Citation Nr: 21040819 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 16-56 853 DATE: July 7, 2021 ORDER Entitlement to service connection for ulcerative colitis is granted. FINDING OF FACT The evidence is at least evenly balanced as to whether the Veteran's current ulcerative colitis began during active service. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for ulcerative colitis are met. 38 U.S.C. §§ 1110, 5107 (b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran was a member of the New Jersey Army National Guard who served on active duty for training (ACDUTRA) from June 2002 to September 2002, and from July 2003 to August 2003. She served on active duty from June 2004 to November 2005, including service in the Southwest Asia theater of operations from January 2005 to October 2005. This matter initially came to the Board of Veterans' Appeals (Board) from an October 2014 rating decision. In January 2019, the Board remanded this matter for further development. Entitlement to service connection for ulcerative colitis 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 there is a balance of positive and negative evidence regarding any material issue, the benefit of the doubt shall be given to the claimant. See 38 U.S.C. § 5107 (b). Reasonable doubt is doubt which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. See 38 C.F.R. § 3.102. The question is whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which event the claim must be denied. Gilbert, 1 Vet. App. at 54. The Board has reviewed all the evidence of record. Although the Board has an obligation to provide adequate reasons and bases supporting its decisions, there is no requirement that the Board discuss every piece of evidence in the record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Board will summarize the relevant evidence, as deemed appropriate, and the Board's analysis will focus on what the evidence shows, or fails to show, as to the Veteran's claim. The type of military service a claimant had governs his or her eligibility for service connection for a given disability. Relevant to this case, there is a difference between "active duty," which includes "full-time duty in the Armed Forces, other than active duty for training," and ACDUTRA ("active duty for training"), which includes "full-time duty in the Armed Forces performed by Reserves for training purposes." 38 U.S.C. § 101 (21), (22). In this case, the Veteran served a period of ACDUTRA from June 2002 to September 2002, and from July 2003 to August 2003 and served active duty from June 2004 to November 2005. See 38 U.S.C. §§ 101 (2), (23), (24), 1110; 38 C.F.R. § 3.6 (d). As set forth below, the distinction between active duty and ACDUTRA governs the circumstances under which the Veteran may be eligible for service connection for the claim on appeal. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Generally, service connection requires: (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. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). However, when a claim for service connection is based on a period of ACDUTRA, there must be evidence that the claimant became disabled (or died) as a result of a disease or injury incurred or aggravated in the line of duty during the period of ACDUTRA. See, generally, 38 U.S.C. §§ 101 (2), (22), (24), 1110; 38 C.F.R. § 3.6 (c); Smith v. Shinseki, 24 Vet. App. 40, 44 (2010). The Veteran contends that she began experiencing symptoms which she believes to be indicative of ulcerative colitis while serving in Iraq. She claims that her disorder became severe in 2013. The Board finds, for the following reasons, that the Veteran experiences current ulcerative colitis, and that the evidence is at least evenly balanced as to whether this disability began during active service. It is not in question that the Veteran has current disability, as she has been diagnosed with ulcerative colitis during the claim period. The Veteran's DD-214 form shows that her military occupational specialty (MOS) for her ACDUTRA period was a unit supply specialist. Her treatment records from ACDUTRA contain multiple complaints of vomiting and nausea and treatments received for those symptoms (see August 2002 and July 2003 service treatment records). Although an April 2004 pre-deployment report provides that the Veteran was seen in January 2004 for ulcer (although unclear as to its location and its type), she only reported being treated for GERD, and the medical provider at the time noted her having manifested intermittent symptoms for about 3-4 months (which would be outside of her ACDUTRA period), and ultimately found her deployable during that time. Turning to the service treatment records from the Veteran's active duty period from June 2004 to November 2005, a biopsy done for determining the cause of the Veteran's abdominal pain and vomiting resulted in a diagnosis of only gastritis and erosion of duodenum. See August 2004 biopsy report. A report of an upper endoscopy performed on the Veteran in November 2004 also diagnosed her with erosive duodenitis, mild diffuse gastritis, and mild hiatal hernia, but there was no mention of ulcerative colitis. Service treatment records from December 2004 and February 2005 document evaluation done for stomach pain and vomiting, but the Veteran was again only found to have gastritis with history of ulcer. A March 2005 aeromedical evacuation patient records notes history of gastric ulcer, and while the Veteran underwent upper endoscopy with gastric biopsy procedure, she was found to have active chronic gastritis and erosive duodenitis, with no evidence of helicobacter pylori. Finally, the Veteran was given a post-deployment health assessment in October 2005, in which the Veteran reported experiencing diarrhea and vomiting during deployment and that her health worsened during her time in Iraq, but there was no indication of ulcerative colitis. The Veteran has undergone multiple VA examinations throughout the claim period (April 2014, June 2014, August 2014, July 2016, and March 2021)in which all of the examiners diagnosed the Veteran with ulcerative colitis. With respect to whether this disability is related to service, the physician who conducted the July 2016 VA examination opined that the Veteran's ulcerative colitis was not likely ("less likely as not") related to military service. There was no further explanation or rationale provided for this opinion. During the March 2021 VA examination, the Veteran reported symptoms of stomach pain, inability to eat, and vomiting in 2004, as well as being told that she had an ulcer and being put on Prevacid. She also reported experiencing bloody stools and stomach pain while in Iraq in 2005, and that she saw a medical provider and was diagnosed with an ulcer. The March 2021 VA examiner diagnosed the Veteran with pancolic ulcerative colitis, and explained its nature and its physiologyi.e. chronic inflammatory bowel disease that causes inflammation in the digestive tract, usually on the innermost lining of the large intestine (colon) and rectum. After acknowledging various symptoms, to include stomach pains, documented in the Veteran's service treatment records, the examiner suggested that the Veteran had symptoms of early colitis in the duodenum (small intestine) in service, based on the EGD conducted in August 2004. The examiner opined that it is fair to speculate that the Veteran's stomach pains were coming from her intestinal tract, and further noted that the symptoms vary in severity, based on the severity of intestinal inflammation and the location of the inflammation. The examiner noted that the Veteran's more severe symptoms, such as bloody diarrhea, were due to the progression of her ulcerative colitis, and that she was ultimately diagnosed as having ulcerative colitis in 2013. Overall, the March 2021 examiner explained that the Veteran had symptoms of ulcerative colitis throughout her active duty, and that she also had co-morbidities of gastritis, peptic ulcer, and H-pylori. The examiner also suggested that immune system malfunction and hereditary causes are potential etiologies for ulcerative colitis. The examiner concluded that it was not likely ("less likely than not"/"less than 50 percent probability") that the Veteran's ulcerative colitis was incurred in or caused by her military service. The July 2016 opinion is of little, if any, probative value because it is not accompanied by any explanation or rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning; threshold considerations are whether the person opining is suitably qualified and sufficiently informed). The Board acknowledges that the March 2021 examiner appears to have provided conflicting opinions as to whether the Veteran's ulcerative colitis is related to service. Although the examiner opined that the disability was not likely caused by service, the rationale that accompanies this opinion essentially explains that the Veteran began to experience early symptoms of ulcerative colitis during active service, and that her symptoms progressed in the years following service until she was diagnosed in 2013. Therefore, the Board finds that the March 2021 examiner essentially opined that the current ulcerative colitis, while not caused by anything in service, nonetheless had its onset in service. In light of the above, the Board finds that the evidence is at least evenly balanced as to whether the Veteran's current ulcerative colitis had its onset in service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for ulcerative colitis is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Brian J. Elwood Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Lee 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.