Citation Nr: 21009926 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 14-23 589 DATE: February 23, 2021 ORDER Entitlement to service connection for a gastrointestinal disability is denied. FINDING OF FACT The preponderance of the evidence is against finding that a gastrointestinal disability began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a gastrointestinal disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from February 1966 to February 1968. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a December 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2015, the Veteran testified at a hearing before the undersigned Veterans Law Judge via video conference. A transcript of the hearing is associated with the record. The Board remanded this matter in June 2016 and March 2018. Most recently, in September 2020, the Board remanded this matter for more development. The Board finds that the Regional Office (RO) substantially complied with the Board’s remand instructions and an additional remand to comply with the Board’s directives is not required. See Stegall v. West, 11 Vet. App. 268 (1998). The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues denied in this decision. The Veteran should not assume that evidence that is not explicitly discussed in this decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). Entitlement to service connection for a gastrointestinal disability The Veteran contends that his gastrointestinal problems began during service and have persisted over the years. The Veteran contends that his service treatment records should reflect his extensive treatment for his gastrointestinal problems, including his hospitalization records. Alternatively, the Veteran contends that he has an undiagnosed intestinal condition. 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). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has had episodes of “abdominal pain and cramping with explosive diarrhea,” the preponderance of the probative evidence is against finding that these episodes are etiologically related to any in-service treatment for or complaints of a gastrointestinal condition or to any other in-service event, injury, or disease. The Veteran’s service treatment records show that in December 1966 he complained of a headache and upset stomach. He had suprapubic pain in May 1967. Later, he was treated in September 1967 for stomach pains accompanied by sore throat and sinusitis. In a December 1967 report of medical history, the Veteran denied having any stomach, liver or intestinal trouble. The Veteran’s December 1967 separation examination noted that there was no rectal disease. The separation examination showed that the Veteran was admitted at Carson hospital for a car accident and did not mention any gastrointestinal problems. The Veteran does not have a current diagnosis of any gastrointestinal disease. However, his treatment records show that the Veteran received treatment for his diarrhea in approximately June 2016, which is decades after his separation from service. The Board has considered the Veteran’s assertion that his gastrointestinal condition is etiologically related to his active service. Although the Veteran is competent to report his current symptoms, such as diarrhea, constipation, upset stomach, and bloating since service, see Layno v. Brown, 6 Vet. App. 465, 469 (1994), he is not considered competent to render an opinion as to the likely etiology of his gastrointestinal condition, as doing so requires specialized medical knowledge and expertise he has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Therefore, the Board instead turns to the competent medical evidence of record to determine whether such an etiological connection exists. In September 2015, the Veteran testified at a Board hearing regarding his gastrointestinal condition. The Veteran testified that he was on a bivouac for 30 days up in the mountains and drank water from the river, after placing an iodine tablet in the canteen. He went to the troop dispensary and they could not figure out what was wrong with him. The Veteran testified that he has not received a diagnosis for his condition. He had a colonoscopy about 10 years ago, which was negative. The Veteran testified his problem is ongoing, there may be two three or four months everything is fine, then suddenly it is a problem. In July 2016, the Veteran was afforded a VA examination for his intestinal condition. The examiner reviewed the record, examined the Veteran, and considered the Veteran’s reports of gastrointestinal symptoms, to include diarrhea, cramping, and bloating. The examiner concluded that the Veteran does not have and has never had a diagnosis of an intestinal condition. In support of that conclusion, the examiner explained that the Veteran has had no diagnostic tests such as a recent colonoscopy, biopsy of the colon, or stool studies. Therefore, the examiner could not render a diagnosis or an opinion as to the Veteran’s claimed gastrointestinal disability. A different VA examiner provided an addendum opinion in July 2017 indicating that further medical evidence received since the July 2016 VA examination has nothing to do with the claimed issue, and therefore does not change the July 2016 VA examiner’s opinion. The medical evidence of record reveals that a March 2016 CT of the abdomen and pelvis showed mild diverticulosis of the colon without findings to suggest diverticulitis. A March 2017 CT of the abdomen and pelvis similarly showed diverticulosis without evidence of diverticulitis. In addition, a March 2017 KUB study of the abdomen showed a small amount of bowel gas centrally within the abdomen, which may be the basis of enteritis or mild adynamic ileus. In September 2018, the Veteran was afforded a VA examination for his intestinal condition. The examiner noted that the Veteran indicated that his immediate condition began about 10 years ago. The Veteran’s symptoms include abdominal pain and cramping with explosive diarrhea and bowel urgency every three months. The Veteran also reported he was hospitalized while in service for abdominal pain, but he recovered. The examiner noted that there were no imaging studies or diagnostic procedures performed. The examiner opined, that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As to the rationale, the examiner stated, “there is no medical documentation of a GI condition and description of current symptoms are not typical of a gastrointestinal condition. In addition, the report of medical history at separation reported a denial of any gastrointestinal trouble.” In July 2020 the Veteran was afforded an examination for his kidney condition. The Veteran reported that he has had a long-standing problem of bowel issues. In December 2020, the Veteran was afforded an examination for his intestinal condition. The examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As to the rationale, the examiner stated, that although there is evidence that the Veteran had an upset stomach on active duty, these occurrences are acute and transient and were resolved. The examiner noted that there were no concurrent complaints of diarrhea at that time, and subsequent medical records were silent for chronic upset stomach problems. There is limited objective evidence to show chronicity of upset stomach leading to diarrhea, bloating, cramping, and stomach pain in relation to service. In addition, the examiner stated that, “due to long health care gap and lack of chronicity of symptom, the diarrhea symptom to support an undiagnosable diagnosis is insufficient.” The examiner also stated that the VA examinations have been consistent, with no recent diagnosis. The examiner reviewed the Veteran’s record regarding his March 2016 and March 2017 CT’s. The examiner stated, There are limited medical concurrent symptoms of diarrhea or signs of GI infections found on records during the radiographic examination. However, it was determined that the Veteran underwent bladder surgery and right percutaneous nephrostomy tube placement at that time, where manipulation of bowels was expected leading to an bowel irritation or enteritis or mild acute dynamic ileus again which less likely resolved and did not result in chronic diarrhea, bloating, cramping and stomach pain. The examiner reviewed the Veteran’s lay testimony, including that he was in a unit hospital in Ft. Carson at a field training site where he suffered from gastrointestinal problems, that the Veteran states has stuck with him for years. The examiner explains that the Veteran’s medical records demonstrate that the condition most likely resolved because the records are silent for any chronic upset stomach condition. The report of medical history and separation examination show no reports of stomach, liver or intestinal trouble, even when the Veteran was examined after a car accident. The examiner considered the Veteran’s contention that he should be considered for an undiagnosable service-connected condition regarding his symptoms of explosive diarrhea and abdominal pain with cramps. The examiner repeated the comments above about how the Veteran’s complaints in service resolved, and that there were no concurrent complaints about diarrhea at the time the Veteran was treated for stomach problems. Finally, the examiner states that there “is a lack of consistency of GI symptoms to render a diagnosis found.” The Board concludes that the Veteran’s lay statements, VA examinations, and treatment records, taken together are consistent in establishing that the Veteran’s gastrointestinal condition is not related to service. There is no evidence in the record that demonstrates that the Veteran has, or had, a diagnosis of a chronic gastrointestinal condition at any time during this appeal period. The Board acknowledges that the Veteran reported stomach problems during service, and then again around 2016, decades after he separated from service. The Board also acknowledges the Veteran’s contention that he did not receive treatment near the time of his separation because he wanted to be released from service. However, the Veteran’s record is consistent, in demonstrating that no VA or private examiner has opined that the Veteran has a diagnosis of a chronic gastrointestinal condition, or that his gastrointestinal condition is related to service. The Veteran is unable to demonstrate that there is a direct service connection because there is no nexus between the Veteran’s gastrointestinal condition and his active service. The Board finds the examiner’s combined opinions are highly probative, because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In summary, service connection is unwarranted on a direct basis. Finally, neither the Appellant nor his representative has raised any issues with the duty to notify or duty to assist regarding the claim denied above. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). The Board has considered the benefit of the doubt doctrine; however, as the preponderance of the evidence weighs against the claim, it is not applicable. See 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Quist, 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.