Citation Nr: 21008942 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 14-19 869 DATE: February 18, 2021 ORDER Entitlement to service connection for a gastrointestinal disorder to include Crohn's disease is denied. FINDING OF FACT The Veteran is currently diagnosed with Crohn’s disease; the current Crohn’s disease did not have its onset during active service and is not otherwise etiologically related to active service. CONCLUSION OF LAW The criteria for entitlement to service connection for a gastrointestinal disorder to include Crohn's disease have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1989 to July 1993. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a July 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Board remanded the matter for further development. Entitlement to service connection for a gastrointestinal disorder to include Crohn's disease The Veteran seeks service connection for a gastrointestinal disorder. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) 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 in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Service treatment records are negative for gastrointestinal complaints or symptomatology. At the separation physical in May 1993, the Veteran specifically denied a history of stomach or intestinal trouble. The May 1993 separation examination noted normal abdomen and viscera. In June 1995, two years post service, the Veteran was seen with a three week history of bloody diarrhea and abdominal cramping. Biopsy results later confirmed severe active colitis. Subsequently dated records show that the Veteran’s inflammatory bowel disease was thought to be Crohn’s disease rather than ulcerative colitis. In the December 2018 Appellate Brief, the Veteran asserted that, while service treatment records do not reflect evidence of Crohn’s disease, given the severe level of his intestinal pathology soon after service, it most probably existed during service. The Board remanded the appeal in January 2019 for an examination and opinion which included consideration of the objective medical findings in service treatment and the Veteran’s theory that, because his severe Crohn’s disease developed so soon after service, it most likely existed during service. A VA examination was conducted in January 2020. The Veteran reported that at that time he experienced vomiting and bloody stools and was later diagnosed with Crohn’s disease. The examiner noted a diagnosis of Crohn’s disease and that the Veteran reported had its onset in 1994. The examiner opined that the Veteran’s Crohn’s disease was less likely than not (less than 50 percent probability) incurred in or caused by service. In the rationale which reflects consideration of the objective medical evidence and the Veteran’s assertions, the examiner explained that the Veteran was not diagnosed until a year after his discharge from the service and there is no complaint for an ongoing abdominal issue on the discharge examination. The examiner noted further that signs and symptoms of Crohn’s disease can range from mild to severe. They usually develop gradually but sometimes will come on suddenly and without warning. There may be periods of time with no signs or symptoms. (Medlineplus.gov). The Veteran describes his onset as severe in nature with a sudden onset. For these reasons, the examiner determined that the condition is less likely than not incurred in or caused by service event or illness. Based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for a gastrointestinal disability to include Crohn’s disease. The Veteran’s service treatment records do not show any complaints or findings related to gastrointestinal symptoms. The Veteran reported at his January 2020 examination that he began experiencing symptoms of vomiting and bloody stools in 1994, while the June 1995 treatment record indicates that the Veteran’s symptoms of bloody diarrhea had been present for three weeks at that time. In either case, the onset was not identified as during the period of service that ended in July 1993. Further, the VA examiner noted that the Veteran’s disability had had a sudden onset that was subsequent to his period of service. The Board acknowledges the Veteran’s various lay assertions regarding the etiology or onset of his Crohn’s disease; however, as a lay person, he is not competent to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The etiology of the Veteran’s Crohn’s disease is a matter not capable of lay observation and requires medical expertise to determine. It is well established that a layperson without medical training is not qualified to render a medical opinion regarding the diagnosis or etiology of certain disorders and disabilities. See 38 C.F.R. § 3.159 (a)(1). In certain unique instances, lay testimony may be competent to establish medical etiology or nexus. Jandreau, 492 F.3d 1376 -77. However, as the origin or cause of Crohn’s disease is not a simple question that can be determined based on mere personal observation by a lay person; the Veteran’s lay statements are not competent to establish medical etiology or nexus. Id. He has not shown that he has medical or any specialized training or expertise to otherwise render his opinion competent. Accordingly, the lay statements from the Veteran as to the etiology of his Crohn’s disease are not competent evidence. Moreover, the Board affords great weight to the VA examiner’s opinion which is competent and persuasive. The VA examiner is a medical professional who reviewed the claims file, considered and discussed the relevant clinical findings and Veteran’s history, and provided a cogent rationale to support her conclusion that the Veteran’s Crohn’s disease was not present in service and was not caused by service. In addition, the opinion of the VA examiner is not contradicted by any other competent medical opinion of record. In short, the competent and credible evidence of record indicates that the Veteran’s gastrointestinal disability, diagnosed as Crohn’s disease, had onset after, and is not etiologically related to, his period of service. In reaching this determination, the Board has considered the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Mazzucchelli, 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.