Citation Nr: 21067287 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-47 194 DATE: November 3, 2021 ORDER Entitlement to service connection for irritable bowel syndrome (IBS) is granted. Entitlement to service connection for gastroesophageal reflux disease (GERD) is granted. FINDINGS OF FACT 1. IBS, a medically unexplained chronic multi-symptom illness, is presumed to be causally related to the Veteran's service in Southwest Asia during the Persian Gulf War. 2. GERD is shown to be causally related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for IBS have been met. 38 U.S.C. §§ 1101, 1110, 1117, 1118, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 2. The criteria for service connection for GERD have been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1989 to January 1993, with service in Southwest Asia during the Persian Gulf War. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in March 2017 by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in October 2021. A transcript of the hearing will be associated with the file in the normal course of business. Service Connection Generally, to establish service connection a Veteran must show: "(1) the existence of a present disability; (2) 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." Davidson v. Shinseki, 581 F.3d 1313, 131516 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). For veterans who served in the Southwest Asia theater of operations during the Persian Gulf War, service connection may also be established for chronic disability that cannot be attributed to a known clinical diagnosis (undiagnosed illness) or for a medically unexplained multi-symptom illness (e.g., chronic fatigue syndrome, fibromyalgia, or irritable bowel syndrome). 38 C.F.R. § 3.317. A claimant's signs or symptoms need not be shown by medical evidence; however, some objective indications of disability are required. 38 C.F.R. § 3.317(a). Objective indications of chronic disability include both signs, in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Signs or symptoms that may be manifestations of undiagnosed illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b). The term Persian Gulf Veteran means a veteran who served on active duty during the Persian Gulf War in the Southwest Asia theater of operations, which refers to Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317(e)(1)(2). The Persian Gulf War is defined as the period beginning on August 2, 1990, and ending on the date thereafter prescribed by law. 38 U.S.C. § 101(33). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 133637 (Fed. Cir. 2006). 1. Entitlement to service connection for IBS. The Veteran was diagnosed with IBS during a February 2017 VA examination, which is considered to be a medically unexplained chronic multi-symptom illness. 38 C.F.R. § 3.317(a)(B)(3), Note (stating that the term "functional gastrointestinal disorders" includes IBS). The Veteran's DD-214 reflects that he received the Southwest Asia Service Medal and the Kuwait Liberation Medal, which establish service in Southwest Asia during the Persian Gulf War. 38 U.S.C. § 101(33); 38 C.F.R. § 3.317(e)(1)(2). Finally, the February 2017 examiner noted an onset of symptoms in approximately 1993. 38 C.F.R. § 3.317(a)(3), (4). Further, the Veteran has testified that he has experienced gastrointestinal symptoms since service. Lastly, the examiner further opined in March 2017 that the Veteran's IBS was likely due to his period of service, based on the Veteran's reports of his long-standing symptoms. Based on the foregoing, the Veteran's IBS is presumed to be causally related to his service in Southwest Asia during the Persian Gulf War. As such, service connection for IBS is granted. 38 C.F.R. §§ 3.102, 3.303, 3.317. 2. Entitlement to service connection for GERD. The Veteran was diagnosed with GERD during a February 2017 VA examination. Further, while the Veteran's service treatment records are silent for any diagnosis of or treatment for GERD, the Veteran testified in October 2021 that he experienced reflux symptoms in service which he treated with over-the-counter medication when possible. The Veteran is competent to report his reflux symptoms in service, and there is no evidence that his statements are not credible. Jandreau, 492 F.3d 1372. As a current disability and an in-service injury have been shown, the dispositive issue is the presence of a nexus. Concerning a nexus, the Veteran testified in October 2021 that he has experienced consistent symptoms of reflux since his period of service in Southwest Asia. The Veteran is competent to report the persistence of his symptoms since service, and there is no evidence that his statements are not credible. Id. As such, the Veteran's testimony is of significant probative weight concerning the presence of a nexus. In March 2017 VA obtained a medical opinion in which the examiner stated that it was at least as likely as not that the Veteran's GERD was related to service. The examiner noted that while there were no medical notes prior to 2010 reflecting treatment for GERD, it is also very common to treat GERD symptoms with over-the-counter medication and not to receive formal treatment. The examiner stated that based on the Veteran's account of his symptoms and their persistence since service, the GERD was likely related to his period of service. There is no evidence that the examiner was not competent or credible, and further the opinion was supported by a well-reasoned rationale. As such, it is entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). No other medical opinions are of record. Based on the foregoing, the Board finds that the evidence of records shows that the Veteran's GERD is causally related to his period of active service, with both the lay and medical evidence of record indicating that the currently diagnosed disability is due to the Veteran's reports of symptoms in service. As such, service connection for GERD on a direct basis is granted. 38 C.F.R. §§ 3.102, 3.303. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Wendell, 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.