Citation Nr: 21040582 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 15-21 244 DATE: July 6, 2021 ORDER Entitlement to service connection for irritable bowel syndrome (IBS), to include as due to an undiagnosed illness, is granted. FINDING OF FACT Giving the Veteran the benefit of the doubt, IBS began during active service, or is otherwise related to an incident, in-service injury, or disease. CONCLUSION OF LAW Giving the Veteran the benefit of the doubt, the criteria for service connection for IBS are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty, including from January 2000 to April 2000 and from January 2003 to October 2003. The Veteran had a hearing before the undersigned Veterans Law Judge in January 2019. In February 2019 and August 2020, the Board remanded this matter for additional development. 1. Entitlement to service connection for IBS, to include as due to service or an undiagnosed illness. The Veteran contends that her IBS began during service or due to her Gulf War service in Southwest Asia. During her February 2019 Board hearing, she reported that she had deployed to Kuwait in 2003 and has had IBS since that time. She claimed symptoms of chronic diarrhea and stomach pains. In June 2015 VA Form 9, she claimed she had been too embarrassed to ask for time off and lived with the condition. Service connection may be granted for a Persian Gulf veteran with objective indications of a qualifying chronic disability that manifested either during active service in the Southwest Asia theater of operations or to a degree of 10 percent or more not later than December 31, 2021. 38 U.S.C. § 1117(a)(1); 38 C.F.R. § 3.317(a)(1). A qualifying chronic disability is a chronic disability that may result from an undiagnosed illness or a medically unexplained chronic multisymptom illness (MUCMI). 38 C.F.R. § 3.317(a)(2)(i). The term MUCMI refers to a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 38 C.F.R. § 3.317(a)(2)(ii). Examples of MUCMIs include chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding structural gastrointestinal disabilities). 38 C.F.R. § 3.317(a)(2)(B). Here, the Veteran had active service in Kuwait in 2003. Therefore, she is considered a Persian Gulf veteran. 38 C.F.R. § 3.317(e). A February 2021 VA examination shows the Veteran has a diagnosis of IBS, a functional gastrointestinal disorder. The Veteran's IBS has existed from at least March 2020 when it was diagnosed following full work-up, per the February 2021 VA examination. IBS is a "qualifying chronic disability" for purposes of 38 C.F.R. § 3.317. IBS is specifically listed as a manifestation of a MUCMI under 38 C.F.R. § 3.317(b)(3). Thus, it is considered chronic under the regulatory definition. Moreover, giving the Veteran the benefit of the doubt, it has manifested to a degree of 10 percent or more because of findings by the March 2014 VA examiner when rated by analogy under Diagnostic Code 7319 for irritable colon syndrome. In this regard, a compensable disability rating for IBS requires frequent episodes of bowel disturbance with abdominal distress. 38 C.F.R. § 4.114, Diagnostic Code 7319. The Veteran has also provided lay statements as to symptomatology and VA medical records document complaints of, or treatment for, gastrointestinal complaints. Although there are negative nexus opinions of records, the Veteran has consistently and credibly reported IBS-like symptoms since service. She is certainly competent to do so. For these reasons and resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran's IBS has manifested to a compensable level during the appeal period. As the Veteran is a "Persian Gulf Veteran" and IBS is considered a qualifying chronic disability under 38 C.F.R. § 3.317, the Board finds that the criteria for service connection for IBS have been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Board notes that it previously remanded to consider whether the Veteran had Lynch Syndrome and if so if it was aggravated by service. The Board had noted that a March 2020 VA medical record indicated that the Veteran had been scheduled for a genetic appointment to clarify if she had a diagnosis of Lynch Syndrome. Following the Board Remand, a September 2020 VA medical record indicates that the Veteran still had not completed the requested genetic testing. Genetic testing has not been completed due to the Veteran failing to attend scheduled testing as indicated in VA medical records. Given that the Veteran has had the opportunity to have genetic testing performed but did not take advantage of such testing offered to her, the Board finds that no additional action is necessary for substantial compliance with the prior Board remand directives. "The duty to assist is not always a one-way street. If [an appellant] wishes help, [s]he cannot passively wait for it in those circumstances where [s]he may or should have information that is essential in obtaining the putative evidence." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Regardless, the Board finds that there is now sufficient evidence of record to decide as to the question of Lynch Syndrome. The February 2021 VA examiner has clarified that the Veteran had previously had an equivocal test for Lynch's syndrome in 2014 and was supposed to have a repeat in 2020, but she did not do that. However, the examiner explained that since her father who had colon cancer and her sister were both tested, they are negative. Therefore, the examiner found that it is not possible for her to have the disease and there is no evidence of Lynch syndrome. VA medical records, such as the September 2020 genetics consult, similarly indicate that there is no confirmed diagnosis of Lynch Syndrome, but that further genetic testing would be helpful. Given that the Veteran does not have a confirmed diagnosis of Lynch syndrome, service connection for such a disorder is not possible. Service connection cannot be granted "[i]n the absence of proof of a present disability." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Giving the Veteran the benefit of the doubt, service connection for IBS is granted. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Lindio 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.