Citation Nr: 21061836 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 15-29 478 DATE: October 5, 2021 ORDER Entitlement to service connection for hemorrhoids is granted. FINDING OF FACT The Veteran's hemorrhoids had their onset during service. CONCLUSION OF LAW The criteria for service connection for hemorrhoids have been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1978 to March 1988. This matter comes before the Board of Veterans' Appeals (Board) from a November 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing with the undersigned in November 2018. A transcript of that hearing has been added to the Veteran's file. This issue was previously remanded by the Board in December 2019 and has since been returned for further adjudication. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran contends that he suffered from hemorrhoids in service as a result of constipation post-hernia surgery. In service, the Veteran sought treatment for constipation after his hernia surgery. During the Veteran's November 2018 hearing, he testifies that he suffered from constipation in service, noticed blood in his stool and hemorrhoids in service, and that these continued after service that he self-treated with suppositories. The Veteran underwent a VA examination in January 2021. The examiner opined that the Veteran's hemorrhoids are less likely than not incurred in or caused by his service due to there being no evidence found of any diagnosis or treatment for hemorrhoids in service, and that there is no association or documentation found between hemorrhoids, heavy lifting in service, or inguinal hernia repair in service with treatment notes in service mentioning treatment for constipation after surgery but no mention of hemorrhoids or rectal bleeding associated with constipation. An addendum opinion was obtained in April 2021. This examiner opined that his hemorrhoids were less likely than not related to service. However, the examiner stated that the cause of hemorrhoids is not precisely known, but they are associated with conditions that increase pressure in the hemorrhoidal venous plexus, such as straining during bowel movements secondary to constipation. Resolving the benefit of the doubt in favor of the Veteran, the Board finds service-connection for hemorrhoids is warranted. Although service treatment records do not document any complaints, treatment, or diagnosis for hemorrhoids in service, his service treatment records do note that he suffered from constipation in service after his hernia surgery. Further, the Veteran's statements that he observed blood in his stools during service are both competent and credible. The April 2021 VA examiner noted that constipation can cause straining during bowel movements, which results in increased pressure in the hemorrhoidal venous plexus and the development of hemorrhoids. Service records and lay statements note that the Veteran has suffered from constipation in service and since service. As constipation is a known cause for the development of hemorrhoids, and with consideration of the Veteran's observations of blood in his stools during service, resolving the benefit of the doubt in his favor, the Board finds that service connection for hemorrhoids is warranted. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Hofmeister 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.