veteran appeared at a hearing before the undersigned Veterans Law Judge in July 2021. A transcript of the hearing is of record. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). The Veteran maintains that his current colitis had its onset in and is related to his period of service. In conjunction with his claim, the Veteran was afforded a VA examination in January 2018. At that time, the Veteran reported chronic diarrhea starting in October 2012, which he related to treatment with doxycycline. He persisted with symptoms for the following year. He developed rectal bleeding, which was attributed to hemorrhoids. He was diagnosed with ulcerative colitis at the time of a March 2016 colonoscopy. Following examination and review of the file, the examiner indicated that he had reviewed the conflicting medical evidence and was providing the following opinion: At the time of the current examination, there was no evidence of record that the Veteran was treated for colitis while in active military service. The examiner noted that the Administrative AHLTA Medical record, created in October 2016, listed mesalamine and budenoside (UC medications) as active medications. The examiner indicated that the data entry was reviewed with the Veteran who confirmed verbally, and in person, that he was not on active duty or in the USNR at that time (2016); and he did not know why those medications, prescribed in 2016 by LMD for the diagnosis of ulcerative colitis, were listed in the Administrative AHLTA EMR. The examiner stated that the service treatment records supported that while on active military service, the Veteran was diagnosed and treated for bleeding hemorrhoids, for which he was service-connected. The examiner noted that the medical literature did not support that the malaria prophylaxis, routinely dispensed to military personnel serving in malaria-endemic geographic areas such as the Veteran did during OIF (Afghanistan 2012-2013), caused and/or resulted in ulcerative colitis, the Veteran's current diagnosis. The examiner stated that the service treatment records were silent for signs, symptoms, and/or diagnosis of antibiotic-associated diarrhea and/or antibiotic-associated colitis. In a May 2017 letter, D. C., a hospital Corpsman who served with the Veteran, indicated that the Veteran experienced abdominal pain, dark watery stool, rectal bleeding, and incontinence while in service. In a September 2019 letter, the Veteran's mother indicated that the Veteran did not have any stomach problems prior to service and that upon his return from Afghanistan, his stomach began to bother him and that this condition had been ongoing. At the time of a July 2019 private examination, the Veteran was noted to have ulcerative colitis, which had been confirmed by a March 2016 colonoscopy. In an accompanying opinion, it was indicated that following a review of service treatment records and private treatment records, the Veteran's ulcerative colitis more likely than not had its onset in or was related to events in service. It was noted that the Veteran's symptoms were consistent with ulcerative colitis at the time he was in service (around October-November 2012). Upon review of all the evidence of record, both lay and medical, the Board finds that the evidence is in equipoise as to whether the Veteran has a current diagnosis of ulcerative colitis and whether the ulcerative colitis is related to service. The Veteran has currently been shown to have ulcerative colitis. While a definitive diagnosis of ulcerative colitis was not rendered in service, the evidence is at least in equipoise as to whether the symptoms displayed by the Veteran in service were the onset of colitis. The private examiner, following examination of the Veteran and review of the file, indicated that the Veteran's symptoms were consistent with colitis. The VA examiner indicated that the Veteran had hemorrhoids in service. The Veteran's mother confirms that the Veteran has had continuous stomach difficulties since his return from Afghanistan. Finally, the medical opinions of record are in equipoise. Both opinions were rendered following a review of the file and examination of the record. The Veteran's private physician has opined that the Veteran's colitis at least as likely as was related to the Veteran's period of service, while the VA examiner has opined that it is not as likely as not that the Veteran's colitis is related to his period of service. In cases such as this, reasonable doubt must be resolved in favor of the Veteran. For these reasons, and resolving reasonable doubt in favor of the Veteran, the Board finds that ulcerative colitis is related to service. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND As it relates to the claim for an increased evaluation for hemorrhoids, the Board notes that the Veteran was afforded a VA rectum and anus examination in July 2020. While the examination provided certain findings, it did not address the issue of anemia, nor were laboratory findings performed to determine the presence of anemia. Moreover, the Veteran, at the time of time of his July 2021 hearing, testified that his symptoms had worsened since the last examination. He also expressed concern about the way the examination was conducted and its findings. He further indicated his willingness to report for an additional VA examination. Given the foregoing, the Veteran should be afforded an additional VA examination. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claim. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. Schedule an examination to determine the extent and severity of his service-connected hemorrhoid condition. All necessary tests must be conducted and all symptoms related with the Veteran's conditions should be described in detail. The examiner is asked to provide an opinion as to whether the Veteran has anemia due to his service-connected hemorrhoids. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. S. Kelly, 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.