Citation Nr: 21071982 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 16-19 656 DATE: December 1, 2021 REMANDED Service connection for Crohn's disease is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from August 1996 to August 2007. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision. By way of procedural history, the September 2013 rating decision denied service connected for Crohn's disease. The Veteran properly appealed this decision to the Board and requested a hearing. The Veteran was scheduled for a Board hearing in July 2019 but did not report to the hearing. The Veteran did not contend he was not notified of the scheduled hearing or provided sufficient reasoning for his failure to attend his hearing. As a result, his request for a hearing is deemed withdrawn. This matter was previously before the Board in October 2020 and July 2021. Service connection for Crohn's disease is remanded. Service connection will be granted if the evidence demonstrates a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); see also Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303. Service connection may also be established by showing a continuity of symptoms since service. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013). A continuity of symptomatology is established if a claimant demonstrates (1) a condition was "noted" during service; (2) evidence of post-service continuity of the same symptoms; and (3) medical, or in certain circumstances lay evidence, of a nexus between the present disability and the post-service symptoms. 38 C.F.R. § 3.303(b); see Walker, 708 F.3d at 1340. Furthermore, service connection may be granted on a secondary basis for a disability which is proximately due to, the result of, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. The United States Court of Appeals for Veterans Claims (Court) held in the case of Ward v. Wilkie, 31 Vet. App. 233 (2019), that aggravation pursuant to 38 C.F.R. § 3.310 does not require a permanent worsening of the condition. Rather, the Court explained, "aggravation" is any incremental increase in disability attributable to the service-connected disability, i.e., any additional impairment of earning capacity that is above the degree of disability existing before the increase, regardless of its permanence. Id. Additionally, the Court has held causation and aggravation are independent concepts and should have separate findings and rationales. See Atencio v. O'Rourke, 30 Vet. App. 74 (2018). The Veteran contends his Crohn's disease is related to his active-duty service. An August 2021 examination report reflects a diagnosis of Crohn's disease. Regarding an in-service event, the Veteran's service medical records show treatment for abdominal pain; however, it is unclear whether the Veteran's in-service abdominal pain is related to his current diagnosis of Crohn's disease. As a result, the RO obtained a VA opinion in August 2021. For direct service connection, the examiner determined it is less likely than not the Veteran's Crohn's disease was incurred in or caused by the Veteran's active service. For their rationale, the examiner states the Veteran's medical records do not support his Crohn's disease is related to his active service or to the complaints of abdominal pain during active service. The Board does not find the August 2021 VA opinion probative. Although the examiner found the Veteran's medical records do not support his Crohn's disease is related to his active service or to the complaints of abdominal pain during active service, the examiner does not provide any rationale for their finding. They give no explanation as to why the Veteran's complaints of abdominal pain and change in stools during active service were not related to his current diagnosis of Crohn's disease. Furthermore, in light of his service connection conditions of gastroesophageal reflux disorder (GERD) and a major depressive disorder with anxious distress, opinions for secondary service connection are needed. As such, on remand, the VA examiner must provide separate and sufficient findings and rationales relating to causation and aggravation. This matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records and any outstanding private medical records identified by the Veteran as pertinent to his claim. 2. Obtain an addendum opinion as to the etiology of the Veteran's Crohn's disease. Following a review of the record, the examiner should address the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) the Veteran's Crohn's disease is related to his active-duty service, to include the reported abdominal pain and bowel changes noted within his service medical records. If the examiner attributes these symptoms to the Veteran's service-connected GERD or other condition, the examiner must provide sufficient rationale for their finding. Further, in providing the requested opinion, the examiner should consider the Veteran's description of his in-service symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms in service and thereafter represented the onset of his current Crohn's disease, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed Crohn's disease is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? (b.) Whether it is at least as likely as not (50 percent probability or greater) the Veteran's Crohn's disease (i) was caused (in whole or in part) or (ii) aggravated (any incremental increase in disability or any additional impairment of earning capacity regardless of its permanence) by the Veteran's service-connected GERD to include any medications taken by the Veteran for his service-connected GERD, and/or his service-connected major depressive disorder with anxious distress. The examiner must provide separate opinions and rationales for secondary causation and secondary aggravation. Atencio, supra. The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. P. M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Buck Denton 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.