Citation Nr: 0006730 Decision Date: 03/13/00 Archive Date: 03/17/00 DOCKET NO. 98-12 288A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUE Entitlement to service connection for a bowel disorder, claimed as due to an undiagnosed illness contracted as a result of service in the Southwest Area theater of operations during the Persian Gulf War. ATTORNEY FOR THE BOARD Jonathan B. Kramer, Associate Counsel INTRODUCTION The veteran had active service from February 1988 to February 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 1996 rating decision rendered by the Regional Office (RO) of the Department of Veterans Affairs (VA) in Nashville, Tennessee, which denied entitlement to the benefit sought on appeal. The Board notes that during the pendency of this appeal, the custody of this case was transferred to the RO in Winston-Salem, North Carolina. FINDINGS OF FACT 1. The veteran had military service in the Southwest Asia theater of operations during the Persian Gulf War, from October 1990 to December 1990, and from February 1991 to April 1991. 2. The veteran is not shown to manifest an undiagnosed illness, to a degree of 10 percent or more, related to his service in the Southwest Asia theater of operations during the Persian Gulf War. CONCLUSION OF LAW The veteran's bowel disorder was not incurred as a result of active duty service, to include participation in the Southwest Asia theater of operations during the Persian Gulf War. 38 U.S.C.A. §§ 1110, 1131, 5107, 1117 (West 1991); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the veteran's claim of entitlement to service connection for an undiagnosed illness, claimed as a bowel disorder incurred as a result of service in the Persian Gulf War, is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. The Board is also satisfied that all relevant facts have been properly developed. No further assistance to the veteran is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a). The law provides that a veteran is entitled to service connection for disability resulting from a disease or injury incurred or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Furthermore, service connection may also be established for a veteran who exhibits objective indications of a chronic disability resulting from an undiagnosed illness, which became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf war, or to a degree of 10 percent or more not later than December 31, 2001. To fulfill the requirement of chronicity, the illness must have persisted for a period of six months. 38 U.S.C.A. § 1117 (West 1991); 38 C.F.R. § 3.317 (1999). The veteran's service medical records (SMRs) includes a September 1991 treatment record indicating the veteran complained of diarrhea since service in Saudi Arabia. There is also an October 1991 medical screening record concerning the veteran's deployment to the Southwest Asia theater of operations during the Persian Gulf, in which the veteran denied experiencing diarrhea or vomiting while deployed. Although the veteran did check "yes" to the question of whether he had experienced "[a]n injury of any other type," he also checked "no" to the question whether he has experienced "[a]n illness not described above." The veteran's October 1991 separation examination report did not note any signs or symptoms involving the gastrointestinal system. A March 1992 VA general medical examination report found the veteran's digestive system and rectum to be normal. A November 1993 VA consultation report stated that the veteran complained of suffering from chronic loose stools since service in the Persian Gulf War. Stool studies were negative for parasites or other abnormalities. Physical examination was noted to be essentially unremarkable. A May 1994 VA colon barium enema report, and June 1994 upper gastrointestinal and small bowel radiology report, were normal. An October 1994 VA intestines and stomach examination report recounted the veteran's complaints of having loose bowel movements, which occasionally occurred more than once a day, and was accompanied by occasional slight discomfort in the upper right quadrant of the abdomen. Abdomen and digital rectal examinations were normal. There was normal, well- formed stool in the rectal ampulla. The diagnosis was a history of loose stools daily, occasionally twice a day, with a normal examination and no evidence of disease. A January 1996 VA consultation report notes the veteran's history of having diarrhea since Persian Gulf War service. The impression was diarrhea. A March 1996 VA treatment record noted the veteran continued to complain of liquid diarrhea. The assessment was irritable bowel syndrome. Follow-up VA treatment records in June 1996 and December 1996 continued to note the veteran's complaints of loose stools, with some abdominal pain, but that the veteran was otherwise in stable condition. A June 1997 VA treatment record reports that the veteran complained of chronic loose bowel movements since March 1991. On examination, there was tenderness, but stool studies were negative. A July 1997 flexible sigmoidoscopy (endoscopy) report was normal. An October 1997 VA treatment record stated an assessment of functional bowel disorder. A follow-up November 1997 VA gastrointestinal clinical consultation report noted a provisional diagnosis of functional bowel disorder, and referred the veteran to psychiatry for evaluation of the effect of emotional or behavioral factors that may have been exacerbating his symptoms. A March 1998 psychological consultation did not find any psychiatric problem that would contribute to the veteran's gastrointestinal disorder. The remaining evidence consists the veteran's variously dated written contentions and the lay statements of various acquaintances. The veteran contends that he suffers from a significant disability of the bowels manifested by chronic and uncontrollable loose stools, sometimes associated with abdominal pain and gas, since his service in the Persian Gulf War's Southwest Area theater of operations in March 1991. The veteran maintains that the cause of these symptoms is an undiagnosed illness, possibly caused by some toxic agent he was exposed to during service, and that any specific diagnoses entered into the medical record with regard to his symptoms do not represent bone fide diagnoses. The veteran also contends that he is entitled to undergo certain tests he requested, but that these tests were not performed. Along with his written statements, the veteran has submitted several informational documents that generally and briefly discuss certain aspects concerning the ill health certain Persian Gulf War veteran's. The lay statements of acquaintances serve to support the veteran's central contention that he contracted an undiagnosed illness in service. As noted earlier, in accordance with 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317, service connection may be granted only for certain objectively manifested undiagnosed disabilities attributed to Southwest Asia service during the Persian Gulf War. Among these are gastrointestinal signs or symptoms. 38 C.F.R. § 3.317(b)(10). The evidence of record shows that since 1993, the veteran has consistently complained of a chronic bowel disability - characterized by chronic and uncontrollable loose stools, with secondary abdominal pain and discomfort - attributable to service in Persian Gulf War during March 1991. Although a single medical record objectively reported tenderness of the abdomen, none of the remaining medical evidence objectively confirms that the veteran suffers from loose stools, or any other gastrointestinal signs or symptoms. Indeed, contrary to the veteran's complaints, an October 1994 VA examination report stated that there was normal, well-formed stool in the rectal ampulla. Moreover, the record indicates that stool samples were taken for laboratory analysis numerous times, that the results were always negative, and the stool for such samples was never described as loose. The Board further observes that when diagnoses were entered into the medical record, such as for diarrhea or irritable bowel syndrome, such diagnoses appear to be based on history rather than by objective medical confirmation. The Board notes that the United States Court of Appeals for Veterans claims (Court) has held that a bare transcription of lay history is not transformed into competent medical evidence merely because the transcriber happens to be a medical professional. LeShore v. Brown, 8 Vet. App. 406 (1995). However, considering the evidence in the light most favorable to the veteran, and supposing that his symptoms are considered to have been objectively confirmed or observed, such symptoms have been associated with irritable bowel syndrome, which is a known diagnosis. The veteran is certainly competent to state whether he has diarrhea but, being a layman, he is not competent to give an opinion regarding medical causation or the diagnosis of the underlying condition. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Since the veteran has been diagnosed with a specific disability manifested by diarrhea, and considering the fact that the medical evidence does not show that the veteran otherwise exhibits objectively confirmed diarrhea to a degree of 10 percent or more (see 38 C.F.R. § 4.114, Code 7319), the Board must conclude that service connection for a bowel disorder manifested by diarrhea under the provisions of 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317 is not warranted. In reaching this decision, the Board has considered the veteran's written statements and the statements of his acquaintances. However, again, as laypersons, the veteran and his acquaintances are not competent to offer opinions concerning a medical diagnosis, or the causation thereof. Espiritu, supra. The Board has also considered the veteran's contention that he should have been afforded additional specified tests to better determine the cause and nature of the veteran's bowel disorder. However, the Board notes that the VA examiner's have, over the course of years, undertaken various tests to evaluate the veteran's reported symptoms, and have determined that further testing is unwarranted. The determination of whether additional tests are warranted are in the purview of the medical professionals and not the veteran. The veteran is not precluded from requesting that these tests be done in the private sector. Finally, as a state of equipoise of the positive evidence and the negative evidence does not exist, the benefit-of-the- doubt doctrine outlined in 38 U.S.C.A. § 5107(b) and Gilbert v. Derwinski, 1 Vet. App. 49 (1990), does not apply in this case. ORDER Service connection for a bowel disorder, claimed as due to an undiagnosed illness contracted as a result of service in the Persian Gulf War, is denied. R. F. WILLIAMS Member, Board of Veterans' Appeals