Citation Nr: 21027664 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 15-09 281 DATE: May 6, 2021 ORDER Entitlement to a 10 percent rating for irritable bowel syndrome (IBS) as of March 8, 2016, through October 20, 2020, is granted. FINDING OF FACT The Veteran's IBS manifested moderate symptoms of frequent episodes of bowel disturbance with abdominal distress as of March 8, 2016. CONCLUSION OF LAW The criteria for entitlement to a 10 percent rating for IBS as of March 8, 2016, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7319. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from August 2001 to November 2011. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2012 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). In September 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. The Board issued a remand in February 2021 instructing the RO to consider the evidence of record and to issue a Supplemental Statement of the Case (SSOC). A remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The RO obtained considered the evidence and issued an February 2021 SSOC. The Board finds the RO substantially complied with the February 2021 remand directives. Entitlement to a compensable rating for IBS prior to October 21, 2020 In May 2019, the Board remanded the claim of entitlement to a compensable rating for IBS. While on remand, the Veteran completed an October 2020 VA examination and was assigned a maximum 30 percent rating effective October 21, 2020, in an October 2020 rating decision. In November 2020, the Veteran communicated with the VA and reported that she disagreed the effective date of the rating assigned for her IBS. Initially, she did not challenge the rating assigned. See also November 2020 Lay Statement (effective date is incorrect); November 2020 Statement in Support of Claim (effective date should be January 27, 2012); November 2020 Decision Review Request. In December 2020, the RO issued a rating decision denying an earlier effective date for the evaluation of IBS and continued the 30 percent rating for IBS effective October 21, 2020. The claim was remanded for consideration of additional evidence added to the record and the issuance of an SSOC. While on appeal, the claim was recharacterized to be entitlement to a compensable rating prior to October 21, 2020. The claim for a higher after October 21, 2020, is not on appeal. The Board notes that a 30 percent rating assigned from October 21, 2020, is the highest rating available under Diagnostic Code 7319 which is applicable to irritable colon syndrome. Disability ratings are determined by the application of VA's Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. §§ 4.7, 4.59 allows consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint. Under Diagnostic Code (DC) 7319, a zero percent rating is warranted for mild IBS symptoms, described as disturbances of bowel function with occasional episodes of abdominal distress. 38 C.F.R. § 4.114. The next higher rating of 10 percent is warranted for moderate symptoms, described as frequent episodes of bowel disturbance with abdominal distress. The next higher and highest rating of 30 percent is warranted for severe symptoms, described as diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. The January 2012 VA examination showed the Veteran had a current diagnosis of IBS. The examiner noted the condition did not require medication and the Veteran had not undergone any surgical treatment. It was noted the Veteran experienced symptoms of alternating diarrhea and constipation and abdominal distension. It also noted that she experienced occasional episodes of bowel disturbance with abdominal distress. The examiner acknowledged the Veteran's past history of surgical treatment for polyps. Laboratory testing and imaging was performed. The examiner thoroughly documented the findings of each test and study which revealed a normal status. Although the Veteran contends that the examination was incomplete, the examination was properly administered and the examiner provided a detail description of the Veteran's condition at the time of the examination. Post-service treatment records show the Veteran continued to experience mild disturbances of bowel disturbance with abdominal distress since the time of service connection on December 1, 2011. See e.g., September 2013 VA treatment record (denied problems with bowel movement or urination); February 2014 Emergency Department Note (no bowel/bladder incontinence); August 2014 Nursing Note (reported continent bowel control, denied bladder problems); December 2015 Gastroenterology Note (denied any symptoms of bowel obstruction). In an August 2014 VA treatment record, the physician discouraged smoking because it exacerbated the IBS. Also in August 2014, the Veteran underwent a CT scan that show bowel wall thickening. Examination revealed no peritoneal signs or evidence or bowel ischemia and no urgent surgical indication On March 8, 2016, the Veteran visited the emergency room complaining of right side abdominal pain. It was noted that the pain was related to her IBS. She was provided medication and instructed to follow up with her primary care physician. In May 2016, the Veteran visited the emergency room again complaining of abdominal pain. Even with medication, her pain did not subside. It was noted that the pain was similar to previous IBS pain. Laboratory testing showed early or partial small bowel obstruction. In April 2017, the Veteran was delivered to the emergency room by ambulance. She complained of nausea and small diarrhea. The impression given was for noncardiac chest pain and dyspepsia or GERD. She was provided medication and sent home. In July 2017, the Veteran underwent a colonoscopy and a 3 mm poly was resected and retrieved. See November 2017 colonoscopy report. In April 2018, the Veteran visited the emergency room again for right side abdominal pain. She reported that she had experienced pain for the past two days. She described the pain as sharp, crampy, intermittent, associated with nausea, no vomiting, and one episode of non-bloody diarrhea that morning. After reviewing all of the evidence of record, the Board finds that a compensable rating is not warranted prior to March 8, 2016. During that period of time, the symptoms appear to have been mild with only occasional episodes of abdominal distress. The January 2012 examination specifically described the frequency as being only occasional. This assessment is confirmed by the treatment records dated prior to March 2016. The Veteran's symptoms increased in severity in March 2016 causing her to visit the emergency room several times. The evidence shows onset of moderate symptoms of frequent episodes of bowel disturbance with abdominal distress. Accordingly, the Board finds that a 10 percent rating for IBS is warranted as of March 8, 2016. A higher rating of 30 percent is not warranted because the evidence does not show severe symptoms of diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Harris, Attorney Advisor 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.