Citation Nr: A21018963 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 200523-87207 DATE: November 29, 2021 ORDER Entitlement to service connection for Crohn's disease is granted. FINDING OF FACT The Veteran's Crohn's disease began during active service. CONCLUSION OF LAW The criteria for service connection for Crohn's disease are met. 38 U.S.C. §§ 1111, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1976 to February 1980 and from August 1989 to October 1989. In May 2018, a rating decision was issued under the legacy system in which the agency of original jurisdiction (AOJ) denied service connection for Crohn's disease, and the Veteran submitted a timely notice of disagreement in May 2019. In December 2019, the AOJ issued a statement of the case (SOC). In January 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and opted into the modernized review system, also known as the Appeals Modernization Act (AMA), from the December 2019 SOC. In May 2020, the AOJ issued the HLR decision on appeal, which considered the evidence of record at the time of the December 2019 SOC. The Veteran timely appealed the May 2020 rating decision to the Board later in May 2020 and requested direct review of the evidence considered by the AOJ. Accordingly, the Board will consider the evidence of record as of the date of the December 2019 SOC. 38 C.F.R. §§ 19.2, 20.301. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, air, or space service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Entitlement to service connection for Crohn's disease The Veteran contends that he has current Crohn's disease which had its onset in service. The Board finds, for the following reasons, that the Veteran has current Crohn's disease and that this disability began during active service. Medical records, including a May 2019 VA gastroenterology note, show that the Veteran has been diagnosed as having Crohn's disease. Therefore, current disability has been demonstrated. As an initial matter, the Board notes that the Veteran has reported that he experienced gastrointestinal symptoms prior service. Regardless, a veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated. 38 U.S.C. §§ 1111, 1137; 38 C.F.R. § 3.304 (b). The term "noted," in 38 U.S.C. § 1111, refers to "[o]nly such conditions as are recorded in examination reports." 38 C.F.R. § 3.304 (b). A "[h]istory of preservice existence of conditions recorded at the time of examination does not constitute a notation of such conditions." 38 C.F.R. § 3.304 (b)(1); see also Crowe v. Brown, 7 Vet. App. 238, 245 (1994). A review of the Veteran's claims file reflects that there is no enlistment examination of record for his period of service from February 1976 to February 1980. Also, a review of the record does not suggest that such an examination was conducted. In Smith v. Shinseki, 24 Vet. App. 40, 45 (2010), it was clarified that the presumption of soundness applies when a veteran has been "examined, accepted, and enrolled for service," and where that examination revealed no "defects, infirmities, or disorders." 38 U.S.C. § 1111. Plainly, the statute requires that there be an examination prior to entry into the period of service on which the claim is based. See Crowe, 7 Vet. App. at 245 (holding that the presumption of sound condition "attaches only where there has been an induction examination in which the later-complained-of disability was not detected" (citing Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991)). Accordingly, because an enlistment examination is not of record for the Veteran's period of service from February 1976 to February 1980, the presumption of soundness does not apply to this period. See Crowe, supra. However, the Veteran's May 1989 entrance examination was normal other than for foot problems. Although he is certainly competent to report a history of gastrointestinal symptoms prior to service, a veteran's report of history, even when related by a medical professional, without an independent basis in the record, is insufficient to rebut the presumption of soundness. Miller v. West, 11 Vet. App. 345 (1998). There is no other evidence of any pre-existing gastrointestinal disability prior to service. Therefore, the Board finds that the evidence is not clear and unmistakable that any gastrointestinal disability pre-existed the period of service from August 1989 to October 1989 and was not aggravated during this period service and the Veteran is presumed sound at service entrance for this period of service. 38 U.S.C. § 1111. There is evidence of gastrointestinal symptoms in service and evidence of continuous symptoms in the years since service. In this regard, the Veteran has reported that although he was not diagnosed as having Crohn's disease until after his October 1989 discharge from service, he began to experience gastrointestinal symptoms (e.g., diarrhea and abdominal pain) during active service. Moreover, his post-service medical records and lay statements indicate that he has experienced continuous gastrointestinal symptoms in the years since service. The Veteran is competent to report gastrointestinal symptoms in service and continuous symptoms in the years since service. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Also, there is no evidence that explicitly contradicts his reports and they are generally consistent with the evidence of record and the circumstances of his service. Therefore, the Board concludes that the Veteran's reports of gastrointestinal symptoms in service and continuous symptoms in the years since service are credible. In an April 2018 VA gastroenterology note, a VA gastroenterologist explained, in pertinent part, that the Veteran reported that he began to experience chronic diarrhea and abdominal pain since he was approximately 20 years old. Approximately two years following his discharge from service, he was initially diagnosed with ulcerative colitis, which was later revised to a diagnosis of Crohn's disease at age 30. Therefore, it was likely ("more likely than not") that the Veteran had undiagnosed Crohn's disease during service. The April 2018 opinion is based upon treatment of the Veteran and consideration of his reported history, and it is accompanied by a specific rationale that is consistent with the evidence of record. Therefore, the April 2018 opinion is entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning; threshold considerations are whether the person opining is suitably qualified and sufficiently informed). In sum, the evidence reflects that the Veteran experienced gastrointestinal symptoms in service and that there have been continuous gastrointestinal symptoms in the years since service. He also experiences current Crohn's disease and there is a probative medical opinion that this disability had its onset in service. There is no medical opinion that is contrary to a conclusion that the current Crohn's disease had its onset in service. Thus, the preponderance of the evidence reflects that the Veteran's current Crohn's disease began during active service, and service connection for Crohn's disease is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Elwood, 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.