Citation Nr: 21064390 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 17-36 483 DATE: October 20, 2021 ORDER Entitlement to an initial disability rating of 30 percent for irritable bowel syndrome (IBS) is granted. FINDING OF FACT Since November 27, 2013, the Veteran's service-connected IBS has been characterized by diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. CONCLUSION OF LAW The criteria for an initial 30 percent disability rating for service-connected IBS are met. 38 U.S.C. §§ 1110, 1131, 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7319. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1986 to January 1988, and from December 1990 to July 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The matter was most recently before the Board in February 2020, at which time it was remanded for further development, to include obtaining outstanding treatment records, and schedule the Veteran for a VA examination. The RO complied with these instructions, and a VA examination was conducted in April 2020. The Board is satisfied that the prior remand directives have been complied with. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to an initial disability rating of 30 percent for IBS The Veteran seeks an earlier effective date prior to April 4, 2020 for the 30 percent disability rating for IBS. See September 2021 Informal Hearing Presentation. Unless specifically provided otherwise in this chapter, the effective date of an award based on an initial claim, or a supplemental claim, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a). A claim means a written or electronic communication requesting a determination of entitlement or evidencing a belief in entitlement, to a specific benefit under the laws administered by VA submitted on an application form prescribed by the Secretary. 38 C.F.R. § 3.1(p). A supplemental claim is defined as "a claim for benefits under laws administered by the Secretary filed by a claimant who had previously filed a claim for the same or similar benefits on the same or similar basis." 38 U.S.C. § 101(36). A complete claim is one on an application form prescribed by the Secretary that (1) provides the name of the claimant, relationship to the veteran (if applicable), and sufficient information for VA to verify the claimed service (if applicable); (2) is signed by the claimant or representative; (3) identifies the benefit sought; and (4) lists a description of the symptoms or medical conditions on which the benefit is based. 38 C.F.R. § 3.160(a). For service connection, the effective date shall be the day following separation from active service or date entitlement arose if a claim is received within one year after separation from service, 38 U.S.C. § 5110(b)(1); otherwise, the effective date is the date of receipt of claim, or date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i). Separation from service means separation under conditions other than dishonorable from continuous active service which extended from the date the disability was incurred or aggravated. Id. After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. 38 U.S.C. § 7104(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A VA claimant need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996); Gilbert at 54. The current appeal arises from a claim received at VA on November 27, 2013. In the August 2014 decision on appeal, the Veteran was awarded service connection for IBS; he was granted an initial 10 percent disability rating effective November 27, 2013, the day he filed his claim for IBS. The Veteran filed a timely notice of disagreement in October 2014 and February 2015. Additionally, in September 2015, the Veteran filed what was purportedly a claim for increased rating of his service-connected IBS. These filings prevented the August 2014 rating decision from becoming final and maintaining November 27, 2013 as the date of claim. In a June 2017 VA Form 9, the Veteran asserted his symptoms had worsened. Subsequently, the Board remanded the case in February 2020 for a VA examination. On April 4, 2020, the Veteran underwent a VA intestinal conditions examination. In a July 2020 rating decision, the Veteran was granted a 30 percent disability rating effective April 4, 2020, the date of his VA examination. For the reasons discussed below, the Board finds that the Veteran has met the criteria for an initial disability rating of 30 percent for IBS. The Veteran's IBS is currently rated as irritable colon syndrome under 38 C.F.R. § 4.114, Diagnostic Code 7319. His current 30 percent rating is the maximum schedular rating available under this code, and is warranted for severe IBS consisting of diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. A rating of 10 percent is assigned if moderate, which is defined as frequent episodes of bowel disturbance with abdominal distress. For a mild condition, defined as disturbances of bowel function with occasional episodes of abdominal distress, a rating of 0 percent is appropriate. A June 2014 VA intestinal conditions examination revealed complaints of daily abdomen cramping, occasional sharp pains (not incapacitating), visible gaseous bloating, borborygmi, marked flatus and belching, and bowel movements. Specifically, he reported that severe cramping resolved with a bowel movement, predominately diarrhea with five to six bowel movements within 24 hours. He reported his diarrhea alternates with days of constipation. It was noted that there was an incident when the Veteran was grossly incontinent of diarrhea stool while asleep in bed. Although the examiner marked that the Veteran did not endorse "episodes of bowel disturbance with abdominal distress, or exacerbations or attacks of the intestinal condition," the Board finds that his reported symptoms do in fact reflect abdominal distress. In the December 2014 Notice of Disagreement (NOD), the Veteran reported severe IBS with symptoms of abdominal pain and cramping, bloating, excessive gas, diarrhea or constipation, mucus and/or blood in his stool. He stated that his symptoms are persistent and cause disruption in his daily life and work life. He stated, "I believe that a rating of 10 [percent] is not reflective of the severity of my illness. I have bouts that last for several days at a time and suffer these nearly weekly." In the June 2017 VA Form 9, the Veteran asserted that he has severe IBS that has gotten worse over time. He reported symptoms of abdominal pain and cramping, bloating, excessive gas, indigestion, diverticulitis, anemia, diarrhea or constipation, mucus, and/or blood in his stool. He stated that his "symptoms are peristent and cause disruption in my daily life and I have had many lost workdays as a result of my symptoms." Further, he stated this his suffering is so severe that he has defecated in his bed while sleeping and his pants while awake. The Veteran underwent a VA intestinal conditions examination in April 2020. The examination report noted review of the VA e-folder and medical records, recounted the Veteran's complaints and history, and included an in-person examination. He reported abdominal bloating and cramps, alternating diarrhea and constipation, abdominal distention, nausea, and vomiting. He endorsed having episodes of bowel disturbance with abdominal distress, more or less constant abdominal distress; and episodes of exacerbations and/or attacks of the intestinal condition to include pain. He reported going two weeks without having a bowel movement or having diarrhea at other times. The Veteran's IBS impacts his ability to work due to frequent episodes of fecal urgency requiring breaks, and embarrassing gas around co-workers. He reported one to two weeks of work time lost in the last 12 months. After a review of all of the lay and medical evidence of record in conjunction with the applicable laws and regulations, the Board finds entitlement to an effective date of November 27, 2013 for an initial rating of 30 percent for IBS is warranted. (Continued on the next page) Here, the Veteran has consistently reported experiencing symptoms of diarrhea, alternating diarrhea and constipation, and abdominal distension as shown in the June 2014 VA examination, December 2014 NOD, June 2017 VA Form 9, and April 2020 VA examination. As such, the Board affords the Veteran the benefit of the doubt and finds that his lay statements provide enough competent evidence to demonstrate that his symptoms are associated with a 30 percent rating. Gilbert, 1 Vet. App. 49. Accordingly, the Board finds that throughout the entire period on appeal, the Veteran's IBS was manifested by symptoms more nearly approximating severe IBS, to include diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress, and grants an initial disability rating of 30 percent for IBS. TRACIE N. WESNER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.M. Edwards, 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.