Citation Nr: 19141017 Decision Date: 05/28/19 Archive Date: 05/28/19 DOCKET NO. 07-33 789 DATE: May 28, 2019 ORDER Entitlement to service connection for blood clot, also claimed as deep vein thrombosis (DVT), to include as secondary to hemorrhoids is denied. Entitlement to service connection for cellulitis, to include as secondary to Zenker’s diverticulum and blood clot is denied. Entitlement to service connection for Zenker’s diverticulum, to include as secondary to hemorrhoids is denied. Entitlement to service connection for hemorrhoids, claimed as gangrene is denied. REFERRED As noted in the January 2012 Board order and in the December 2013 Board order, the issues of compensation under 38 U.S.C. § 1151 for blood clot and cellulitis as a result of VA medical treatment were raised below and were referred to the Agency of Original Jurisdiction (AOJ) for adjudication. These claims still have not yet been addressed by the AOJ. Again, as of now, these matters are not before the Board and are again referred to the AOJ for adjudication. FINDINGS OF FACT 1. The Veteran’s blood clot, also claimed as deep vein thrombosis (DVT) did not manifest until after 1996, and did not begin during active service, and is not related to an in-service injury or disease; the claimed condition is also not related to any service-connected disability. 2. The Veteran’s cellulitis did not begin during active service, and is not otherwise related to an in-service injury or disease; the condition is also not related to any service-connected disability. 3. The Veteran’s Zenker’s diverticulum did not begin during active service, and is not otherwise related to an in-service injury or disease; the condition is also not related to any service-connected disability. 4. The Veteran’s hemorrhoids did not begin during active service, did not worsen during active-service, and is current disability is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for blood clot, also claimed as deep vein thrombosis (DVT), to include as secondary to hemorrhoids have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309 3.310. 2. The criteria for entitlement to service connection for cellulitis, to include as secondary to Zenker’s diverticulum and blood clot have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for entitlement to service connection for Zenker’s diverticulum, to include as secondary to hemorrhoids have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for entitlement to service connection for hemorrhoids, claimed as gangrene have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from October 1989 to October 1991, including service in Southwest Asia. The matters at hand came to the Board of Veterans’ Appeals (Board) on appeal from a March 2007 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. In a December 2013 Board decision, the matters were remanded again for further development. In a July 2015 Board decision, entitlement to service connection for heel spurs was denied, and the remaining claims (currently on appeal) were remanded for further development. It does not appear that there are any outstanding that would prevent adjudication of the claims on appeal. The prior Board decisions identified and ordered cured the development deficiencies, and review shows these remand directives from the prior Board decisions have been substantially complied with. Stegall v. West, 11 Vet. App. 268 (1998). While the various duties of the VA, including the duty to assist and examine as noted in the April 2019 Appellant’s Post-Remand Brief are acknowledged, there is not any specific outstanding error alleged in this regard, and no further discussion of these factors is warranted. 38 U.S.C. § 7105(d). The claims on appeal may be adjudicated. Service Connection To establish direct service connection, there must be competent evidence showing: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the in-service injury incurred or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disability that is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. Certain chronic diseases may be presumed to have been incurred in or aggravated by service if manifested to a compensable degree within one year of discharge from service. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307(a). This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307(d), 3.309(a). A showing of chronicity requires a combination of manifestations sufficient to identify a disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” 38 C.F.R. § 3.303(b). When a disease listed at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was shown in service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Id.; Savage v. Gober, 10 Vet. App. 488, 495-96 (1997); Walker v. Shinseki, 708 F.3d 1331, 1336, 1339 (Fed. Cir. 2013) (explaining that “shown as such in service” means “clearly diagnosed beyond legitimate question”). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker, 708 F.3d at 1338-39. Generally, a claimant has the responsibility to present and support a claim for benefits. All information, lay evidence and medical evidence in a case is to be considered by the Board in deciding the claim. When there is an approximate balance of positive and negative evidence regarding any material issue, the claimant is to be given the benefit of the doubt. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue.”). The Board has an obligation to provide reasons and bases supporting its decision, but there is no need to discuss, in detail, every piece of evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Board’s analysis is to focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant). 1. Entitlement to service connection for blood clot, also claimed as deep vein thrombosis (DVT), to include as secondary to hemorrhoids is denied. The Veteran seeks service connection for a blood clot or deep vein thrombosis, and contends such is secondary to hemorrhoids. The service treatment records are silent for complaints of, treatment for, or a diagnosis of a blood clot or any venous condition. However, in conjunction with a September 1991 separation examination, the Veteran reported swollen or painful joints, and specifically identified that his ankles, knees and calf muscles hurt when he was running, with cramps in his calf muscles. The Veteran’s blood clot condition (recurrent deep venous thrombosis or DVT) appears to have been first diagnosed following a March 1996 surgery for the excision of Zenker’s diverticula. See March 1996 Hospital Admission (“[P]atient is status post repair of his Zenker’s diverticulum at the beginning of March and apparently developed a deep venous thrombosis ten days postop.”). In September 1996, a duplex doppler examination of the venous system of the right lower extremity confirmed a nonocclusive deep venous thrombosis extending from the mid superficial femoral vein to the popliteal vein. See July 2010 VA ambulatory care note (summarizing medical history); September 1996 Private Treatment Record; September 1996 Private Treatment Record. The Veteran’s blood clot condition was subsequently treated with warfarin, a blood thinner, but the clotting condition continued to occur, and the Veteran developed a venous insufficiency. A vena caval filter was used and continued warfarin use prescribed. Clots continued to occur in the right lower extremity, and the Veteran was subsequently under the regular care of a hematologist. See July 2010 VA ambulatory care note; June 2007 VA examination. In a February 2014 VA examination, the VA examiner noted review of the records, and noted that the Veteran’s DVT resulted in recurrent episodes of cellulitis. The examiner noted that he could not find evidence of blood clots, a clotting disorder, or DVT while the Veteran was in active service or in the year afterwards. The examiner noted the leg cramps on the separation examination, but noted that these were reported as related to exercise, which was not consistent with DVTs. The examiner noted that he did not find symptoms of leg swelling, tachycardia, or inus bradycardia. The examiner noted that the Veteran’s DVT was not diagnosed until after a surgery, which would suggest the surgery as a possible cause. The examiner noted that the Veteran’s DVT was due to his blood clotting in the lower leg and was not caused by or aggravated by hemorrhoids. Although there is evidence establishing a current disability, the preponderance of the evidence is against entitlement to service connection under any theory. There is no evidence that the condition existed during active service. The contentions raised on appeal regarding the leg cramps documented in service being related to the claimed condition are noted, but such is a question for a medical professional. The VA examiner is the sole competent opinion of record on this point. In sum, after review of the pertinent evidence, the examiner opined that the leg cramps noted in service were not consistent with DVT. This opinion was from a qualified clinician, is considered competent, and is afforded probative weight. The opinions of the Veteran and the Veteran’s representative to the contrary are acknowledged, but are afforded no weight because their opinions are mere lay opinions, not shown in the record to be competent. Also, although the Veteran contends in various pleadings that all conditions are related to the Gulf War or various unknown injections he was given during active service, there is no competent support for this assertion; the Veteran, as a layperson, is not competent to diagnose the condition at hand or provide an opinion on the etiology thereof. See Jandreau v. Nicholson, 492 F.3d at 1374. The Veteran’s claim of secondary service connection was considered, but as the Veteran is not entitled to service connection for hemorrhoids (or Zenker’s diverticulum), service connection on a secondary basis under 38 C.F.R. § 3.310 is not possible. The Veteran’s claim for service connection for blood clot, also claimed as deep vein thrombosis (DVT), to include as secondary to hemorrhoids is denied. 38 C.F.R. §§ 3.303, 3.309. There is no doubt to resolve. 38 C.F.R. § 3.102. 2. Entitlement to service connection for cellulitis, to include as secondary to Zenker’s diverticulum and blood clot is denied. The Veteran seeks service connection for cellulitis as secondary to the Zenker’s diverticulum or the blood clot. The Veteran does not contend, and the evidence does not establish any existence of pre-1996 cellulitis (the year of the initial surgery for Zenker’s diverticulum). There is no indication in the service treatment records that the Veteran had symptoms, complaints of, or treatment related to such prior to 1996. As noted in the February 2014 VA examination, the examiner noted review of the records and noted that the Veteran’s DVT resulted in recurrent episodes of cellulitis. There does not appear to be a serious dispute with this conclusion on appeal. Although the Veteran contends in various pleadings that all conditions are related to the Gulf War or various unknown injections he was given during active service, there is no competent support for this assertion, and the Veteran, as a layperson, is not competent to diagnose the condition at hand or provide an opinion on the etiology thereof. See Jandreau v. Nicholson, 492 F.3d at 1374. As the Veteran is not entitled to service connection for Zenker’s diverticulum or the blood clotting disorder (DVT), service connection on a secondary basis to either of these conditions under 38 C.F.R. § 3.310 is not possible. Service connection on a direct basis is not warranted as the evidence does not show any in-service incurrence or nexus between the condition and the Veteran’s active service. 38 C.F.R. § 3.303. There is no doubt to resolve in this claim. 38 C.F.R. § 3.102. 3. Entitlement to service connection for Zenker’s diverticulum, to include as secondary to hemorrhoids is denied. The Veteran seeks service connection for Zenker’s diverticulum. His initial claim contended this condition was related to his hemorrhoid condition, but the pleadings also suggest that the condition was caused or aggravated by active service. The evidence of record does not support entitlement to service connection under any theory. The Veteran’s pre-service treatment records noted a peptic ulcer condition in March 1982, for which he was placed on Tagamet. A February 1982 GI examination showed “suggestion of irritability.” In November 1984, he was noted to have a sore throat and tonsillitis. On entrance examination in March 1989, the Veteran’s mouth and throat were noted to be normal, and the Veteran was noted not have a peptic ulcer condition at the present. He reported a prior history of tonsillitis, and a history of gastroenteritis, both of which were noted to be asymptomatic. A letter from Dr. S. J. indicated that the Veteran is not plagued with peptic ulcer disease, and another letter indicated his upper GI was normal with no ulcers. There are no complaints of, treatments for, or diagnoses of any GERD, Zenker’s diverticulum, throat, esophageal, or stomach problem during active service. He denied stomach or belly pain in a June 1991 medical evaluation, and indicated he was not aware of any medical problems at the present time. On separation examination in September 1991, the Veteran denied ear, nose or throat trouble, and denied stomach, liver, or intestinal trouble, and denied frequent indigestion. The Veteran also had a diagnosis of GERD. An April 2001 VA gastroenterology note indicating Dr. B. explained that reflux can affect the cricopharyngeal sphincter that can cause a Zenker’s diverticulum. On VA examination in June 2007, the Veteran reported that his gastroesophageal reflux disease was diagnosed after a scope in 1996. He reported taking Omeprazole medication. He reported having surgery on his throat in the past, he reported pocketing, and reported resections. He reported that diverticulitis started in 1996. The examiner confirmed the diagnoses of GERD and diverticulitis, and opined that the conditions were less likely than not related to service. A February 2014 VA examination noted that after review of the records, the examiner could not find evidence of a Zenker’s diverticulum while in the service. The examiner did not find complaints of dysphasia or regurgitation and his separation examination was normal and without complaints of stomach problems or frequent indigestion. The examiner noted that the diverticula were thought to be caused by motor abnormalities of the esophagus and are not likely to be caused or aggravated by hemorrhoids. The November 2016 VA examination addendum opinion noted that the condition that existed prior to service was not aggravated beyond its natural progression by an in-service event, injury, or illness. The examiner noted the pre-service March 1, 1982 treatment note where the complaint was of burning in the epigastrium and belching which waked the Veteran at night. The enlistment examination was noted to have had a history of gastroenteritis, asymptomatic, and February 1989 letter from the Veteran’s physician noted the Veteran did not have peptic ulcer disease at the present a, which indicated a preexisting condition of peptic ulcer disease. The examiner explained these conditions were not the same as GERD or Zenker’s diverticulum, the latter of which is a sac-like outpouching of the esophagus mucosa. The examiner explained that although the symptoms may have been previously misdiagnosed and could have been GERD rather than peptic ulcer disease, there was no evidence of either GERD or Zenker’s diverticulum as a preexisting condition. The examiner also noted that there was no evidence of aggravation of the preexisting condition during active service. The examiner also noted that the Veteran reported that he did not have frequent indigestion, stomach liver or intestinal trouble, or a chronic cough at separation. The examiner noted that in 1995, the Veteran had clear signs and symptoms of GERD and Zenker’s diverticulum, including a barium swallow. The Veteran could have had similar symptoms over the years as there are multiple causes of epigastric pain and indigestion, both acute and chronic: mechanical, infectious, physiological. However, the examiner noted that review of the service treatment records and the separation examination did not reveal objective evidence of signs or symptoms pathognomonic for either condition, and as such, it was less likely than not that the Veteran’s GERD or Zenker’s diverticulum were caused or incurred by active duty service. In the analysis of this issue, a brief discussion of the presumption of soundness and the presumption of aggravation is warranted. The law provides that every Veteran is considered to have been taken in sound condition when examined, accepted and enrolled for service, except as to (1) defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or (2) where clear and unmistakable evidence demonstrates that (a) the injury or disease existed before acceptance and enrollment, and (b) was not aggravated by such service. 38 U.S.C. § 1111; See Cotant v. Principi, 17 Vet. App. 116 (2003); Jordan v. Principi, 17 Vet. App. 261 (2003); and VAOPGCPREC 3-2003. With regards to the issue at hand, the presumption of soundness applies to the Veteran. The evidence is not clear and unmistakable that the Veteran had Zenker’s diverticulum or GERD prior to service. Although the Veteran was treated for a stomach condition in March 1982, the Veteran’s private clinician indicated the Veteran did not have peptic ulcer disease prior to enlistment, and the Veteran’s prior diagnosed gastroenteritis and tonsillitis conditions were noted as being asymptomatic on enlistment examination. The Board considered the possibility of a pre-service misdiagnosis of GERD as peptic ulcer disease. However, even if such misdiagnosis had occurred, and the Veteran experienced GERD prior to enlistment, there is no evidence that the condition persisted after 1982, much less through enlistment in 1989. Absent competent evidence to the contrary, GERD is generally not considered a chronic disease. See 38 C.F.R. § 3.309. As also noted by the VA examiner, there is no evidence to support a finding that GERD existed or manifested at any time during service, review of the service treatment records and the separation examination did not reveal objective evidence of signs or symptoms pathognomonic for either GERD or Zenker’s diverticulum. It is acknowledged that a doctor’s opinion alone is not the type of unconditional evidence necessary to meet the clear and unmistakable standard of non-aggravation. See Cotent v. Principi, 17 Vet. App. 116, 131 (2003). However, the disability must be shown to have existed or to have increased during service. See 38 C.F.R. § 3.306. Browder v. Brown, 5 Vet. App. 268 (1993). In this case, even had the evidence been sufficient to find the claimed pre-service disability existed, it would be clear and unmistakable that there had been no aggravation of the condition from active service, as there was no manifestation whatsoever during active service. The lay statements from the Veteran were considered, but these lack sufficient competence or credibility to be useful in the adjudication of this claim. First, the Veteran is not competent to diagnose the conditions at hand or provide an opinion on etiology, and his contentions that the condition is related to injections or Gulf War service is given less weight than the examiner’s competent opinion. See Jandreau v. Nicholson, 492 F.3d at 1374. Although the Veteran is competent to report the onset of symptoms, his lay statements in this regard are vague and moreover do not describe an in-service onset of symptoms. In the January 2007 Statement in Support of Claim he contended his stomach problems began between the years of 1992 and 1995, which is after his active service (and rather vague). In his initial claim, he contended that his Zenker’s diverticulum began in 1991, but there is no evidence of any diagnosis of such until several years later. He apparently chose 1991 as the date of onset based on the date he claims to have had a hemorrhoidectomy, but (a) he is not competent to make the connection between the two conditions, and (b) his claim of having had a hemorrhoidectomy during active service lacks credibility for reasons discussed below. In sum, the lay statements are not considered credible or competent, and weight cannot be assigned to these statements. In sum, the weight of the competent and credible evidence shows the claimed conditions did not have an in-service manifestation, and did not clearly and unmistakably preexist active service. The sole competent medical opinion of record from the VA examiner, who, after complete review of the evidence of record, opined that the condition is otherwise unrelated to service. As such, service connection is not warranted for Zenker’s diverticulum. 38 C.F.R. § 3.303. Notwithstanding the lack of competent evidence linking the claimed Zenker’s diverticulum condition to hemorrhoids, service connection for Zenker’s diverticulum as secondary to hemorrhoids is not possible as the Veteran’s hemorrhoid disability is not entitled to service connection. 38 C.F.R. § 3.310. The benefit-of-doubt provisions were carefully considered, but the weight of the evidence is against the claim under any theory of entitlement. 38 C.F.R. § 3.102. 4. Entitlement to service connection for hemorrhoids, claimed as gangrene is denied. The Veteran seeks service connection for hemorrhoids. He contends that his condition had an in-service onset, and that he had surgery for his hemorrhoids at a hospital in Fort Hood during service. The Veteran’s private treatment records establish that he had recurrent problems with hemorrhoids. In December 1982, he reported a sore spot on his bottom, and was noted to have an external hemorrhoid. It was lanced, and jelly clots were expressed. In March 1986, the Veteran’s hemorrhoid was noted to have popped out, for which he was given cream, Tucks medicated cooling pads, and a sitz bath. On the entrance examination in March 1989, no hemorrhoids were reported or noted. The service treatment records are silent for complaints of, treatment for, or diagnosis of any hemorrhoid condition. The Veteran denied any medical problems or bloody bowel movements in a June 1991 medical evaluation. The Veteran denied having been a patient in any type of hospital on his October 1991 separation questionnaire. He did, however, answer “yes” to “rectal disease or piles,” and below, the examiner clarified that the response was referring to a not recent history of hemorrhoids. An October 1995 private treatment note indicated the Veteran reported bright red blood on tissue paper during bowels, which has been a finding for years. The Veteran reported a hemorrhoidectomy in the past. Examination confirmed external hemorrhoids. The March 2014 VA examination noted an in-person examination was performed, and the Veteran’s file was reviewed. The Veteran described a bump which was painful in 1991, with a surgery for “gangrenous hemorrhoid.” He reported an occasional small hemorrhoid since then, which was reported to be itchy and respond to preparation H. He was noted not to have current problems, and his condition was noted to be mild. The examiner noted that the Veteran’s condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the c-file showed the Veteran having been treated prior to service. The examiner noted that the condition clearly existed prior to service, and given the mild disease he currently had, it was unlikely that his disability was aggravated during service. In analyzing this claim, although a hemorrhoid condition is not noted on entry, the medical evidence is clear and unmistakable that the Veteran had a pre-service manifestation of a hemorrhoid condition. The condition at entry was apparently asymptomatic; any manifestation of a hemorrhoid condition to the point of requiring surgery would represent a worsening of the condition, and would potentially qualify the condition for service connection due to having been aggravated by service, in accordance with 38 U.S.C. § 1117 and 38 C.F.R. § 3.306. However, on careful review by the VA examiner and by the Board, there appears no competent or credible evidence that the condition manifested, was problematic, or required surgery during active service. The sole in-service reference to hemorrhoids is on the separation examination, which was apparently the Veteran’s report of a non-recent history of hemorrhoids. This report does not show any clinical evidence that the condition manifested or worsened during service, and the examination did not note any hemorrhoid condition. There were no records of a hemorrhoidectomy or hospital stay at Fort Hood returned after request, and an October 2016 memorandum noted that such records were not available. The Veteran’s lay statements of having this hemorrhoidectomy performed during active service were carefully considered to determine if such was sufficient proof of an in-service manifestation and treatment. This was carefully considered because his post-service statements were relatively consistent, insofar as he reported having had the procedure in 1991 throughout many years of post-service medical records beginning in 1995. However, these subsequent statements are inconsistent with and given less probative weight than the Veteran’s contemporaneous response in the October 1991 separation examination, where he denied having been a patient in a hospital. Moreover, the Veteran’s claim does not hang together with other details in the record. The Veteran served in Southwest Asia until April 14, 1991, which would have given him roughly a six-month window to have the operation at Fort Hood prior to his separation. He denied bloody bowel movements and reported no current medical problems in June 1991, and reported a history of hemorrhoids, none recent in October 1991 (an unlikely description if he underwent recent surgery). Moreover, the separation examination did not note any scars related to a hemorrhoidectomy. For these reasons, the Veteran’s statement of record as to having been a patient in a hospital for a hemorrhoidectomy in 1991 during active service lack credibility. Aside from the claimed hemorrhoidectomy, there is no competent or credible link to service. The VA examiner’s opinion that the hemorrhoid condition was not aggravated by service was proffered after a full review of the file, and is due significant weight. The Veteran’s contentions that the condition is related to injections received during service or otherwise related to his service in the Gulf War are not supported by any competent medical evidence, and the Veteran is not considered competent to provide an opinion on the etiology of the condition. See Jandreau v. Nicholson, 492 F.3d at 1374. The competent and credible evidence indicates that the hemorrhoid disability is unrelated to service, and did not increase during active service. For the above reasons, service connection for hemorrhoids is not warranted as the condition did not have an in-service onset, was not worsened during active service, and is not otherwise related to service. 38 C.F.R. §§ 3.303, 3.306. (CONTINUED ON NEXT PAGE) The evidence preponderates against the claim, and the benefit-of-doubt rule is inapplicable. 38 C.F.R. § 3.102. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. C. King, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.