Citation Nr: 20004071 Decision Date: 01/16/20 Archive Date: 01/16/20 DOCKET NO. 14-38 760A DATE: January 16, 2020 ORDER Entitlement to service connection for rectal colon polyps, post-operative, is DENIED. FINDING OF FACT The weight of the evidence is against a finding that the Veteran’s currently diagnosed rectal colon polyps were caused by active duty service in the Air Force. CONCLUSION OF LAW The criteria for entitlement to service connection for colon polyps have not been satisfied. 38 U.S.C. §§ 1101, 1131, 1133, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the United States Air Force from January 1974 to September 1978. The Veteran also served as an active guard reserve (AGR) member of the Air Force National Guard from August 1979 to January 2003. 1. Entitlement to service connection for rectal colon polyps, post-operative, is denied. In August 2012, the Veteran submitted a VA Form 21-526b. Therein, the Veteran initiated a claim entitlement to service connection for recurring colonic polyps. In general, a service connection claim may be granted for a disability resulting from a disease or injury incurred in, or aggravated by, active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). “To establish a right to compensation for a present disability, a Veteran must show: ‘(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called ‘nexus’ requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). In each case where service connection for any disability is sought, due consideration shall be given to the places, types, and circumstances of such Veteran’s service as shown by such Veteran’s service record, the official history of each organization in which such Veteran served, such Veteran’s medical records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154 (a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). In March 2003, the Veteran’s service treatment records (STRs) were associated with the claims file. In June 1993, the Veteran was admitted to the hospital with a history of chronic polyps, status post polypectomy. In September 1997, a history of polyps was identified; however, the military provider noted no current problems. In March 2013, the Veteran underwent a VA examination that considered the nature and etiology of rectum and anus conditions. The VA provider noted a diagnosis for external or internal hemorrhoids. The Veteran declined a rectal/anal examination. The VA provider reported that, “CBC: mild lymphocytosis of unknown etiology.” In June 2013, the Veteran underwent a VA examination that considered the nature and etiology of intestinal conditions. The VA provider noted a diagnosis for diverticulitis. The VA provider noted a history of colon polyps, which was diagnosed in 1991. The VA provider noted that a polypectomy was conducted in 1991 and 1994. The VA provider noted that there was no current diagnosis for colon polyps, because the condition had resolved. The VA provider noted that there were no colon polyps identified after a colonoscopy at the St. Joseph Medical Center in June 1994. The VA provider also noted that the Veteran’s last two colonoscopies were negative for polyps. In December 2017, the Veteran supplied sworn testimony to the undersigned Veterans Law Judge (VLJ). At that time, the Veteran revealed that he began receiving colonoscopies during his mid-30s. The rectal and colon examinations followed the Veteran’s identification of blood in his stool. The Veteran testified that, “I'm at the five-year mark. And I just had a colonoscopy within the last month. And they had polyps again. I've had lots of colonoscopies it seems like.” The Veteran relayed that the last time he endured rectal bleeding occurred approximately 10 years ago. During the hearing, the Veteran’s attorney noted that the VA had not conducted a colonoscopy. The Veteran confirmed that his treatment for colon polyps has been done only by the miliary or private providers. The Board notes that while the Veteran is competent and credible to testify about the symptoms he has observed during the course of his claimed disability, he is not competent to identify the etiology for his colon polyps. See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (citing Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992)). In July 2018, the Board considered the Veteran’s entitlement claim for service connection for rectal colon polyps, post-operative. At that time, the Board acknowledged an in-service incurrence of colon polyps. However, the Board concluded that, “(the) March 2013 report of ‘mild lymphocytosis of unknown etiology’ is insufficient for a current disability in this Board analysis.” The Board remanded the Veteran’s entitlement claim to the agency of original jurisdiction (AOJ) for additional development. Specifically, the Board directed the AOJ to schedule a VA examination to determine if the Veteran maintained a current diagnosis for colon polyps. If so, the VA provider was directed to opine whether it was at least as likely as not (a 50 percent probability or greater) that any current colon polyp disability began in service or is related to an incident in service. In January 2019, the Veteran’s treatment records from the Wichita VA Medical Clinic were associated with the claims file. Therein, in May 2009, the Veteran reported that, “he does have history of polyps so he gets his colonoscopies every three years. His last one was in July 2008.” In the May 2009 colorectal screening, no polyps were reported after the July 2008 colonoscopy. In February 2019, the Veteran’s treatment records from the St. Anthony Hospital were associated with the claims file. Therein, it was noted that a colonoscopy in April 2017 revealed a 5 mm polyp in the sigmoid colon and 7 mm polyp in the rectum. After deliberate review, the Board notes that the treatment records do not opine regarding the etiology of the Veteran’s colon polyps. In September 2019, the Veteran underwent a VA examination that considered the nature and etiology of rectum and anus conditions. The VA provider noted that a 5mm polyp was removed from the Veteran’s sigmoid colon in April 2007. The VA provider noted that the Veteran initially had a colon polyp excised in 1991. The Veteran reported that, “history of blood in stool. He had a colonoscopy while active duty and polyp was removed. He recall having a colonoscopy almost annually while active duty. Now, he has colonoscopy every 5 years. He had blood in the stool about 18 months ago that prompt his most recent colonoscopy.” The VA provider noted that a physical examination was not conducted at that time because, “evaluation of polyp can be only done with scope.” The VA provider opined that, “Veteran does not have a current diagnosis of colon polyp disability. Polyps within the colon are identify at colonoscopy procedure and are removed by polypectomy. Therefore, condition would be consider resolved.” The VA provider also opined that, “Veterans post military polypectomy are less likely than not incurred in or caused by the claimed in-service injury, event, or illness. Once polyps are noted on colonoscopy procedure, polyp(s) are then removed. Therefore, consider resolved. His development of additional colon polyps post military are independent of the previous excised polyps. Adenomatous polyps epidemiology and risk factors includes increased in age, increased in BMI and male gender. Veteran has all of these risk factors.” Along with the negative etiology opinion, the VA provider supplied the following medical literature: “Overview of Colon Polyps,” By Finlay A. Macrae, MD. Therein, Dr. Macrae specifically addresses the positive correlation between gender, age, and body mass index (BMI) with the development of colon polyps. The Board finds that the records from St. Anthony Hospital identify a current diagnosis for rectal colon polyps. Consequently, the first requisite of a direct service-connection entitlement claim has been substantiated. See Holton, 557 F.3d at 1366. As observed in the July 2018 Board remand, the evidence supports a finding that the Veteran incurred colon polyps while on active duty in the Air Force. Therefore, the second requisite element has also been substantiated. See id. However, the Board concludes that the preponderance of the evidence does not support a nexus between the first and second requisite elements for entitlement to service connection for rectal colon polyps. Ultimately, the Board finds that the preponderance of the evidence stands counter to the Veteran’s colon polyp entitlement claim. Since the preponderance of the evidence is against this claim, the provisions of 38 U.S.C. § 5107(b), regarding reasonable doubt, are not applicable. The Veteran’s claim of entitlement to service connection for colon polyps must be denied, because the preponderance of the evidence weighs against his claim. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board RLBJ, 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.