Citation Nr: 21007815 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 16-20 852 DATE: February 10, 2021 ORDER Service connection for collagenous colitis is granted. FINDING OF FACT The medications used to treat the Veteran’s GERD and panic disorder caused or aggravated the collagenous colitis. CONCLUSION OF LAW The criteria for entitlement to service connection for collagenous colitis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the U.S. Navy from January 2008 to October 2014. This matter comes to the Board of Veterans’ Appeals (Board) initially from a December 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). When the Veteran filed her March 2016, substantive appeal following issuance of a March 2016 statement of the case, she requested a Board hearing. Initially, the Veteran was scheduled for a live videoconference Board Hearing at the Detroit local office in May 2019, which following a motion to postpone, was rescheduled in June 2019. Thereafter, in October 2020, the Veteran filed a motion to postpone the October 2020 hearing. The hearing was again postponed and rescheduled in November 2020. 38 C.F.R. §§ 20.702, 20.704. In December 2020, the Veteran had a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the electronic claims file. Entitlement to service connection for collagenous colitis The Veteran contends that she is entitled to service connection for her collagenous colitis. Specifically, the Veteran contends that medication she was prescribed while on active duty in the Navy has led to her development of collagenous colitis. Entitlement to service connection benefits is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the medical “nexus” requirement). See, Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The standard of proof to be applied in decisions on claims for Veterans’ benefits is set forth at 38 U.S.C. § 5107. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran has a current disability of collagenous colitis as reflected in private treatment records and the VA examination report. While in service, the Veteran sought medical care for soft bowel movements and soft diarrhea stools, as well as mild abdominal cramping, recorded in the Veteran’s service treatment records (STRs). The Veteran also reported experiencing four to five liquid stools a day, as well as constant abdominal distress. In May 2015, after separation from service, the Veteran saw a private medical provider (Dr. BD), who subsequently diagnosed the Veteran with collagenous colitis after performing a colonoscopy. Additionally, the Veteran is in receipt of service connection for panic disorder and GERD and several joint disabilities. In October 2015, the VA received a medical opinion from a VA examiner who reviewed the Veteran’s file. The examiner opined that even though the Veteran was diagnosed with collagenous colitis, it was less likely as not related to her service-connected gastroesophageal reflux disease (GERD) with globus pharyngis, as GERD is not an etiological factor for microscopic colitis. However, while the VA examiner offered a rationale that showed the Veteran’s disability was not secondarily service connected for GERD, the medical opinion was silent as to a theory on direct service connection. However, the Veteran’s private providers have stated that the Veteran’s collagenous colitis may be due to the medication she was prescribed during service. In July 2015, Dr. BD stated that the collagenous colitis is “possibly Zoloft related,” a drug the Veteran had been prescribed in service for her panic disorder, anxiety, and depression. In April 2016, the Veteran obtained a letter from PA SS and Dr. BD, stating that Zoloft and the anti-inflammatory agents that the Veteran had been prescribed in service can both exacerbate the Veteran’s condition and make her symptoms worse. The letter did exhibit hesitancy in finding a true line that can be established between the medication and the Veteran’s condition, but it was stated that these drugs can worsen her condition. At the Veteran’s hearing, she made multiple lay statement describing her symptoms in service, as well as the medications she had been prescribed in service. While the Veteran is not competent to diagnose herself, she is certainly competent and credible to report the symptoms she experienced while in service. The Veteran’s lay statements describing her bowel issues are at least somewhat probative in the present case. The Veteran submitted a December 2020 letter from P.J.O., PA-C, stating that the Veteran was prescribed proton pump inhibitor medication (Nexium) and selective serotonin reuptake inhibitor medication in 2013 while in the Navy. According to the physician assistant, there is quite extensive clinical documentation and research showing that these medications are not only triggers for the symptoms of collagenous colitis but can also be potential causative agents as well. The PA then stated that “it is just as likely that her diagnosis of collagenous colitis was due to the use of listed medications as it would be from other potential causes.” There can be no doubt that further medical inquiry could be undertaken with a view towards development of the claim. Specifically, the Board could seek clarification of the 2015 VA examiner’s opinion and further rationale, to include discussion of the theory for direct service connection. However, under the law, where there exists “an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter,” the Veteran shall prevail upon the issue. Ashley v. Brown, 6 Vet. App. 52, 59 (1993); see also Massey v. Brown, 7 Vet. App. 204, 206-207 (1994). In this case, although the examination provided a negative nexus, the evidence also reflects the Veteran’s consistent and credible testimony, as well as positive opinions from her private medical provider. She is service-connected for panic disorder, GERD and several joint disabilities and her service treatment records reflect she was prescribed several medications for these conditions. Her treating practitioner linked her current condition to these medications. Thus, the combination of the Veteran’s lay statements and STRs detailing her symptoms, along with her private providers offering opinions that the Veteran’s medication could trigger and be causative of collagenous colitis allows the Board to find entitlement to service connection for the Veteran. Therefore, the benefit of the doubt must be resolved in favor of the Veteran and entitlement to service connection for collagenous colitis is warranted. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E.L. Aumiller, Associate 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.