Citation Nr: 21028055 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 14-37 530 DATE: May 10, 2021 ORDER Entitlement to service connection for a stomach and/or intestinal disability is denied. FINDING OF FACT While the Veteran has occasional episodes of constipation, it is not shown to result in functional impairment consistent with a stomach and/or intestinal disability. CONCLUSION OF LAW The criteria for service connection for a stomach disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from December 1987 until her honorable discharge in March 1988, from October 1988 until her honorable discharge in November 1992, from November 2001 until her honorable discharge in November 2002, and from October 2003 until her honorable discharge in April 2004, with addition service in the naval reserves. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision of the Regional Office (RO) of the Department of Veterans Affairs (VA). In December 2020, the Board remanded the case to the RO for further development. Specifically, the Board directed the RO to obtain a VA examination on the Veteran's stomach disability. The Veteran's claim for entitlement to service connection for uterine fibroid cysts, status post myomectomy, was also remanded for a new VA examination. That claim is no longer on appeal as it was granted by the RO in a February 2021 rating decision. In November 2018, the Veteran testified before the undersigned at a hearing via videoconference. A transcript of her testimony has been associated with the claims file. Service Connection VA provides compensation for a disability resulting from disease or injury incurred in or aggravated by service. This is referred to as a "service connection." 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may 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). Generally, Service Connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service the so-called "nexus" requirement. Holton v Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially 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). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated by a service-connected disability. In order to prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing that the service-connected disability caused or aggravated the nonservice-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). Furthermore, in deciding whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (2014); 38 C.F.R. § 3.102 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. Id. Entitlement to service connection for a stomach disability. The Veteran asserts that she developed a stomach disability due to her uterine fibroid cyst disability or due to anxiety. Unfortunately, there is no competent medical evidence of record that the Veteran has a stomach disability. The Veteran has never been diagnosed with a stomach disability; her service treatment records, VA treatment records, and VA examinations are all devoid of a diagnosis. There is a single reference to gastrointestinal distress in service with symptoms of diarrhea in September 1993. This was acute and transitory as the Veteran later sought further treatment for other illnesses without treatment for continued symptoms of diarrhea. Furthermore, the Veteran contends that her current symptoms are constipation and urine leakage. The Veteran asserts that her symptoms began due to fibroid cysts putting pressure on her abdomen. She had fibroid surgery in 2004 and claims that she had constipation and urine leakage as a result. She filed her claim in March 2012 and had her first VA examination in July 2012. Although the examiner noted that she experienced symptoms, she was not diagnosed with a stomach disability. Medical treatment records indicated that the Veteran did not have any stomach or intestinal trouble from as early as November 1992 to November 2004. The February 2004 operative report stated that "she has no stress urinary incontinence" and there were no noted complications from surgery. A private treatment provider stated that "with the location of the fibroid it is certainly very possible that her constipation and lower back discomfort are from the fibroid." See September 2014 Private Treatment Record. The RO reviewed this evidence and denied the claim in an August 2018 supplement statement of the case (SSOC) stating, "Constipation is not a disability in and of itself. There was no explanation as to how a uterine fibroid would cause constipation. [Dr. B.K.] did not opine that there is a chronic diagnosed disability of the stomach that is otherwise due to service." Subsequent VA treatment records fail to note symptoms of constipation or urine leakage beyond the Veteran's reports at VA examinations. In more recent VA treatment records, she denied "nausea, vomiting, diarrhea, abdominal pain or changes in bowel habits." See 2018 and 2019 VA Treatment Records. Those treatment notes also stated, "She has hypothyroidism for a few years and reports no symptoms of weight [increase], fatigue, abdominal pains[,] constipation, diarrhea etc." The most recent VA examination in January 2021 also found that the Veteran did not have a diagnosable stomach disability. The examiner concluded, "there is not a significant amount of symptomology to render a diagnosis for this [V]eteran. The [V]eteran relates monthly nausea and constipation in line with her cycle. Her symptoms are not described as debilitating and do not require a prescribed medication." Id. Several isolated VA treatment records reference that the Veteran takes "ranitidine ... as needed for stomach." However, her active medical problems are listed as hypothyroidism, depression, insomnia, foot pain, and allergic rhinitis. In reaching this decision, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. A. Johnston, 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.