Citation Nr: 21009048 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 17-17 466 DATE: February 18, 2021 ORDER Service connection for a gastrointestinal (GI) disorder is denied. FINDINGS OF FACT 1. The Veteran had active duty from January to June 1961. 2. A preexisting GI disorder clearly and unmistakably preexisted service and was clearly and unmistakably not aggravated by service. CONCLUSION OF LAW A GI disorder was not aggravated by service. 38 U.S.C. §§ 1110, 1111, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION In January 2019, the Board denied the issue on appeal. The Veteran appealed to the Veterans Claims Court. In September 2019, the Court Clerk granted a Joint Motion for Remand. The Board remanded the issue in March 2020 and the case has now been returned to the Board for further appellate action. The relevant laws and regulations were discussed in the prior Board decision and will not be repeated. The initial question is whether the Veteran had a preexisting GI disorder. Turning to the medical evidence, the clinical assessment at the time of enlistment was silent for any GI or vomiting disorder. The pre-enlistment Report of Medical History included self-reported complaints of GI issues. When reviewing the self-reported GI problems, the reviewing clinician wrote that the Veteran had “indigestion but no ulcers.” Thus, although the clinical assessment of the abdomen was normal at entrance to service, the reviewing health care provider did, in fact, note a history of indigestion. This history, recorded at enlistment, is consistent with the Veteran in-service complaints of a nervous stomach and vomiting. Therefore, the presumption of soundness did not attach. This finding is supported by the service treatment records (STRs). Specifically, after slightly over a month on active duty, the Veteran was treated for constant gastroenteritis with vomiting and diarrhea with a 3-year history. Two weeks later, he reported having vomiting for 5 years which was worse since entering active duty. He reported being diagnosed with nervous spasm stomach prior to service. An April 1961 neurology consultation found that the symptoms were present under pressure, perpetuated by physical exertion, and did not occur at night. This evidence, reflected just shortly after entering active duty and accepted by the in-service treating providers as a disorder that preexisted service, supports a pre-service onset. Post-service examiners have also accepted that the Veteran’s GI symptoms preexisted service. An October 2015 examiner reflected that the Veteran reported monthly episodic vomiting beginning in high school and continuing until the present date. Although the examiner noted the presence of GI issues, the examiner determined that there was no evidence of a current disability. While it was suggested that the Veteran’s symptoms were secondary to anxiety, the October 2015 examiner stated that there were many possible causes of frequent vomiting. Further, the examiner concluded that there was no evidence that the pre-existing symptom was aggravated by service. The examiner reasoned that after leaving the service, the Veteran reported that he never discussed this symptom with a doctor, never had an evaluation, and never received a diagnosis, although he continued to experience periods of GI upset. In a May 2020 medical opinion, the clinician noted that there was an “extensive evidence of record” that the Veteran’s onset of his symptoms of vomiting started prior to entering active duty as evidence by the findings in the STRs. As to a current diagnosis, the clinician found that there was no evidence of a GI diagnosis or complaints as far back as the 2001 medical records. The clinician reflected that the Veteran had had no referral to a GI specialist in the last two decades. Based on the Veteran’s self-report of preexisting GI symptoms, the service record noting a GI disorder (indigestion) at the time of enlistment, the closeness in time between entering active duty and initial GI complaints, and the post-service reviews of the record indicating a preexisting disorder, the Board finds that the Veteran had a preexisting GI disorder at the time of enlistment. As to the issue of whether the preexisting GI disorder clearly and unmistakably was not aggravated by service, the Board emphasizes that “temporary or intermittent flare-ups of a pre-existing injury or disease are not sufficient to be considered aggravation in service unless the underlying condition, as contrasted to symptoms, is worsened.” Crowe v. Brown, 7 Vet. App. 238,247-48 (1994); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). However, the increase need not be so severe as to warrant compensation. Browder v. Derwinski, 1 Vet. App. 204, 207 (1991). The STRs reflect that the general consensus among the treating health care providers in service was that the Veteran’s GI complaints became worse after entering active duty. He reportedly had lost weight and sought treatment on multiple occasions for vomiting. A separation summary noted that he was referred for a mental health consultation due to frequent vomiting, extreme nervousness, and nausea. It was noted that the condition had become more acute since entering active duty which had rendered him ineffective for continued military duty. It was recommended that he be separated for unsuitability. He was discharged in June 1961. Therefore, a reasonable reading of the evidence is that the symptoms became worse during service. Therefore, the threshold question is whether the worsening of the Veteran’s preexisting disorder was a temporary or intermittent flare-up (not considered aggravation) or a worsening of the underlying condition (is considered aggravation). To that end, the medical evidence weighs against aggravation. Specifically, the October 205 VA examiner found there was no evidence that the Veteran’s symptoms were aggravated by service. Of note, the examiner determined that there was no evidence of a current GI disorder. Further, the examiner found that after leaving the service, the Veteran reported that he never discussed this symptom with a doctor, never had an evaluation, and never received a diagnosis, although he continued to experience periods of GI upset. This finding is supported by the clinical records. In April 2005, VA treatment records show that the Veteran complained of vomiting a few days before which he attributed to food poisoning. Other than that single instance, VA medical records are silent for vomiting, or actively deny it. To this end, the VA treatment show that he specifically denied vomiting in April 2001, April 2005, March 2006, and March 2020. Therefore, although the preexisting GI symptoms of vomiting was reported to have increased during service, the post-service records reflect no worsening of an underlying GI disorder. As noted, the October 2005 VA examiner did not identify a diagnosis of a GI disorder, and explained that vomiting was a symptom rather than a diagnosis. The May 2020 VA examiner found that the Veteran’s preexisting condition was aggravated during service; however, a reasonable reading of the entirety of the opinion reflects that the examiner was acknowledging the worsening symptoms that the Veteran experienced in service rather than making a legal finding of aggravation. To this end, the May 2020 examiner found that there was no current diagnosis of a GI disorder. The examiner reflected that she had reviewed the STRs, VA clinical records, the Joint Legacy Viewer, and CPRS and emphasized that there was no record of a GI diagnosis or complaints back to 2001 and with no referral to a specialist, despite at least biannual visits to a primary care provider. Thus, it is reasonable to conclude that the examiner’s use of the word “aggravation” was meant to describe the increase in symptoms only for the period during active duty. As the May 2020 examiner found not current GI diagnosis and no GI treatment for many years, the evidence does not support a finding of a worsening of an underlying GI disorder during service. Next, the Veteran reported to the May 2020 examiner that he randomly vomited with eating, that it caused him to break blood vessels and get a rash on his face, causing functional impairment. While the Court has found that even without a diagnosis, pain or symptoms causing functional impact, may constitute a current disability for the purposes of service connection, Saunders v. Wilkie, 886 F.3d 1356, 1363 (Fed. Cir. 2018), the functional impairment described by the Veteran (broken blood vessels in his face), does not constitute functional impairment of a GI disorder for purposes of service connection. The Board has considered the Veteran’s lay statements that he has a current GI disorder that was aggravated by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, although here, as discussed above, his complaints of ongoing GI complaints are not supported by the medical evidence and assigned less probative weight. Additionally, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Further, as noted, an April 2005 VA treatment note show he complained of vomiting from food poisoning from a salad bar. At this point, he made no mention of recurrent vomiting, rather framing it as an isolated event. In combination with the various points in VA medical records outlined above where he denied any issues with vomiting, his report of recurrent vomiting throughout the appeal period is assigned less credibility as it is inconsistent with the record. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection based on aggravation and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brendan A. Evans, 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.