Citation Nr: 21029344 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 16-63 685 DATE: May 13, 2021 ORDER Service connection for pancreatitis on a secondary basis is granted. FINDING OF FACT The Veteran's pancreatitis is etiologically related to his service-connected IBS disability and/or medications used to treat his service-connected right knee disability. CONCLUSION OF LAW The criteria to establish entitlement to service connection for pancreatitis, to include as secondary to the service-connected IBS disability and/or to treatment administered for the service-connected right knee disability, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1989 to April 1993, and from November 2001 to November 2002, including service in Southwest Asia. In February 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. The issue on appeal was previously remanded by the Board in April 2020 and December 2020 for further development. The case has been properly returned to the Board for further appellate consideration. Service Connection for PancreatitisLaws and Analysis Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). 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). Only chronic diseases listed under 38 C.F.R. § 3.309 (a) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303 (b). Walker v. Shinseki, 708 F.3d 1331 Fed. Cir. 2013). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310 (a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). In Ward v. Wilkie, the United States Court of Appeals for Veterans Claims held that, for secondary service connection, "aggravation" need not be permanent in nature. 31 Vet. App. 233, 241-42 (2019). In rendering a decision on appeal the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57(1990). When all the evidence is assembled, 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 a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Analysis The Board finds that the Veteran is currently diagnosed with pancreatitis. See May 2020 VA Gallbladder and Pancreatis Disability Benefits Questionnaire report. As relevant here, the Veteran is currently service connected for IBS and right knee patellofemoral syndrome, and the record contains medical evidence associating the Veteran's pancreatitis to those service-connected disabilities. A May 2009 VA treatment record noted that the Veteran had constipation-predominant IBS and, "superimposed on this," he also had a history of recurrent pancreatitis. In a May 2020 VA pancreatitis examination report, the examiner noted that "given concern for a component of IBS, [the Veteran] was prescribed nortriptyline which he did not tolerate." This statement suggests to the Board some indication that the medications prescribed to alleviate the Veteran's pancreatitis were restricted given his IBS disability. This evidence is probative and tends to supports the theory of secondary service connection via aggravation. Additionally, VA obtained a medical opinion in December 2020 regarding the etiology of the Veteran's pancreatitis disorder. The Board notes that the VA examiner did not address whether the Veteran's pancreatitis was aggravated by his service-connected IBS disability. Nonetheless, the Board finds that the information the examiner provided in the 2020 VA medical opinion places the evidence at least in equipoise as to whether the Veteran's pancreatitis is etiologically related to his service-connected disabilities. In this regard, the December 2020 examiner indicated that the "third most common" cause of pancreatitis occurred after receiving an endoscopic retrograde cholangiopancreatography (ERCP). VA treatment records dated in 2009 show that the Veteran, in 2008, underwent a colonoscopy, abdominal ultrasound, hepatitis serologies, and reported what "sound like an ERCP." Moreover, the December 2020 VA examiner noted that "corticosteroids" were "definitely associated with acute pancreatitis." VA treatment records show that, in 2015, the Veteran was treated with corticosteroid injections in the right knee to help alleviate his knee inflammation. On review of all evidence, the Board concludes that the medical evidence supports the claim based on the following: (i) the corticosteroid injection treatment prescribed for the Veteran's right knee disability is associated with his diagnosed pancreatitis, (ii) the medication usually prescribed to alleviate symptoms of pancreatitis (i.e., nortriptyline) had to be discontinued as the Veteran's IBS was impacted, and (iii) the medical evidence showing that the Veteran's recurrent pancreatitis was "superimposed" on his constipation-predominant IBS. (Continued on the next page) For these reasons, and resolving reasonable doubt in the Veteran's favor, the Board finds that service connection for pancreatitis as secondary to the service-connected IBS disability and/or to treatment administered for the service-connected right knee disability is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The appeal is granted. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Casadei, 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.