14-27 194, 14-27 194

Veteran served in the U.S. Army (1959–1970; 1971–1982) and is service‑connected for PTSD.
Veteran seeks service connection for ulcerative colitis (direct and as secondary to PTSD); appeal from a July 2011 RO decision.
VA travel board hearing held January 2017; VHA gastroenterology opinion obtained June 2017.
VA examiner diagnosed ulcerative colitis and the veteran reported frequent flare‑ups and difficult disease management.
VHA gastroenterologist concluded PTSD aggravated the veteran’s ulcerative colitis and discussed stress‑mediated mechanisms linking psychological factors and IBD.
Board found the medical nexus sufficient and granted secondary service connection on a proximate‑cause basis under 38 C.F.R. § 3.310(a).

Issue	Plaintiff's Argument	Defendant's Argument	Held
Entitlement to service connection for ulcerative colitis as secondary to service‑connected PTSD	Ulcerative colitis is related to or aggravated by PTSD and stress; nexus shown by medical opinion and symptom history	RO/VA previously denied; challenges to causation noted in record and literature	Granted: Board awarded secondary service connection based on VHA opinion and benefit‑of‑the‑doubt rule

Jackson v. Virginia, 443 U.S. 307 (trier of fact may draw reasonable inferences from basic facts)
Bastien v. Shinseki, 599 F.3d 1301 (factfinder evaluates and weighs evidence and inferences)
Allen v. Brown, 7 Vet. App. 439 (secondary service connection/ aggravation principles)
Wallin v. West, 11 Vet. App. 509 (elements required to establish secondary service connection)