Citation Nr: 22018247 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 18-32 854 DATE: March 28, 2022 ORDER Entitlement to service connection for fibromyalgia is denied. Entitlement to service connection for irritable bowel syndrome (IBS) is denied. FINDINGS OF FACT 1. The evidence is persuasively against a finding that the Veteran has had a current diagnosis of fibromyalgia at any time during the appeal. 2. The evidence is persuasively against a finding that the Veteran has had a current diagnosis of IBS at any time during the appeal CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for fibromyalgia have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303, 3.317. 2. The criteria for entitlement to service connection for IBS have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the Army from November 1990 to September 1991. This matter is before the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2021, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge of the Board. A transcript of the hearing is in the record. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Service connection may be also 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 chronic means that the disability has existed for 6 months or more, to include intermittent episodes of improvement or worsening over that period. 38 C.F.R. § 3.317(a)(4). The Veteran served in Southwest Asia from January 1991 to September 1991. Therefore, he is considered a Persian Gulf Veteran. 38 C.F.R. § 3.317(e). The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for fibromyalgia is denied. The Veteran contends that he has fibromyalgia that is related to his service in the Gulf War from 1990 to 1991. An August 1991 demobilization medical examination reported that all the Veteran's systems were normal. The only reported defect was muscular low back pain, which was secondary to heavy lifting in August 1991. A July 2014 private medical record reported that the Veteran had polyarthritis with involvement of the metacarpophalangeal joints, proximal interphalangeal joints, and knees. He denied myalgias. A September 2015 VA podiatry note reported the Veteran was experiencing intermittent pain on the top of his left midfoot. It was reported that the Veteran recently began working in a position that required standing throughout his shift. The Veteran was provided a VA fibromyalgia examination in March 2016. The Veteran reported that his low back gets tight often. He also has pain in his knees, feet, and right elbow. The examiner reported that he is not on continuous medication for fibromyalgia symptoms and was not undergoing treatment for the condition. He experienced sleep and fatigue. The veteran had tenderness in the lateral epicondyles and trapezius muscles bilaterally but did not have any other positive tender points. The examiner concluded that the Veteran's physical examination was not consistent with a diagnosis of fibromyalgia. In March 2016, the Veteran was also provided a VA Gulf War examination. The examiner reported the Veteran was not found to meet the diagnostic criteria for fibromyalgia. The examiner found that the Veteran's fatigue is likely related to sleep apnea, mental health problems, and poorly controlled diabetes; therefore, he advised the Veteran to have this evaluated with his treating physician. He was not found to have a disability pattern consistent with an undiagnosed illness, a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, or a diagnosable chronic multisymptom illness with a partially explained etiology. The examiner reported that all claimed conditions have a clear and specific etiology and diagnosis. None of the Veteran's conditions were found to be related to hazardous environmental exposures. A March 2017 VA primary care note reported the Veteran had lumbago, but his back pain was well-controlled. He also complained of pain and swelling in the knuckles of his hands. X-rays showed minor spurs. The Veteran also had a history of bilateral knee pain and left foot pain. The Veteran was engaged in full-time factory work and part-time food delivery and cell phone sales. It was reported that the Veteran had an active lifestyle, which included biking. A March 2018 VA treatment record reported the Veteran was walking and riding his bike nine city blocks to and from work. He planned to continue to walk and ride bike for exercise. At the Veteran's November 2021 Board hearing, he testified that his treating physician had not diagnosed him with fibromyalgia. As previously described, an August 1991 demobilization medical examination reported that all the Veteran's systems were normal. The only reported defect was muscular low back pain, which was secondary to heavy lifting in August 1991. A March 2016 VA examination found that the Veteran did not have fibromyalgia. At the Veteran's November 2021 Board hearing, he testified that his treating physician had not diagnosed him with fibromyalgia. The Board finds the weight of the evidence is against the finding of a present disability for which entitlement for service connection can be established. In so finding, the Board notes that the existence of a current disability is the cornerstone of a claim for VA disability compensation. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Specifically, service connection requires a showing of a current disability. Here, the evidence does not indicate a clinical diagnosis of fibromyalgia at any point during the course of this appeal. For the reasons and bases stated above, the Board finds that service connection for fibromyalgia is not warranted. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the evidence is persuasively against the claim and the positive and negative evidence is not nearly in balance, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the Veteran's service connection claim for fibromyalgia is denied. 2. Entitlement to service connection for IBS is denied. The Veteran contends that he has IBS that is related to his service in the Gulf War from 1990 to 1991. A review of the Veteran's service treatment records does not reflect any complaints, findings, or treatment for IBS. An August 1991 demobilization medical examination reported that all the Veteran's systems were normal. An August 1991 demobilization report of medical history documented the Veteran's report that he did not experience frequent indigestion or stomach, liver, or intestinal trouble. A July 2014 private treatment record reported the Veteran had gastroesophageal reflux disease that was well-controlled with proton pump inhibitors. In November 2015, the Veteran submitted a statement in which he expressed that he had experienced IBS for at least ten years. He described having stomach cramps and a burning and aching feeling with diarrhea or constipation. He reported that he sometimes has a sick feeling that makes him vomit or feel like he is going to vomit. The Veteran was provided a VA intestinal conditions examination in March 2016. The examiner found that the Veteran did not have or had ever been diagnosed with an intestinal condition. The Veteran stated that he had been told he should get tested for IBS. He reported having constipation but also stated he goes to the bathroom usually every day. He reported experiencing frequent abdominal pain. He did not have a regular diet and experienced diarrhea about once a week. When he goes to the bathroom, his bowel movements are sometimes solid and sometimes runny. He reported that he had not seen a physician for the condition. The examiner reported that the Veteran had signs or symptoms attributable to a non-surgical non-infectious intestinal condition, as he experienced diarrhea about one time per week. It was reported that the Veteran had occasional episodes of bowel disturbance with abdominal distress. A kidney, ureter, and bladder x-ray showed a large amount of stool and a non-specific bowel gas pattern. The examiner reported the Veteran was found to have very poorly controlled diabetes. Given the effects that diabetes has on bowel function, the examiner stated that it was likely that this played a role in the Veteran's on the Veteran's bowel problems. According to the examiner, it would be impossible to diagnose another abdominal condition until the Veteran's diabetes is better controlled over an extended period. In March 2016, the Veteran was also provided a VA Gulf War examination. The examiner reported the Veteran was not found to meet the diagnostic criteria for irritable bowel syndrome. The examiner found that the Veteran's fatigue is likely related to sleep apnea, mental health problems, and poorly controlled diabetes; therefore, he advised the Veteran to have this evaluated with his treating physician. The Veteran was not found to have a disability pattern consistent with an undiagnosed illness, a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, or a diagnosable chronic multisymptom illness with a partially explained etiology. The examiner reported that all claimed conditions have a clear and specific etiology and diagnosis. None of the Veteran's conditions were found to be related to hazardous environmental exposures. A January 2017 VA primary care note reported the Veteran complained of pain in his chest. He denied nausea, vomiting, diarrhea, or constipation. A March 2017 VA treatment record reported the Veteran's diabetes was poorly controlled. The Veteran denied nausea, vomiting, diarrhea, or constipation. A May 2017 VA urgent care note reported the Veteran injured his shoulder pushing his dog off the bed but otherwise felt fine. The Veteran denied nausea, vomiting, diarrhea, or constipation. A March 2018 VA treatment record reported that the Veteran denied nausea, vomiting, diarrhea, or constipation. An April 2018 VA treatment record reported the Veteran's diabetes was poorly controlled. His last bowel movement was the day prior to the medical visit. The Veteran reported no change in bowel habits, abdominal pain, constipation, or diarrhea. At the Veteran's November 2021 Board hearing, he testified that he was diagnosed with IBS by his treating physician "a while ago." He also stated his treating physician stated his IBS "might be connected" to his military service. As previously described, the Veteran's service treatment records do not show any relevant symptoms, complaints, treatment, or diagnoses of IBS. An August 1991 demobilization report of medical history documented the Veteran's report that he did not experience frequent indigestion or stomach, liver, or intestinal trouble. Although the Veteran testified at his November 2021 Board hearing that he was diagnosed with IBS "a while ago," his records do not reflect any diagnoses of IBS. A March 2016 VA examination found that Veteran does not meet the diagnostic criteria for IBS. Moreover, VA treatment records from 2017 and 2018 reflect that the Veteran consistently denied nausea, vomiting, diarrhea, or constipation. The Board finds the weight of the evidence is against the finding of a present disability for which entitlement for service connection can be established. In so finding, the Board notes that the existence of a current disability is the cornerstone of a claim for VA disability compensation. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Specifically, service connection requires a showing of a current disability. Here, the evidence does not indicate a clinical diagnosis of IBS at any point during the course of this appeal. (Continued on the next page) For the reasons and bases stated above, the Board finds that service connection for IBS is not warranted. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the evidence is persuasively against the claim and the positive and negative evidence is not nearly in balance, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the Veteran's service connection claim for IBS is denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Moore, 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.