Citation Nr: 18154569 Decision Date: 12/04/18 Archive Date: 11/30/18 DOCKET NO. 08-32 171 DATE: December 4, 2018 ORDER Entitlement to service connection for a neck disability, to include as secondary to a service-connected low back disability is denied. REMANDED Entitlement to a rating in excess of 10 percent for a left foot painful surgical scar is remanded. Entitlement to a rating in excess of 0 percent for a left foot residual scar is remanded. Entitlement to a rating in excess of 0 percent for hemorrhoids is remanded. FINDING OF FACT The criteria for entitlement to service connection for a neck disability, claimed as secondary to a service-connected low back disability, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310 CONCLUSION OF LAW The criteria for entitlement to service connection for a neck disability, claimed as secondary to a service-connected low back disability, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310 REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1981 to January 1986. This appeal comes before the Board of Veterans’ Appeals (Board) on appeal from July 2007, January 2015, and May 2015 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in of the Columbia, South Carolina. Entitlement to service connection for a neck disability, to include as secondary to a service-connected low back disability The Veteran contends that a neck disability was caused or aggravated by a service-connected low back disability. More specifically, the Veteran asserts that he began to develop and notice neck pain following the low back disability. Service connection may be established for disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. That determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Service connection may be established for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). A disability that is proximately due to or the result of a service-connected disability shall be service-connected. When service connection is established for a secondary disability, the secondary disability shall be considered a part of the original disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In that instance, the Veteran is compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b) (2016); Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran is diagnosed with degenerative arthritis of the cervical spine. In a May 2016 VA examination, the examiner opined that the Veteran’s neck disability was not caused or aggravated by a service-connected low back disability. The examiner concluded that any degenerative changes were most likely the result of a motor vehicle accident that occurred following service. No rationale was provided. In a September 2017 VA examination, the Veteran reported experiencing neck problems for the past twenty years. The Veteran stated that he did not recall a particular incident or event that caused the neck disability. The Veteran reported being in a motor vehicle accident in 1995 and again in 2012. The examiner opined that the neck disability was less likely than not caused by service, or caused or aggravated by the service-connected low back disability. The examiner reasoned that the neck condition is a condition that is totally separate from the back. Furthermore, the Veteran did not recall a neck injury occurring in surgery and there was no documented record of injury or degenerative joint disease. The examiner opined that the neck injury was more likely the result of the motor vehicle accident because it was around the time of the reported onset of neck pain. The Board acknowledges the Veteran’s assertions that he believes his neck disability is the result of active service or was caused or aggravated by a service-connected low back disability. As a lay person, he is not competent to offer an opinion as to the etiology of a neck disability as that requires specialized knowledge and training. Specifically, the diagnosis and etiology of a neck disability extends beyond an immediately observable cause-and-effect relationship. Rather, that requires knowledge of the lumbar and cervical spine, and the impact of motor vehicle accidents in the development of degenerative joint disease. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Therefore, the Veteran is not competent to provide an opinion on the etiology of a neck disability and his opinion that his neck disability is related to service or a service-connected disability is assigned no probative weight. The September 2017 VA examiner opined that a back disability is separate from a neck disability. Medical reports indicated that the Veteran’s onset of neck pain likely occurred around 1997. Based on the Veteran’s statements, the reported neck pain followed a motor vehicle accident, as noted by the VA examiner. Therefore, the Board finds that a neck disability, to include as secondary to a service-connected low back disability, is not shown to be causally or etiologically related to any disease, injury, or incident during service. Consequently, service connection for a neck disability is not warranted. The Board finds that the preponderance of the evidence is against the claim of entitlement to service connection for a neck disability. Therefore, the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to a rating in excess of 0 percent for hemorrhoids is remanded. The Veteran contends that his hemorrhoids are worse than compensated by the current rating. In addition, the Veteran asserts that he has thrombosed external hemorrhoids. The Veteran has not had a VA examination since June 2016 and has alleged that the disability is worse. As a result, a new examination is needed to ascertain the current severity of hemorrhoids. 2. Entitlement to a rating in excess of 10 percent for a left foot painful surgical scar is remanded. 3. Entitlement to a rating in excess of 0 percent for a left foot residual scar is remanded. The Veteran contends that he is entitled to an increased rating for a residual scar and a painful scar based on current symptoms including pain and bleeding several times a month. The Veteran has not had a VA examination since June 2016 and has alleged that the disabilities are worse. As a result, a new examination is needed to ascertain the current severity of the Veteran’s left foot scar. The matters are REMANDED for the following action: 1. Obtain all outstanding VA medical records and associate them with the claims file. If any records cannot be located, specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. If records are not obtained (a) notify the claimant of the specific records that VA is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claim. The claimant must then be given an opportunity to respond. 2. Then, schedule the Veteran with a VA examination to determine the current severity of hemorrhoids. The examiner must review the claims file and should note that review in the report. All indicated studies should be performed, and all findings set forth in detail. The examiner should provide the following information: (a.) Identify all symptoms associated with hemorrhoids. (b.) Indicate whether the Veteran’s hemorrhoids are manifested by large or thrombotic hemorrhoids; whether the hemorrhoids are irreducible; whether there is excessive or redundant tissue; whether there is any indication that the disability is productive of frequent recurrences; and whether there is evidence of persistent bleeding, anemia, or fissures. 3. Then, schedule the Veteran for a VA scars examination, to be performed by a medical doctor, to determine the nature and severity of any left foot scars. The examiner must review the claims file and should note that review in the report. All indicated studies should be performed, and all findings set forth in detail. The examiner should provide the following information: (a.) Describe all scars present on the left foot, and include measurements of the scars. Note whether there are any additional scars than the ones noted to be related to service in the June 2016 VA examination report. (b.) Report whether any scar is superficial and unstable. (c.) Report whether any scar is superficial and painful. (d.) Report whether any scar or the combined scarring causes additional loss of motion or function. (e.) Report any additional pertinent findings, such as evidence of swelling, redness, tenderness, or discoloration. If possible, provide photographs of the scars. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. D. Cross, Associate Counsel