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Citation Nr: 1730452 Decision Date: 07/27/17 Archive Date: 08/09/17 DOCKET NO. 14-27 194 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUE Entitlement to service connection for ulcerative colitis, to include as secondary to service connected posttraumatic stress disorder (PTSD). REPRESENTATION Veteran represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD EM Lederman, Associate Counsel INTRODUCTION The Veteran had active duty service in the United States Army from January 1959 to August 1970 and from August 1971 to June 1982. This case comes before the Board of Veterans' Appeals (Board) on appeal from a July 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah. Jurisdiction was subsequently transferred to the RO in Seattle, Washington. The Veteran testified at a Travel Board Hearing before the undersigned Veterans Law Judge in January 2017. A transcript of the hearing is of record. In June 2017, the Board requested a Veterans Health Administration (VHA) opinion. 38 C.F.R. § 20.901(a). This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2016). 38 U.S.C.A. § 7107(a)(2) (West 2014). FINDING OF FACT The Veteran's ulcerative colitis is proximately due to his service-connected PTSD. CONCLUSION OF LAW The criteria for secondary service connection for ulcerative colitis are met. 38 U.S.C.A. §§ 1110, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.310(a) (2016). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran seeks service connection for ulcerative colitis, both on a direct basis and as secondary to PTSD. As secondary service connection is warranted, only that theory of entitlement will be addressed herein. Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a nonservice-connected disorder that is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. See 38 C.F.R. § 3.310 (b); Allen v. Brown, 7 Vet. App. 439, 448 (1995). To prevail on the issue of secondary service causation, the record must show: (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Here, the Veteran is diagnosed with ulcerative colitis. See March 2016 VA examination report. He is also service-connected for PTSD. Thus, the first two elements of secondary service connection are established. Regarding element three, nexus, there is one competent opinion of record addressing secondary service connection. Specifically, in a June 2017 opinion, a VHA expert gastroenterologist concluded that the Veteran's ulcerative colitis has been aggravated by his PTSD. In support of his opinion, the expert reasoned that stress may have a role in the exacerbation of symptoms in patients with known irritable bowel disease (IBD), and emphasized that the Veteran reported frequent symptom flare-ups and his physicians noted difficulty managing his ulcerative colitis. The gastroenterologist noted that "[s]tress has been implicated in the activation of the enteric nervous system and elaboration of proinflammatory cytokines." While the June 2017 VHA expert gastroenterologist ultimately concluded that the Veteran's ulcerative colitis has been "aggravated" by his PTSD, the Board finds sufficient evidence to award secondary service connection on a proximate cause basis under 38 C.F.R. § 3.310(a). Specifically, in addressing secondary service connection, the VHA expert stated that "[s]tudies examining an association between psychological factors (in this case PTSD) and the risk of developing IBD have yielded inconsistent results" - in other words, some studies have supported such a relationship, while others have not. Jackson v. Virginia, 443 U.S. 307, 319 (1979) (stating it is 'the responsibility of the trier of fact fairly to . . . draw reasonable inferences from basic facts to ultimate facts"); Bastien v. Shinseki, 599 F.3d 1301, 1306 (Fed. Cir. 2010) ("The evaluation and weighing of evidence and the drawing of appropriate inferences from it are factual determinations committed to the discretion of the fact finder."). The Board will afford the Veteran the benefit of the doubt in this regard. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Therefore, secondary service connection for ulcerative colitis is established. ORDER Secondary service connection for ulcerative colitis is granted. https://www.va.gov/vetapp17/files5/1730452.txt

I applied for ILP and Self Employment a few days ago. Preparing my business plan now. My list of items for business should be between $50-$70k; uphill battle with a quoted "win or die" approach. I'm 70% (back 40%, depression 50%, and skin (shaving)10% with IU + SSDI. @Asknod...That greenhouse is mad expensive, lol. It would make a good case study as to what is or isn't possible.

Hello friend, I am 30 yrs old and will apply for SSDI in May (once I finish this last class I am taking). I have prepared for the application phase by purchasing 3 programs that assist in showing you how to properly fill out the forms and what to say to your doctor to help you in the process. It's all functional. Your medications cause dizziness and extreme nausea, but without the meds you cannot get out of bed. This is one of the guides within the program. Currently, you have to get a lawyer to represent you. Note: When attending your future appt., while speaking to the doc, focus the entire exam on your wanting to work, but being unable due to depression/PTSD related issues. The doctor may feel your faking it to get a "free ride" so stress to them that you hate yourself for not being able to work, but you constantly have decreased energy and are overly paranoid when interviewing. SSA does not care about how much pain you're in nor do they care whether that meager job can support you. They ONLY care whether you can perform one of much simple unskilled type of jobs. Can you return to past work/Can you do any work at all? You must prove you cannot return to past work. Your medical record must show that you did not leave because you were slightly in pain. What can hurt your case? 1) Lack of ongoing treatment (less than once per month) 2) Not attending or cooperating with your appointment(s) 3) A medical record that does not support your case (doc. feels your faking, seeking drugs, doesn’t like paperwork, doesn’t want to lose business from insurance companies) I highly recommend a person who is doing an initial claim for SSDI to purchase quality programs that show you how to fill the forms properly and what to or not to say to SSA when they interview you. - MDASH1