Citation Nr: A21017932 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 200212-66682 DATE: November 5, 2021 ORDER Service connection for ulcerative colitis is granted. FINDING OF FACT Resolving all doubt in favor of the Veteran, his currently diagnosed ulcerative colitis had its onset during his military service. CONCLUSION OF LAW The criteria for service connection for ulcerative colitis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1982 to December 2002. This matter comes before the Board of Veterans' Appeals (Board) from a rating decision issued in March 2019 issued by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA). In February 2020, the Veteran filed a timely Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) and requested a hearing before a Veterans Law Judge, which was held before the undersigned in August 2021. A transcript of the hearing is associated with the record. Based on the Veteran's election, the Board may only consider the evidence of record at the time of the issuance of the rating decision on March 12, 2019, and any evidence submitted by the Veteran at the hearing or within 90 days thereafter; however, he waived the 90 day evidence submission period. 38 C.F.R. § 20.302(a). Entitlement to service connection for ulcerative colitis. 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 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). The Veteran contends that his currently diagnosed ulcerative colitis had its onset during his military service. Specifically, he testified that his in-service symptoms of abdominal pain and diarrhea were consistent with his post-service diagnosis of ulcerative colitis and resulted from the food he was served while deployed to Southwest Asia. In this regard, the Veteran's service treatment records (STRs) reveal that, in November 1983, he was seen in emergency care and an assessment of acute gastroenteritis (AGE) was noted. In June 1991, the Veteran complained of stomach cramping and, in July 1992, he had stomach cramps, watery diarrhea, and some nausea. An assessment of AGE was noted. Additionally, in September 1998, the Veteran complained of diarrhea 12 times a day that was watery and reoccurred. He denied bloody stool or melena, and an assessment of AGE versus food poisoning was noted. In September 2016, an intestinal conditions Disability Benefits Questionnaire (DBQ) was received from Dr. C.A. wherein he reported a diagnosis of ulcerative colitis since May 2011. In the medical history section, he indicated that the Veteran presented with bloody diarrhea and abdominal pain, and his diagnosis was based on a colonoscopy and biopsies. In February 2017, the Veteran was afforded a VA examination at which time the examiner opined that his ulcerative colitis was less likely than not related to his in-service bouts of diarrhea. In support thereof, she explained that the diarrhea in service was watery in consistency without blood, transient in nature, and resolved with antibiotics, and other episodes were self-limiting and resolved with symptomatic treatment. In this regard, the examiner explained that bloody diarrhea was a significant symptom in the diagnosis of ulcerative colitis. She further noted that the Veteran's November 2002 separation examination was negative for a gastrointestinal condition and there was a gap of 13 years between his last episode of diarrhea in 1998 and his diagnosis of ulcerative colitis in 2011, with no documentation of consult and/or treatment for diarrhea during that time period. However, in July 2018, the Veteran submitted numerous statements from fellow servicemembers who had served with him. In this regard, they stated that the Veteran had frequent bowel movements, diarrhea, and blood in his stools during his military service and his symptoms worsened thereafter. Moreover, in August 2018, Dr. C.A. submitted a letter noting that he has cared for the Veteran since 2011, at which time he presented with chronic abdominal pain associated with bloody diarrhea. A colonoscopy revealed moderately severe ulcerative colitis involving the entire colon and biopsies confirmed the diagnosis of ulcerative colitis. Dr. C.A. also reported that the Veteran's history dated back to many years ago as he was having chronic abdominal pain with diarrhea that was treated empirically with antibiotics during his time in the military. The Veteran stated he that he believed he had a colonoscopy by another physician in 2005, with findings of inflammation in the colon, but was not diagnosed with ulcerative colitis at that time. In this regard, a September 2005 endoscopy report on file reflects that such was performed in light of the Veteran's report of recurrent episodes of diarrhea, and revealed mild colitis. Additionally, in a November 2018 VA treatment record, the Veteran's treatment provider noted that the Veteran's severe ulcerative colitis began many years ago while he was still in service and he had been incapacitated for days at a time due to bloody diarrhea. Subsequently, in February 2019, the Veteran underwent another VA examination, at which time the examiner opined that his ulcerative colitis was less likely than not caused by or related to his military service as his STRs were silent for a diagnosis and treatment of such disorder. With regard to the November 2018 VA treatment record, the examiner noted that the physician's statement was written as per Veteran's recollection of his past medical history and was inconsistent with the STRs as such were silent for a diagnosis of ulcerative colitis or a chronic gastrointestinal condition; rather, such diagnosis was made 8 years after his separation from service. However, the Board notes that, in light of the Veteran's and his fellow servicemembers reports of relevant in-service symptomatology and a notation of mild colitis as early as September 2005, the February 2017 and February 2019 VA examiners' reliance on the fact that his STRs were silent as to a diagnosis of ulcerative colitis and his post-service treatment records were negative for any relevant findings for 8 years after service fails to consider, and account for, the totality of the evidence of record. Thus, such opinions are afforded no probative weight. Consequently, the Board resolves all doubt in favor of the Veteran and finds that his currently diagnosed ulcerative colitis had its onset during his military service. Specifically, Dr. C.A. and the November 2018 VA treatment provider are competent medical professionals who considered all relevant facts, as well as accepted medical principles, and provided a rationale for their respective opinions. Additionally, the February 2017 VA examiner commented that bloody diarrhea was a significant symptom in the diagnosis of ulcerative colitis, and the Veteran competently testified that he had bloody stools during service, which was corroborated by his fellow service members who likewise recalled him experiencing such symptomatology. Furthermore, the September 2005 endoscopy reflects the Veteran's contemporaneous reports of recurrent episodes of diarrhea and an impression of mild colitis, which was within 3 years of his separation from service. Consequently, service connection for such disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Clark 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.