Citation Nr: 20022012 Decision Date: 03/30/20 Archive Date: 03/30/20 DOCKET NO. 11-22 383 DATE: March 30, 2020 REMANDED The issue of service connection for anal/rectal abscesses, to include as secondary to diabetes mellitus is remanded. The issue of service connection for a skin disorder, to include as secondary to diabetes mellitus is remanded. REASONS FOR REMAND Service connection for anal/rectal abscesses, to include as secondary to diabetes mellitus Service connection for a skin disorder, to include as secondary to diabetes mellitus. The matters are REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: The appellant contends that the Veteran’s anal/rectal abscesses and skin disorder were DUE TO OR WORSENED BY his service-connected diabetes mellitus. Although the Board denied the claims in December 2018, in January 2020 the appeal was remanded for the Board to comply with the instructions below. 2. Send the Veteran’s medical records to the same examiner who conducted the August 2018 examination. If that examiner is not available, send the Veteran’s record to another examiner the RO deems appropriate. The Veteran’s claims file, to include a copy of this Remand, should be made available to and reviewed by the examiner. The examination report should reflect that such review was accomplished. a. The examiner must provide an opinion as to whether the Veteran’s service-connected diabetes caused a worsening his anal/rectal abscesses. THE EXAMINER MUST BE ADVISED THAT IN ORDER FOR COMPENSATION TO BE GRANTED, THE LAW DOES NOT REQUIRE A “PERMANENT” WORSENING, AND THE EXAMINER MUST REPORT ANY INCREMENTAL WORSENING. b. As noted above, the examiner should review the record in conjunction with rendering the requested opinion; however, his/her attention is drawn to the following: * 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. 4. Send the Veteran’s medical records to the same examiner who conducted the August 2018 SKIN DISORDER examination. If that examiner is not available, send the Veteran’s records to another examiner the RO deems appropriate. a. The examiner must provide an opinion as to whether the Veteran’s diabetes caused or aggravated the Veteran’s skin condition. The Board notes that the opinion must include a determination as to whether the Veteran’s skin condition was aggravated by his service-connected diabetes. THE EXAMINER MUST BE ADVISED THAT IN ORDER FOR COMPENSATION TO BE GRANTED, THE LAW DOES NOT REQUIRE A “PERMANENT” WORSENING, AND THE EXAMINER MUST REPORT ANY INCREMENTAL WORSENING. b. As noted above, the examiner should review the record in conjunction with rendering the requested opinion; however, his/her attention is drawn to the following: * 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. 6. Thereafter, and after undertaking any additional development deemed necessary, readjudicate the issues on appeal. If the benefit sought on appeal remains denied, the appellant and her representative must be provided with a Supplemental Statement of the Case (SSOC) and be afforded reasonable opportunity to respond. The case should then be returned to the Board for further appellate review, if otherwise in order. (Continued on the next page)   (CONTINUED ON NEXT PAGE) Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Wozniak, Joshua 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.