Citation Nr: 21013686 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 14-42 005 DATE: March 10, 2021 ORDER Entitlement to service connection for a gastrointestinal disorder, to include colon polyps and diverticulosis but excluding colon cancer, is denied. FINDING OF FACT The Veteran’s diverticulosis, colon polyps, and abdominal pain are residuals of his colon cancer; the Veteran does not have a separate gastrointestinal disorder for which service connection can be granted. CONCLUSION OF LAW The criteria for entitlement to service connection for a gastrointestinal disorder, to include colon polyps and diverticulosis but excluding residuals of colon cancer, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from May 1977 to May 1981, January 1989 to May 1989, January 1991 to June 1991, and in May 1992. This matter comes before the Board of Veterans Appeals (Board) on appeal from a September 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in June 2018, August 2019, and October 2020. The most recent remand directed the RO to obtain the Veteran’s outstanding VA treatment records and associate them with the claims file, and to obtain an addendum medical opinion from a VA examiner regarding the nature and etiology of any gastrointestinal disabilities (excluding colon cancer) the Veteran has. The RO has substantially complied with these instructions, and the Board is now able to issue a decision. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a gastrointestinal disorder Direct service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection typically requires evidence of three things: (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 on a presumptive basis for chronic diseases listed in § 3.309 under the following circumstances: (1) Where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. For a Persian Gulf Veteran, service connection may also be granted when there are objective indications of chronic disability resulting from an undiagnosed illness, that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more not later than December 31, 2021, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). For all three of these potential paths to service connection, the threshold question is whether the Veteran currently has a disability. The Veteran previously filed claims of entitlement to service connection for both colon cancer and an unspecified gastrointestinal disorder, which were separately considered and subsequently denied by the RO. In the June 2018 Board decision, the Board agreed that it was appropriate for the RO to adjudicate these claims separately, before remanding both for further development. In August 2019, the Board issued a final denial on the issue of entitlement to service connection for colon cancer, but remanded the issue of entitlement to service connection for a gastrointestinal disorder to exclude colon cancer. Therefore, in order to meet the first requirement for service connection in this particular case, the Veteran must be shown to have a current gastrointestinal disability which is distinguishable from colon cancer. The Board finds that he has not. The Veteran has had four VA medical examinations related to this claim, all of which reached essentially the same conclusions. However, the Board will only give probative weight to the most recent of these opinions, for reasons discussed below. In August 2012, the Veteran underwent a Gulf War examination which found that the Veteran’s gastrointestinal symptoms were all known to be associated with colon cancer, and therefore had a clear and specific etiology and diagnosis. Following this examination, the Veteran submitted additional colonoscopy results showing evidence of polyps and diverticulosis that were not addressed in the opinion; the Board therefore ordered a new examination in its June 2018 remand, to account for this new evidence. In April 2019, a VA examiner opined that the Veteran’s only current colon disorders were colon cancer status post colectomy, and appendicitis status post appendectomy. The examiner noted that while the appendicitis occurred in service, there were no residuals other than the Veteran’s surgical scar, and this condition was not currently causing any gastrointestinal problems. The Board found this medical opinion to be inadequate because, again, it did not discuss the Veteran’s colon polyps or diverticulosis. In January 2020, another VA examiner found that the Veteran had abdominal pain and constipation, but offered blatantly contradictory explanations for the etiology of these symptoms. In a single paragraph, the examiner said that the Veteran’s gastrointestinal symptoms were not related to his military service because they (1) existed prior to the Veteran’s Gulf exposures in 1991, (2) did not exist prior to the Veteran’s diagnosis with colon cancer in 2000, and (3) were caused by diverticulosis, which in turn was caused by diet and lifestyle as the Veteran got older. These “reasons” are irreconcilable with each other, to the point that the examiner’s opinion may as well have no rationale at all. See Bloom v. West, 12 Vet. App. 185, 187 (1999). (The Board also notes that there is no evidence in the claims file, other than this examiner’s statement, that the Veteran began experiencing gastrointestinal symptoms prior to 1991. The Veteran’s service treatment records make no mention of abdominal pain or gastrointestinal problems, and when the Veteran was admitted to the emergency room for gastrointestinal symptoms in May 2000, he said he had been experiencing those symptoms over the past two months.) The October 2020 opinion, obtained pursuant to the last remand, appears to have corrected the deficiencies in prior opinions. The examiner had access to the complete claims file, and addressed the relevant medical evidence supporting the Veteran’s claim (the examiner did not leave out discussion of the Veteran’s observed polyps and diverticulosis). The October 2020 opinion concluded that the Veteran had no gastrointestinal disability apart from colon cancer status post colectomy. The examiner noted that “Veteran has colon polyps and mild diverticulosis on colonoscopy 4/6/2015, but no known disability has been found to be related to these conditions in this file.” The examiner also cited the Veteran’s medical records, which show that the Veteran’s gastrointestinal symptoms had their onset around the same time as he was diagnosed with colon cancer in May 2000. The Veteran sought treatment for abdominal pain, nausea, and vomiting in April 2000, claiming that he had first began experiencing gastrointestinal symptoms in March of that year. In April 2000, a treating physician opined that the Veteran “probably” had diverticulitis. Polyps were noted in May 2000. The October 2020 examiner found that these “temporal associations” between the Veteran’s first complaints of gastrointestinal symptoms and his diagnosis with colon cancer support a finding that the Veteran’s continuing gastrointestinal symptoms are residuals of colon cancer. Furthermore, the Veteran’s May 2015 colonoscopy did not note any abnormalities around the Veteran’s appendectomy site, which the October 2020 examiner took as evidence that the Veteran’s status post appendectomy is unrelated to his current gastrointestinal condition. Because the October 2020 opinion is based on a full review of the Veteran’s medical history, and provides adequate reasoning for its conclusions, the Board affords the opinion great weight. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Following its own review of the complete claims file, the Board has found no medical evidence to contradict the October 2020 examiner’s finding that the Veteran has no gastrointestinal disability separate from his colon cancer. The preponderance of the evidence is therefore against the Veteran’s claim; the benefit-of-the-doubt rule does not apply, and the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 4.3. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shermila Sundquist 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.