Citation Nr: 18156044 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 11-22 383 DATE: December 6, 2018 ORDER Service connection for anal/rectal abscesses, to include as secondary to diabetes mellitus is denied. Service connection for a skin disorder, to include as secondary to diabetes mellitus is denied. FINDINGS OF FACT 1. The Veteran’s diagnosed anal/rectal abscesses, were not caused by the Veteran’s service and were not caused or aggravated by his service-connected diabetes. 2. The Veteran’s diagnosed skin disorder, was not caused by the Veteran’s service and was not caused or aggravated by his service-connected diabetes. CONCLUSIONS OF LAW 1. The criteria for service connection for anal/rectal abscesses, to include as secondary to diabetes have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2017). 2. The criteria for service connection for skin disorder, to include as secondary to diabetes have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1961 until September 1964. The Veteran died in mid- 2014, with his perfected claim pending on appeal. The appellant is the properly substituted party. See 38 U.S.C. § 5121A. The Board remanded these claims previously in May 2018 for additional development. Service Connection Service connection may be granted for current disability arising from disease or injury incurred or aggravated by active service. 38 U.S.C. § 1110. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310 (a) where it is demonstrated that a service-connected disorder has caused a nonservice-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection is currently in effect for diabetes. Entitlement to service connection for anal/rectal abscesses, to include as secondary to diabetes mellitus In the Veteran’s July 1964 examination for service separation, the Veteran noted no complaints relevant to an anal/rectal abscess. In an April 1983 private treatment note, the Veteran was reported to have a diagnosis of an anal-rectal abscess. The clinician also noted that the Veteran had “never had trouble before.” In a June 2007 treatment note, the clinician noted that the Veteran’s rectal dysfunction was presumed to be a diabetic complication. However, the physician did not provide additional detail or reasoning for this conclusion. A January 2010 statement from the Veteran’s treating physician reflects that the Veteran had diabetes mellitus, hypertension, and several other medical conditions. The physician opined that the Veteran’s longstanding diabetes mellitus was a major factor in his subsequent medical symptoms and complications. In August 2018, the Veteran’s file was reviewed by a VA examiner. The examiner noted that the Veteran was treated for an anal-rectal abscess for the first time in April 1983. The examiner also noted that the main etiology of these abscesses is acute infection of the internal glands of the anus. The examiner explained that a fistula is a tunnel that forms under the skin and connects the clogged, infected glands to the abscess. The examiner concluded that a fistula developed in the Veteran’s case. The examiner reported that in some circumstances, diabetes can aggravate this condition but opined that there was no aggravation in the Veteran’s case. The examiner also noted that Agent Orange has not been causally related to this acute symptom. Medical documentation submitted by the appellant in October 2018 indicates that diabetes can be a risk factor for developing rectal abscesses. In an October 2018 lay statement, the appellant posited that some evidence suggests that anal rectal abscesses can be a first sign of diabetes and reported that the Veteran first experienced abscesses in 1983 and was not diagnosed with diabetes until 1987. The Board has considered the appellant’s assertions that the Veteran’s anal/rectal abscesses were caused by his service-connected diabetes. The appellant is not competent, however, to offer an opinion as to the etiology of this type of medical condition due to the medical complexity of the matter involved. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994). A preponderance of the evidence is against a finding that the Veteran’s anal/rectal abscesses originated during service or as a result of the Veteran’s service-connected diabetes. The Board notes that the Veteran was first seen for his anal/rectal abscesses in April 1983, many years after service separation. Generally, the law recognizes that the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider is weighed by such factors as its thoroughness and degree of detail, and whether there was review of the veteran’s claims file. Prejean v. West, 13 Vet. App. 444 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. Bloom v. West, 12 Vet. App. 185 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data); Miller v. West, 11 Vet. App. 345 (1998) (observing that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record). The Board has considered the June 2007 treatment note comment stating that the Veteran’s “rectal dysfunction” was presumed to be related to the Veteran’s diabetes. However, it is unclear whether this physician was referring to the Veteran’s anal/rectal abscesses. Assuming that the clinician was referring to the Veteran’s anal/rectal abscesses, the clinician did not provide an explanation as to how the Veteran’s condition could be related to diabetes when it actually predated his diagnosis. According to the appellant, the Veteran’s anal/rectal abscesses began in 1983 and the Veteran was not diagnosed with diabetes until 1987. The August 2018 VA examiner noted the that the Veteran’s electronic medical records, prior opinions, letters, and statements were all reviewed. The VA examiner also thoroughly explained the Veteran’s condition and provided a reasoned explanation that the Veteran’s anal/rectal abscesses were due to infection and not the Veteran’s diabetes. A preponderance of the evidence is against a finding that the Veteran’s anal/rectal abscesses was substantially caused by his service-connected diabetes, or his service generally. Therefore, service connection for anal/rectal abscesses is not warranted and the claim is denied. Entitlement to service connection for a skin disorder, to include as secondary to diabetes mellitus In the Veteran’s July 1964 examination for service separation, the Veteran noted no complaints relevant to a skin disorder. In an October 2001 treatment note the Veteran was seen for a follow up appointment regarding an intradermal cyst. An October 2002 treatment note indicates a history of intradermal cysts with past cysts becoming infected and being removed. In a December 2003 treatment note, the Veteran was noted to have a lipoma on the back of his neck. The clinician referred the Veteran to another physician to have it surgically removed. In a March 2007 treatment note, the Veteran was reported to have surgery to remove two cysts on his back. In a June 2009 lay statement, the Veteran noted that he has had blackheads and cyst-type lumps over his entire body since shortly after service separation. The Veteran reported that this condition had worsened over time. A January 2010 statement from the Veteran’s treating physician reflects that the Veteran had diabetes mellitus, hypertension, and several other medical conditions. The physician opined that the Veteran’s longstanding diabetes mellitus was a major factor in his subsequent medical symptoms and complications. In August 2018, the Veteran’s file was reviewed by a VA examiner. The examiner noted that the Veteran began treatment for skin lesions in the early 2000’s, decades after service separation. The examiner reported no evidence of lesions in service and reported that this condition is not related to Agent Orange exposure or diabetes mellitus and often has an etiology related to genetics. In an October 2018 lay statement, the appellant reiterated the presence of lipomas on the Veteran at various times after service separation. The Board notes that no submitted evidence shows the existence of cysts or lipomas while the Veteran was in service. The Board has considered the appellant’s assertions that the Veteran’s skin disorder was caused by his service-connected diabetes. The appellant is not competent, however, to offer an opinion as to the etiology of this type of medical condition due to the medical complexity of the matter involved. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994). The preponderance of the evidence is against the claim and the appeal is denied. . Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Wozniak, Joshua