Citation Nr: 22012274 Decision Date: 03/03/22 Archive Date: 03/03/22 DOCKET NO. 18-52 971 DATE: March 3, 2022 ORDER Entitlement to service connection for a digestive system disorder, to include diverticulitis and gastroesophageal reflux disease (GERD), is granted. FINDING OF FACT The evidence reflects that the Veteran's digestive system disorder was due to his active service. CONCLUSION OF LAW The criteria for service connection for a stomach disorder have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1969 to October 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The issue was twice before the Board in July 2019 and March 2021. In July 2019, the Board declined to grant the Veteran's request to reopen the issue of service connection for a duodenal ulcer and denied service connection for GERD and diverticulitis. In February 2020, the Veteran appealed the Board's denial to the Court of Appeals for Veterans Claims (Court). In a July 2020 Memorandum Decision, the Court set aside the Board's July 2019 decision and remanded the appeal. As to the question of reopening service connection for a duodenal ulcer, the Court specifically found that the Board erred in failing to consider whether newly received service personnel records warranted reconsideration of the original claim for service connection for a duodenal ulcer, which was first denied in February 1973 RO and in a May 1973 Board decision. The issues of service connection for GERD and diverticulitis were deemed as inextricably intertwined with the request to reopen a claim for service connection for a stomach ulcer. In March 2021, the Board found that reconsideration was warranted for the issue of service connection for a duodenal ulcer and remanded all three issues. The RO was mandated to reconsider the issue of service connection for a duodenal ulcer according to 38 C.F.R. § 3.156 (c) and obtain nexus medical opinions from a gastroenterologist for the said ulcer, GERD, and diverticulitis. Further, the RO was to also obtain outstanding VA and private treatment records and associate them with the claims file. The outstanding treatment records were associated with the claims file, and in September 2021, medical opinions were obtained. The medical opinions are adequate, for they considered the entirety of the record, including the Veteran's in-service complaints of epigastric distress and the lay statements attesting to continuity of symptomology. Thus, there has been substantial compliance with the remand directives. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). The Board notes that the issue of service connection for a duodenal ulcer was granted in a rating decision of November 2021. As for service connection for diverticulitis and GERD, the Board has recharacterized the said claims as a single claim as one of entitlement to service connection for a digestive system disorder, including diverticulitis GERD. Clemons v. Shinseki, 23 Vet. App. 1 (2009) (stating that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record). REFERRED At the time of this decision, the Veteran is unrepresented. In correspondence received to VA on December 06, 2021, and dated November 26, 2021, he seems to seek an earlier effective date for the grant of service connection for his duodenal ulcer, in response to a November 19, 2021 rating decision (the notification of this decision was dated November 23, 2021). As such, the Board is herein referring the issue to the RO to provide the Veteran with the information to complete the said claim if he so desires. Entitlement to service connection for a stomach disorder, to include diverticulitis and GERD, is granted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity for certain diseases. 38 C.F.R. §§ 3.303 (a), (b), 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also 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). To establish service connection for the claimed disorder, there must be (1) 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, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331(Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence considering the entirety of the record. The standard of proof to be applied in decisions on claims for veterans' benefits is outlined in 38 U.S.C. § 5107 (2012). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran contends that he has an additional digestive disorder, including GERD and duodenal diverticulitis, that was incurred in service and continued. The Veteran's service treatment records show an October 1969 complaint of epigastric distress following running and physical training. The Veteran's post-service treatment records additionally show that Veteran's treatment for GERD and diverticulosis. In September 2021, the Veteran was afforded a VA medical opinion addressing his duodenal diverticulitis. The examiner found that the Veteran's c-file presents objective evidence of chronicity of care for a duodenal diverticulitis diagnosis and a nexus to service. He explained that a duodenal diverticulitis diagnosis per UpToDate (an electronic clinical resource tool for physicians) Diverticula are sac-like protrusions of the bowel wall and occur throughout the small and large bowel. Small bowel diverticula can occur anywhere in the small bowel but are most often found in the duodenum. Duodenal diverticula are thought to be acquired [because of] herniation through a defect caused by the entrance of large vessels supplying the bowel wall. A combination of increased intraluminal pressures and intrinsic weakness of the muscular layer is thought to play a role. [Additionally,] per the Arthritis Foundation, "[e]ven in basic training, soldiers are carrying 60-100+ lb. packs that can injure and weaken their bodies." The Board accords to the above opinion and rationale most probative to the finding that the duodenal diverticulitis resulted from service. In arriving at the opinion, he specifically acknowledged a review of the entirety of the records. Shedden, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (holding that a physician should have information regarding relevant case facts.) Further, there is not any competent medical evidence of record that contradicts his findings. Accordingly, as the nexus element is satisfied, the Board finds that the evidence is in favor of service connection. 38 U.S.C. § 5107(b) (2012). D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Stevens, 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.