Citation Nr: 21005202 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 09-24 839 DATE: January 29, 2021 ORDER Entitlement to service connection for sleep apnea syndrome is denied. Entitlement to service connection for hemorrhoids is denied. Entitlement to service connection for a low back disability, to include as secondary to the service-connected bilateral knee disability, is denied. Entitlement to an initial compensable rating for service-connected colon polyps is denied. FINDINGS OF FACT 1. Sleep apnea has not been shown to be related to an injury, disease, or event during the Veteran’s first period of active service. 2. Clear and unmistakable evidence demonstrates that sleep apnea preexisted the Veteran’s second and third periods of active service and that there was no increase in disability beyond the normal progress of the disease. 3. Clear and unmistakable evidence does not demonstrate that the Veteran’s hemorrhoids preexisted a period of active service. 4. Hemorrhoids have not been shown to be related to an injury, disease, or event during active service. 5. A low back disability did not manifest during service, is etiologically not related to service, and is not secondary to the service-connected bilateral knee disability. 6. The Veteran’s colon polyps have been manifested by benign colon polyps, without compensable symptoms or residuals due to the polyps or removal. CONCLUSIONS OF LAW 1. Sleep apnea was not incurred in or aggravated by service. 38 U.S.C. §§ 1111, 1110, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306. 2. Hemorrhoids were not incurred in or aggravated by service. 38 U.S.C. §§ 1111, 1110, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306. 3. A low back disability did not manifest during service, is unrelated to service, and was not caused or aggravated by the service-connected bilateral knee disability. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for an initial increased compensable rating for colon polyps have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.114, Diagnostic Code 7344. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service including from July 1971 to July 1974, from August 2002 to July 2003, and from October 2003 to January 2005 with an additional period of inactive service. He was afforded a hearing before the undersigned in January 2012. In an April 2012 decision the Board, in part, denied the issues of entitlement to service connection for sleep apnea, a bilateral knee disorder, and a low back disorder. The Veteran appealed the denial of entitlement to service connection for sleep apnea, a bilateral knee disorder, and a low back disorder to the United States Court of Appeals for Veterans Claims (Court), which, by Order dated March 2013, granted a Joint Motion for Remand (Joint Motion). In a rating decision in November 2020, the Regional Office granted service connection for left knee meniscal tear status post arthroscopy and osteoarthritis of the right knee, thus the issue of service connection for a bilateral knee disability is no longer in appellate status. Issues 1-4: Entitlement to service connection for: sleep apnea syndrome; low back disability, to include as secondary to the service-connected bilateral knee disability; and hemorrhoids. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disorder. 38 C.F.R. § 3.310(a). Secondary service connection may be found in certain instances in which a service-connected disability aggravates another condition. Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310(b). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has distinguished between those cases in which the preexisting condition is noted upon entry into service, and those cases in which the preexistence of the condition must otherwise be established. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); Horn v. Shinseki, 25 Vet. App. 231, 234 (2012); see also 38 U.S.C. § 1111 (presumption of sound condition). In a case, as in the instant case, where there is no preexisting condition noted upon entry into service, a veteran is presumed to have entered service in sound condition, and the burden falls to the government to demonstrate by clear and unmistakable evidence that (1) the condition preexisted service and (2) the preexisting condition was not aggravated by service. Horn, 25 Vet. App. at 234. The government may show a lack of aggravation by establishing by clear and unmistakable evidence “that there was no increase in disability during service or that any ‘increase in disability [was] due to the natural progress of the’ preexisting condition.” Wagner, 370 F.3d at 1096; see also, 38 U.S.C. § 1153; 38 C.F.R. § 3.306. This burden of proof must be met by “affirmative evidence” demonstrating that there was no aggravation. The burden is not met by finding “that the record contains insufficient evidence of aggravation.” Horn, 25 Vet. App. at 236-37. “Clear and unmistakable evidence” is an “onerous” evidentiary standard, requiring that the preexistence of a condition and the no-aggravation result be “undebatable.” Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009). With regard to the existence of a preexisting condition, to be “noted” within the meaning of the presumption of soundness statute, the condition must be recorded in the entrance examination report. 38 C.F.R. § 3.304 (b); 38 U.S.C. § 1111; Crowe v. Brown, 7 Vet. App. 238, 245 (1994). As previously noted, the Veteran had three separate periods of active service. The Veteran contends that his sleep apnea and hemorrhoids pre-existed his second and third active service periods and were aggravated by his active service. See, e.g., January 2012 Board hearing transcript and December 2019 brief from the Veteran’s attorney. During his Board hearing, the Veteran testified that he was diagnosed with sleep apnea in the late 1990s. He explained that he was called up to active duty and when he returned, he underwent a sleep study that showed that his sleep apnea was worse. In January 2012 the Veteran testified that his low back disability was secondary to his bilateral knee disability. See December 2019 brief from the Veteran’s attorney. During the first period of service, from July 1971 to July 1974, service treatment records do not show complaints or findings of sleep apnea, hemorrhoids, or a low back disability. Service treatment records from subsequent periods of service do not show a low back disability. A May 2000 report of medical history, prior to the Veteran’s second period of service from August 2002 to July 2003, and third period of service from October 2003 to January 2005, shows that the Veteran was diagnosed with sleep apnea and used a CPAP machine with good results. The May 2000 report of medical history shows that the Veteran checked no as to having experienced recurrent back pain. In a June 2003 post-deployment questionnaire (completed after the second period of active service), the Veteran checked no as to having experienced back pain. A March 2003 polysomnogram shows obstructive sleep apnea. Service treatment records in April 2003 show a new onset of hemorrhoids. Two months after the Veteran was separated from service in July 2003, a September 2003 record shows hemorrhoids and rectal bleeding over the past few months. After service, a June 2008 private treatment record shows that the Veteran was seen in the office on April 23, 2008 and reported a work-related injury that occurred in March 2007. He stated that he was lifting a heaving air handler and wrenched his neck and right shoulder and experienced low back pain. Dr. S.B. assessed the Veteran with cervical spondylosis and lumbar disc disease. Dr. S.B. stated that she believed the Veteran’s lumbar problems were secondary to his cervical disorder. There is one favorable opinion regarding the etiology of the Veteran’s sleep apnea. In a September 2013 opinion a private sleep specialist opined that it is more likely than not that there is a medical nexus between the Veteran’s active duty service and his worsening obstructive sleep apnea and co-morbidities. She noted that during her first visit with the Veteran in March 2003 he had obstructive sleep apnea which was treated with a CPAP device at 9 centimeters of pressure. The Veteran reported hypersomnia. During the current visit a polysomnogram indicated severe obstructive sleep apnea and required an increase in CPAP pressure from 9 centimeters to 13 centimeters of pressure. She concluded that polysomnographic testing done before, during and following service showed the Veteran’s obstructive sleep apnea worsened. The unfavorable opinions regarding the nature and etiology of the Veteran’s sleep apnea, hemorrhoids, and low back disability are discussed below. As for hemorrhoids, the Veteran was afforded a VA examination in November 2010. The claims file was reviewed. It was noted that the onset of the Veteran’s hemorrhoids was in 2010. He reported that the first time they mentioned hemorrhoids was this year when they did a rectal examination a few weeks ago. He stated that he had not had any itching or noticed any hemorrhoids or pain. They found internal hemorrhoids during the colonoscopy. On examination, the Veteran had small external hemorrhoids. The Veteran was diagnosed with hemorrhoids. The examiner noted that the Veteran had a colonoscopy during service in May 2003 that revealed multiple benign colon polyps but no external hemorrhoids were noted. The examiner opined that the Veteran’s hemorrhoids were less likely as not caused by or a result of military service. The examiner explained that there was a lack of diagnosis of hemorrhoids during service. On VA examination for sleep apnea in May 2014, which the examiner signed in June 2014, the Veteran reported that he was diagnosed with sleep apnea in 1971 and did not have follow-up treatment until 2003. He reported that his sleep apnea was aggravated by service. To the extent that the Board in the January 2020 remand found the June 2014 opinion regarding the etiology to be inadequate the findings and conclusions need not be further discussed. On VA examination in May 2014, which the examiner signed in June 2014, the examiner rendered an opinion regarding the etiology of the Veteran’s hemorrhoids, which the Board in the January 2020 remand found to be inadequate and thus it need not be further addressed. On VA examination for the back in May 2014, which the examiner signed in June 2014, the diagnosis was degenerative arthritis of the spine and intervertebral disc syndrome. The Veteran stated that he injured his back carrying a ruck sack in 2003 and 2005. The Veteran also noted on the job back injuries in the 1990s and 2008. The examiner opined that the Veteran’s low back disorder was not at least as likely as not etiologically related to service or worsened by his bilateral knee disability. In a VA opinion in June 2015, the examiner opined that the Veteran’s back disability was less likely than not proximately due to or the result of his bilateral knee disability. The examiner noted that the Veteran reported that the onset of his lower back pain was in March 2007. In an opinion in February 2020, the examiner opined that it is less likely than not that the Veteran’s sleep apnea syndrome and hemorrhoids were incurred in or caused by service. As for obstructive sleep apnea, the examiner noted that a 2003 sleep study, which showed sleep apnea, indicates that the Veteran was on CPAP and is consistent with the Veteran’s history of having sleep studies in 1990 and thus was not incurred during a period of active service. As for hemorrhoids, the examiner noted that a May 2003 rectal exam and colonoscopy do not show hemorrhoids were incurred in service. The examiner acknowledged that an April 2003 treatment record shows “new onset of hemorrhoids” however the examiner found that this was the subjective portion of an exam and an opinion was deferred. The Veteran was referred to GI and the examiner determined that this would not be attributable to confirming hemorrhoid presence in April 2003, especially in light of that rectal exam and colonoscopy done one month after this note, which did not show presence of hemorrhoids. As to the question if the hemorrhoids were aggravated was any increase clearly and unmistakable due to the natural progress of the disease, the examiner opined that the hemorrhoids could not be aggravated as they were not definitively diagnosed until 2010, as 2003 scope and PE done by GI was negative for hemorrhoids and these would have been apparent on exam and during scope. As to the question whether there was clear and unmistakable evidence that the Veteran’s sleep apnea and hemorrhoids did not undergo a permanent increase in severity (aggravation), the examiner explained that the initial sleep study reported in the 1990s with a CPAP setting of 9 was not seen in the records but referenced in statements. He had a second sleep study in 2003 with recommended CPAP setting of 13. There was then a 2005 study that recommended CPAP setting of 11. The examiner noted that the Veteran weighed 250 pounds in August 2002, and 240-pounds in March 2003, when the sleep study was conducted. The Veteran actually lost weight during his second period of service. The examiner acknowledged that there was slight increase from baseline in the 1990s to the 2005 study (9 to 11) however, there were long periods of time when the Veteran was not on active duty. Additionally, the examiner stated that there are multiple known risk factors influencing and affecting obstructive sleep apnea (OSA) “including age, weight, sex” and the examiner was unable “to attribute his risks for OSA or aggravation to a single entity or to time to state causative for aggravation rather than natural progression.” As for hemorrhoids, the examiner opined that they could not be aggravated as they were not definitively diagnosed until 2010, as 2003 scope and PE done by GI was negative. The examiner explained that it is not possible to aggravate a condition in service that was not diagnosed until after service. In conclusion, the examiner noted that hemorrhoids and polyps do not cause or aggravate sleep apnea and degenerative joint disease of the knees or vice versa. Osteoarthritis of the knees is a degenerative joint process and does not cause sleep apnea or aggravate it based on anatomy and pathophysiology. There is no pathophysiologic basis to correlate rectal and intestinal disorders of hemorrhoids and polyps to the degenerative joint disease of the knees. There is no pathophysiologic basis to correlate rectal and intestinal conditions of hemorrhoids and polyps to obstructive sleep apnea. While the examiner checked the box indicating that the “claimed condition, which clearly and unmistakably existed prior to service, was aggravated beyond its natural progression by an in-service injury, event, or illness” as well as the box that the “claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness”, the check mark next to the former appears to be a typographical error as the overall context of the opinion regarding sleep apnea is consistent with the latter. Medical reports must be read as a whole and in the context of the evidence of record. See Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012). On VA back examination in November 2020 the diagnosis was degenerative disc disease. The examiner noted that the Veteran reported that his back disorder was due to his knee pain, which caused him to walk with an altered gait leading to low back pain. In an accompanying opinion the examiner opined that the Veteran’s back disability was less likely than not proximately due to or the result of the Veteran’s service-connected bilateral knee disability based on the rationale that there was no clear evidence from review of orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb, unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than 5 centimeters so that the individual’s gait pattern was altered to the extent that clinically there is an obvious Trendelenburg gait. The examiner found that this level of severity is not supported based on record review, history or exam. It was not unusual for two joints to share properties in the same person, but one joint’s disease does not ‘spread’ to another or cause damage to it. Therefore the examiner opined that the back disability was less likely than not related to the bilateral knee disorder. The examiner further concluded that a review of the claims file does not provide evidence that the Veteran’s back disability was caused or aggravated beyond its natural progression by the bilateral knee degenerative joint disease. The Board finds the February 2020 and November 2020 VA opinions to be probative as they were based on medical principles and applied to the facts of the case. Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008). The examiners considered the nature of the Veteran’s sleep apnea, hemorrhoids, and low back disorder in proffering the opinions. They are consistent with the other competent and probative evidence of record. The Board rejects the favorable private opinion in September 2013 regarding the Veteran’s sleep apnea as the examiner only partially considered the Veteran’s medical history as she focused on one instance of increase in CPAP pressure without addressing subsequent decrease in CPAP and other risk factors. As a lay person, the Veteran is competent to report symptoms pertaining to his sleep apnea, hemorrhoids, and back disability. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the etiology of the Veteran’s sleep apnea, hemorrhoids, and back disability falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). These disorders are not the type of conditions that are readily amenable to mere lay diagnosis or probative comment regarding their etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating such disorders. Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. As the lay evidence is not competent, the matter of whether it is credible is not reached. Thus, the weight of the competent and probative evidence does not show that the Veteran is entitled to service connection for a low back disability due to service or secondary to a service-connected disability, nor does the evidence show that his sleep apnea is related to his first period of active service or that his hemorrhoids are due to his first period of service or were incurred in a subsequent period of service. There is clear and unmistakable evidence that the Veteran’s sleep apnea preexisted the Veteran’s second and third periods of active service and the evidence is clear and unmistakable that the obstructive sleep apnea was not aggravated by the second and third periods of active service. There is no clear and unmistakable evidence that the Veteran’s hemorrhoids preexisted a period of active service. Accordingly, because the preponderance of the evidence is against the claim of service connection for sleep apnea, hemorrhoids, and a low back disability, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.   Issue 4: Entitlement to an initial compensable rating for service-connected colon polyps. Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings”. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s service-connected colon polyps are evaluated by analogy as noncompensable under Diagnostic Code 7344 for Benign Neoplasms, Exclusive Skin Growth, which provides that benign neoplasms, exclusive of skin growths, should be evaluated under an appropriate diagnostic code, depending on the predominant disability or the specific residuals after treatment. 38 C.F.R. § 4.114. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. In the instant case Diagnostic Codes warranting consideration include Diagnostics Code 7319 and 7323. Under Diagnostic Code 7319, for mild irritable colon syndrome, with disturbances of bowel function with occasional episodes of abdominal distress, is rated noncompensably disabling. Moderate irritable colon syndrome with frequent episodes of bowel disturbance with abdominal distress, is rated as 10 percent disabling and severe irritable colon syndrome with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress is rated as 30 percent disabling. 38 C F R. § 4 114. Under Diagnostic Code 7323, a 10 percent rating is warranted for moderate colitis with infrequent exacerbations, a 30 percent rating is warranted for moderately severe colitis with frequent exacerbations. A 60 percent rating is warranted for severe colitis with numerous attacks a year and malnutrition and with health only fair during remissions. A 100 percent rating is warranted for pronounced colitis resulting in marked malnutrition, anemia, and general debility, or with serious complication as liver abscess. 38 C F R. § 4 114. Words such as “severe” and “pronounced” as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The use of terminology such as “severe” by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. By way of history, in a rating decision in January 2014 service connection for colon polyps was granted with an evaluation of zero percent effective March 12, 2010. In the August 2014 notice of disagreement, the Veteran contended that he is entitled to a compensable rating for his polyps due to bleeding. In October 2014 the Veteran through his attorney contended that he is entitled to a 10 percent rating for his polyps pursuant to Diagnostic Code 7332 pursuant to constant slight, or occasional moderate leakage. Under Diagnostic Code 7332, impairment of sphincter control that causes constant slight or occasional moderate leakage is assigned a 10 percent rating. Occasional involuntary bowel movements necessitating wearing of pads are assigned a 30 percent rating. Impairment of sphincter control that causes extensive leakage and fairly frequent involuntary bowel movements is assigned a 60 percent rating. Complete loss of sphincter control is assigned a total, 100 percent rating. VA treatment records in June 2010 show hemorrhoidal bleeding. On VA rectum examination in November 2010, there was no anal or rectal stricture, no impaired sphincter, and no rectal prolapse. The Veteran reported intermittent blood in stool. On VA intestinal examination in June 2012, the examiner determined that the Veteran did not have any signs or symptoms attributable to any non-surgical non-infectious intestinal disorder. There were no episodes of bowel disturbance with abdominal distress or exacerbations or attacks of the intestinal condition. There was no weight loss or malnutrition attributable to an intestinal condition. On VA examination for rectum and anus conditions in May 2014, the Veteran complained of bleeding associated with hemorrhoids. On VA rectum examination in January 2018, the examiner found that the rectal area was normal. In an accompanying opinion the examiner noted that a recent colonoscopy in July 2016 showed three hyperplastic benign polyps, which were resected. The examiner opined that there was no known medical literature to support any relationship between benign colon polyps and disability in impairment of sphincter control. The examiner explained that on physical examination as well as on evaluation in July 2016 there was no sphincter impairment to cause leakage of stool or fluid. The examiner explained that the Veteran did not have any history of neurologic damage to cause leakage. His sphincter tone was completely normal and strong. On VA stomach and duodenal examination in January 2019, which was signed in February 2019, the examiner noted that the Veteran had rectal bleeding with hemorrhoids and abdominal discomfort. The Veteran’s symptoms included periodic abdominal pain, transient nausea. The examiner opined that colon polyps typically do not cause symptoms, nevertheless some individuals including the Veteran do experience dysfunction of the colon to include, involuntary bowel movements, abdominal pain, and change in bowel movements. The examiner noted the Veteran’s claims of mild impairment of sphincter control not necessitating the use of a pad. On VA examination for rectum and anus conditions in February 2020, the diagnosis was hemorrhoids with a date of diagnosis in 2010. The other diagnosis was rectal polyps. The examiner noted that the Veteran had rectal bleeding in 2002 and was diagnosed with polyps, which were removed. His current symptoms included intermittent rectal bleeding. The examiner noted that in March 2013 five polyps were removed throughout the colon. There were internal hemorrhoids observed in March 2013, which were felt to cause the Veteran’s bleeding. On VA examination for intestinal condition in February 2020, the examiner noted the Veteran in November 2010 had diarrhea, blood in his stool, and rectal bleeding. The examiner noted that the Veteran had a polyp shown on colonoscopy in January 2009. A July 2016 colonoscopy showed a digital rectal exam was normal, multiple hyperplastic normal colon to the cecum, and normal ileum with 3 hyperplastic rectal polyps without evidence of dysplasia or carcinoma. On the February 2020 examination the examiner stated that polyps remained the same since their onset. Continuous medication was not required. There was intermittent bleeding. There were no episodes of bowel disturbance with abdominal distress or exacerbations or attack of the intestinal condition. The Veteran did not have weight loss attributable to an intestinal condition. The Veteran did not have malnutrition, serious complications or other general health effects attributable to the intestinal condition. The Veteran had benign neoplasm and polypectomies in 2003 and 2016. The examiner noted that the Veteran did not have any residuals conditions or complications due to the neoplasm. The above findings are consistent with the other competent evidence of record. As discussed above, Diagnostic Code 7344 does not contain specific ratings, indicating that the predominant disability should be rated. Here, while there is a notation of diarrhea in November 2010, the Veteran’s polyps do not more nearly approximate the criteria for a compensable rating under Diagnostic Codes 7319 and 7323 as the Veteran did not have abdominal distress, constipation, colitis, malnutrition or debility. The Board recognizes that in a September 2014 private opinion, the examiner opined that the Veteran due to his colon polyps had rectal bleeding once per day due to impairment of sphincter control resulting in slight leakage. Nevertheless, this opinion is outweighed by the unfavorable VA opinion in February 2020 whereby the examiner opined that there was no objective sphincter impairment based on the rationale that there was no impairment in sphincter control on exam or noted in specialty exams or testing. The examiner stated that records in July 2016 show three hyperplastic benign polyps which were resected and sent for pathology evaluation. Pathology showed “benign colonic mucosa with superficial hyperplastic change” and these findings along with good sphincter control on exam, did not support the 2014 opinion provided by Dr. B. Unlike the VA examiner, the private examiner in September 2014 did not provide an adequate rationale for the conclusion reached. A mere conclusion statement is insufficient to allow the Board to make an informed decision as to the weight to assign to the medical statement. Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007). Furthermore, the February 2020 VA opinion is consistent with the findings on VA rectum examination in November 2010 and January 2018. The Board also acknowledges that in the February 2020 VA opinion the examiner opined that the Veteran had rectal bleeding secondary to rectal polyps and hemorrhoids. The examiner was unable to apportion contribution of each to the bleeding, however the weight of the evidence during the entire appeal period shows that the Veteran’s rectal bleeding was attributed to his hemorrhoids for which service connection is not being granted herein. See, e.g. June 2010 VA treatment records, May 2014 VA examination, January 2019 VA examination, and February 2020 VA examination report that shows in March 2013 five polyps were removed and the March 2013 hemorrhoids were felt to be the cause of the Veteran’s bleeding. The Board notes that the Veteran is competent to describe pain and discomfort and the Board finds that his statements are credible. Layno v. Brown, 6 Vet. App. 465, 470 (1994). In this case, however, the Board finds that the objective medical findings by skilled professionals are more persuasive, which, as indicated above, do not support a compensable rating for his service-connected colon polyps. Where the rating schedule does not provide a zero percent (noncompensable) evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. There is no contention or indication that any another Diagnostic Code would be more appropriate. As the preponderance of evidence does not more nearly approximate a compensable rating for the Veteran’s colon polyps under any potentially applicable code, there is no reasonable doubt to be resolved, and the claim is denied. 38 C.F.R. §§ 4.3, 4.114. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mac, 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.