Citation Nr: 20021345 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 17-57 300 DATE: March 25, 2020 ORDER Entitlement to service connection for hemorrhoids is granted. REMANDED Entitlement to service connection for a right knee disability, to include as secondary to a right foot disability is remanded. Entitlement to service connection for a right hip disability, to include as secondary to a right foot disability is remanded. FINDING OF FACT The Veteran’s hemorrhoids had their onset in service. CONCLUSION OF LAW The criteria for entitlement to service connection for hemorrhoids are met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from March 1994 to February 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2017 rating decision by an agency of original jurisdiction (AOJ) of the Department of Veterans Affairs (VA). In February 2020, the Veteran testified at a videoconference hearing before the undersigned. The Board acknowledges the Veteran’s report that his disabilities preclude him from following his normal occupation. See, e.g., Hearing Transcript at 9. If the Veteran believes that he is unable to secure or maintain substantially gainful employment due to his service-connected disabilities, he is encouraged to file a claim for entitlement to a total disability rating due to individual unemployability (TDIU) on the appropriate VA-promulgated form. 1. Entitlement to service connection for hemorrhoids is granted. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. The Veteran’s enlistment examination report shows no rectal or anal abnormalities at service entry. See Service Treatment Records (STRs). His STRs show that he was diagnosed with internal hemorrhoids during basic training in 1994. See STRs. He testified that he was diagnosed with hemorrhoids during basic training and was told that they were likely due to his prolonged sitting on pavement. See Hearing Transcript at 3-5. He credibly testified that his hemorrhoids have been present since then and that he self-treated with over-the-counter remedies, and that he did not seek outside treatment as he had found a self-treatment method that worked for him. See id. at 10. His separation examination report shows that he was not examined for abnormalities of the rectum and anus. See STRs. Here, the Veteran is presumed to have been sound at service entry. His hemorrhoids are noted in his service treatment records and his separation examination report does not show that this condition resolved in service. The Veteran is competent to report the presence of hemorrhoids, and his report of persistent hemorrhoids since service that he has self-treated is credible. Indeed, the Veteran’s competent and credible testimony is the most probative evidence of record as to the nature and etiology of current hemorrhoids. Accordingly, as all the evidence of record weighs in favor of the claim, service connection for hemorrhoids is warranted. REASONS FOR REMAND 2. Entitlement to service connection for a right knee disability, to include as secondary to a right foot disability is remanded. 3. Entitlement to service connection for a right hip disability, to include as secondary to a right foot disability is remanded. The Veteran asserts that his right knee and right hip disabilities are proximately due to his service-connected right foot disability. While the December 2016 examination report showed a normal right knee and right hip, that examiner did not have diagnostic tests available, and recent radiology reports show bilateral hip arthritis, right greater than left, as well as right knee pain and patellar crepitation with clicking on flexion and extension. Accordingly, the presence of a right hip disability is conceded, and a new examination is necessary as to the presence of a right knee disability. Moreover, a new medical opinion is necessary, as the December 2016 examiner’s opinion was not based on an accurate history of the Veteran’s disabilities. On remand, the examiner should address whether these disabilities are due to the Veteran’s right foot disability, to include as the result of an intermittent antalgic gait favoring the right side that has been present since at least 2014. See February 2014 VA Examination Report; see also December 30, 2019 VA Treatment Note (reports right foot injury has put strain and stress on his right knee and hip). Updated VA and private treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. With any necessary assistance from the Veteran, secure any relevant outstanding private treatment records. 3. After completing #1 and #2, schedule the Veteran for an examination to determine the nature and etiology of his claimed right hip disability. All necessary testing should be performed. Following a review of the claims file, the examiner should address the following: (a) Diagnose all current right hip disabilities. If no orthopedic disability is identified, the examiner must indicate whether the Veteran’s reported right hip pain causes any functional impairment. (b) For each diagnosed disorder or functional impairment in part (a), please opine whether it is at least as likely as not (50 percent probability or greater) that such disorder: (i) had its onset during or is otherwise etiologically related to the Veteran’s active duty service; (ii) is proximately due to his right foot disability, to include as a result of an antalgic gait and/or a change in weight-bearing; or (iii) has been aggravated (worsened beyond natural progression) by his right foot disability, to include as a result of an antalgic gait and/or a change in weight-bearing. Please address each sub-part separately. In addressing this question, the examiner must discuss (i) the February 2014 VA examination report showing an intermittent antalgic gait favoring the right side, and (ii) the Veteran’s x-rays showing bilateral hip arthritis, right greater than left. See December 30, 2019 VA Radiology Report. The examiner should accept the Veteran’s competent and credible reports of the onset and persistence of his right hip pain. The examiner is advised that a negative opinion premised solely upon the absence of evidence of treatment is legally inadequate. A rationale must be provided for all opinions rendered. If the examiner cannot provide any requested opinion without resorting to speculation, the examiner should so state and explain why an opinion would be speculative. 4. After completing #1 and #2, schedule the Veteran for an examination to determine the nature and etiology of his claimed right knee disability. All necessary testing should be performed. Following a review of the claims file, the examiner should address the following: (a) Diagnose all current right knee disabilities. If no orthopedic disability is identified, the examiner must indicate whether the Veteran’s reported right knee pain causes any functional impairment. (b) For each diagnosed disorder or functional impairment in part (a), please opine whether it is at least as likely as not (50 percent probability or greater) that such disorder: (i) had its onset during or is otherwise etiologically related to the Veteran’s active duty service; (ii) is proximately due to his right foot disability, to include as a result of an antalgic gait and/or a change in weight-bearing; or (iii) has been aggravated (worsened beyond natural progression) by his right foot disability, to include as the result of an antalgic gait and/or a change in weight-bearing. Please address each sub-part separately. In addressing this question, the examiner must discuss the February 2014 VA examination report showing an intermittent antalgic gait favoring the right side. The examiner should accept the Veteran’s competent and credible reports of the onset and persistence of his right knee pain. The examiner is advised that a negative opinion premised solely upon the absence of evidence of treatment is legally inadequate. A rationale must be provided for all opinions rendered. If the examiner cannot provide any requested opinion without resorting to speculation, the examiner should so state and explain why an opinion would be speculative. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.M. Badaczewski, 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.