Citation Nr: A21018141 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 190624-56843 DATE: November 12, 2021 ORDER Entitlement to service connection for residuals of resection of the large intestine due to ulcerative colitis with toxic megacolon is granted. Entitlement to service connection for gastroenteritis is granted. FINDINGS OF FACT 1. The Veteran's current residuals of resection of the large intestine due to ulcerative colitis with toxic megacolon began during and is related to his qualifying service. 2. The Veteran's current gastroenteritis began during and is related to his qualifying service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for residuals of resection of the large intestine due to ulcerative colitis with toxic megacolon have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 2. The criteria for entitlement to service connection for gastroenteritis have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had qualifying service from May 1968 to May 1970, including in the Republic of Vietnam. The Agency of Original Jurisdiction (AOJ) decision currently on appeal is the May 2019 Statement of the Case (SOC) that: (1) granted reopening of entitlement to service connection for colectomy (now adjudicated as resection of the large intestine due to ulcerative colitis with toxic megacolon), but denied service connection based on the lack of an etiological relationship between that disability and the Veteran's service and service-connected posttraumatic stress disorder (PTSD); and (2) denied entitlement to service connection for gastroenteritis based on the lack of an etiological relationship between that disability and the Veteran's service and service-connected PTSD. In a June 2019 VA Form 10182, the Veteran opted into the modernized review system by electing the Board's review of the May 2019 SOC via the Hearing Docket under the Appeals Modernization Act (AMA). In a February 2020 Notification Letter, VA informed the Veteran that his appeal had been placed on the Hearing Docket. In March 2021, the Veteran and his spouse testified at a Board Virtual Hearing before the undersigned Veterans Law Judge. The Hearing Docket only permits the Board to review the evidence of record at the time of the prior AOJ rating decision as well as any evidence submitted at the hearing (including the testimony) and within 90 days after the hearing. 84 Fed. Reg. 138, 177 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 19.2(d)). If the Veteran desires to add evidence to the claims file outside of the period when new evidence is allowed, then he may file a Supplemental Claim and submit or identify this evidence; if the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. 38 C.F.R. §§ 3.2501, 20.300. Specific instructions for filing a Supplemental Claim are included with this decision. Service Connection Direct service connection may be warranted if the evidence shows: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Although a competent medical opinion is generally required to establish etiology, competent and credible lay evidence of chronicity and continuity of symptomology may also establish etiology. 38 C.F.R. § 3.303(b); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran generally contends that his gastrointestinal symptoms, currently diagnosed as gastroenteritis and residuals of resection of the large intestine due to ulcerative colitis with toxic megacolon, began during and have continued since service. See March 2021 Board Hearing transcript. Service treatment records are silent regarding pertinent complaints, treatment, or diagnoses upon entrance to, during, and upon separation from service. However, the Veteran's reports regarding lay-observable gastrointestinal symptoms (including diarrhea, vomiting, bloody stools, gas, and bloating) since his time in Vietnam have remained consistent throughout the record and are corroborated by the lay-observations of his spouse and by his reports to medical providers tracing back to 1976 when he sought formal treatment and had surgery. See October 1976 private treatment record (the Veteran reported periodic bouts of diarrhea and vomiting since 1969 when he returned from Vietnam); July 2011 Statement (the Veteran reported onset of symptoms during service); June 2012 Statement (the Veteran reported onset of symptoms during service); May 2016 VA examinations (the Veteran reported onset of symptoms during service); March 2021 Board Hearing transcript (the Veteran reported onset of symptoms during service and periodic symptoms ever since, which was corroborated by the Veteran's spouse's observations). The Board finds these reports, especially the Veteran's 1976 report of periodic symptoms since service, the be highly probative because they are competently made, credible, and longitudinally consistent. Although the May 2016 VA examiner rendered an unfavorable etiological opinion, it is clear that the examiner did not give as much probative value to the lay reports regarding in-service onset as the Board does due to the lack of documentation of symptoms during and for approximately six years after service until the Veteran sought formal treatment. However, the Board highlights that the Veteran and his spouse's probative reports have established that, during that time, the Veteran still had ongoing symptoms that progressively worsened until they became unbearable and forced the Veteran to finally seek formal treatment in 1976; notably, the severity of condition in 1976 (requiring hospitalization and surgical intervention) further supports the lay reports that the symptoms had progressively worsened until then. Based on the evidence above, the Board finds that the Veteran's gastroenteritis and residuals of resection of the large intestine due to ulcerative colitis with toxic megacolon began during and are related to his qualifying service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). As such, service connection is warranted, and the Board grants the claims. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Daus, 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.