Citation Nr: 21006288 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 16-07 509 DATE: February 3, 2021 ORDER Service connection for a digestive disorder, to include pancreatitis and cholecystectomy residuals, is denied. FINDING OF FACT The Veteran’s currently diagnosed digestive disorder is related to alcohol abuse, which constitutes willful misconduct. CONCLUSION OF LAW The criteria for service connection for a digestive disorder, to include pancreatitis and cholecystectomy residuals have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.301, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 2005 to November 2008. In April 2020, the Board remanded the case for further development by the originating agency. The case has been returned to the Board for further appellate action. Service connection for a digestive disorder, to include pancreatitis and cholecystectomy residuals Service connection may be granted for disability resulting from disease or injury incurred in or aggravated in the line of duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent medical or lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). For claims filed after October 31, 1990, direct service connection may be granted only when a disability was incurred or aggravated in the line of duty, and was not the result of willful misconduct or the result of abuse of alcohol or drugs. 38 U.S.C. § 105; 38 C.F.R. § 3.301(a). In Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit Court) held that compensation cannot be awarded pursuant to 38 U.S.C. § 1110 and 38 C.F.R. § 105 (a) either for a primary alcohol/drug abuse disability incurred during service or for any secondary disability that resulted from primary alcohol/drug abuse during service. Id., at 1376. However, there can be service connection for compensation for an alcohol/drug abuse disability acquired as secondary to a service-connected disability. Allen, supra. The Veteran contends that she has a current digestive system disorder that developed as a result of her active military service. Specifically, during her February 2020 Board hearing, she reported that she had her gallbladder removed in 2017 and believed that her symptoms during service, which were diagnosed as pancreatitis, were actually gallbladder-related. Service treatment records show complaints and treatment for acute pancreatitis in October 2007 and February 2008. Post-service treatment records show treatment for a digestive disorder years after service. Specifically, VA treatment records show elevated levels suggestive of pancreatitis in 2012 a strong suspicion of pancreatitis in 2014, and a July 2017 cholecystectomy. On VA examination in October 2015, the Veteran complained of upper abdominal pain, which the examiner concluded was more likely than not of a pancreatic and gallbladder etiology. The examiner noted further that gallbladder disease, including but not limited to gallstones, will cause intermittent pain, and can cause a mild or even severe pancreatitis, such as the one that the Veteran was treated for during service in 2006. However, no confirmed diagnosis of pancreatitis or gallbladder disease was made at that time, and the examiner did not link any current digestive disorder to the Veteran’s active service. On VA examination in July 2020, the Veteran was noted to have undergone a cholecystectomy in 2016, and was diagnosed with pancreatitis, with onset in 2007. The Veteran reported that during a period of heavy alcohol use, she went in for evaluation of lower abdominal pain and was diagnosed with acute pancreatitis. At the time of the examination, there were no symptoms attributable to a gallbladder or pancreatic condition. In a July 2020 medical opinion, the VA examiner noted that the Veteran’s records show an onset of low back pain that was determined to be due to acute pancreatitis in 2007 during service after complaining of stabbing left lower back pain and being noted to have mildly elevated labs. The Veteran reported that she had been drinking alcohol heavily at that time. The Veteran's records show that she was again found to have pancreatitis in 2012, and again during evaluation for left lower back pain in 2014 with mildly elevated labs noted. The GI doctor appears to have initially thought this pain may be due to the gallbladder, but then places an addendum that notes elevated pancreatic labs that, upon review, were consistent with a diagnosis of chronic pancreatitis. Imaging of the gallbladder in 2007 and 2012 showed no evidence of gallstones. The Veteran described having been diagnosed with gallstones and having her gallbladder removed in 2016. The diagnosis of gallstones and the surgery appear to have been done outside of the VA as no records were located to expound upon the Veteran's description. Based on this evidence, the examiner opined that the diagnosed chronic pancreatitis, which is most likely due to alcohol use, was at least as likely as not incurred in or caused by the digestive disorder, to include acute pancreatitis, during service. The examiner also opined that the claimed cholecystectomy residuals were not incurred in or caused by any digestive disorder during service. In rendering this opinion, the examiner noted that the Veteran was diagnosed with cholecystectomy by verbal history of the procedure alone, as no confirmatory records were noted other than those VA records also recording the Veteran’s verbal history of that procedure. He noted further that although the Veteran reported being diagnosed with gallstones prior to undergoing the reported cholecystectomy, records show that she was specifically evaluated for gallstones during service and again in 2012, and none were found. There was also no evidence of biliary obstruction that could indicate pancreatic disease due to potential stones during service. There is no contrary medical opinion of record. (Continued on the next page)   Although the 2020 VA examiner opined that the current chronic pancreatitis is related to the acute pancreatitis in service; he also opined that the acute pancreatitis in service was most likely due to alcohol use. As noted above, the Veteran reported during examination that she was using alcohol “heavily” in service when being treated for pancreatitis. VA treatment records also show the Veteran’s reports in 2019 and 2020 of “intermittent alcohol abuse”, “drinking too much”, and a “drinking issue” in the past. January 2018 treatment records also show that the Veteran discussed reducing alcohol use with her primary care physician. As such, the Board finds that the evidence demonstrates that the Veteran’s current chronic pancreatitis is related to acute pancreatitis in service, which was due to alcohol abuse during and/or after active service, and that such abuse constituted willful misconduct. As the Board has determined that the Veteran's alcohol abuse in service constituted willful misconduct, a digestive disorder, including pancreatitis, resulting from alcohol abuse shall not be deemed to have been incurred in the line of duty. 38 C.F.R. §§ 3.1(m), 3.301(d). There is no evidence, VA or private, otherwise linking a current digestive disorder, not due to willful misconduct, to the Veteran’s active military service. As such, this claim must be denied. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board F. Yankey, 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.