Citation Nr: 21063317 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 17-48 401 DATE: October 13, 2021 ORDER Entitlement to service connection for pancreatitis, to include as secondary to service-connected disabilities, is denied. Entitlement to service connection for an anal abscess, to include as secondary to the service-connected diverticulitis, is denied. Entitlement to service connection for bilateral eye swelling, to include as secondary to the service-connected hairy cell leukemia, is denied. Entitlement to service connection for blurred vision to include as secondary to the service-connected hairy cell leukemia, is denied. Entitlement to service connection for a gallbladder disorder, to include as secondary to the service-connected hairy cell leukemia, is denied. FINDINGS OF FACT 1. The Veteran's pancreatitis is not secondary to service-connected disabilities, and is not otherwise related to an in-service injury or disease. 2. The Veteran's anal abscess is not secondary to service-connected diverticulitis, and is not otherwise related to an in-service injury or disease. 3. The Veteran's bilateral eye swelling is not secondary to service-connected hairy cell leukemia, and is not otherwise related to an in-service injury or disease. 4. The Veteran's blurred vision is not secondary to service-connected hairy cell leukemia, and is not otherwise related to an in-service injury or disease. 5. The Veteran's gallbladder disorder is not secondary to service-connected hairy cell leukemia, and is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for pancreatitis due to service or service-connected disabilities are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for an anal abscess due to service or service-connected diverticulitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for bilateral eye swelling due to service or service-connected hairy cell leukemia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 4. The criteria for service connection for blurred vision due to service or service-connected hairy cell leukemia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 5. The criteria for service connection for a gallbladder disorder due to service or service-connected hairy cell leukemia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from April 1985 to April 2005. This matter is on appeal from an April 2016 rating decision, and was previously remanded by the Board of Veterans' Appeals (Board) in December 2019. The Board also remanded the issue of service connection for a psychiatric disorder. That issue is no longer on appeal since a June 2020 rating decision granted service connection for persistent depressive disorder with anxious distress due to medical condition. Since the June 2020 Supplemental Statement of the Case, additional evidence has been added to the claims file. Since it is either not relevant or is cumulative or duplicative of information previously considered, a remand is not necessary. In this regard, the additional evidence shows treatment for blurred vision. However, it does not suggest that it is not related to service, and is thus not relevant to the Veteran's claim for service connection for blurred vision. Service Connection 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. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. 1. Pancreatitis The Veteran contends that he has pancreatitis that is either due to service or that is secondary to his service-connected disabilities. Regarding service connection on a direct basis, the question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. As for service connection on a secondary basis, the question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by service-connected disability. The Board concludes that, while the Veteran has a current diagnosis of pancreatitis, and evidence shows that he had in-service abdominal complaints, the preponderance of the evidence weighs against finding that the Veteran's pancreatitis began during service or is otherwise related to an in-service injury, event, or disease. The preponderance of the evidence also weighs against finding that pancreatitis is proximately due to or the result of, or is aggravated beyond its natural progress by service-connected disability. Beginning with service connection on a direct basis, VA treatment records show the Veteran was not diagnosed with pancreatitis until October 2015, a decade after his separation from service. While the Veteran is competent to report having experienced symptoms of abdominal problems since service, he does not have the training or credentials to provide a diagnosis in this case or determine that these symptoms were manifestations of pancreatitis. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, the January 2020 VA examiner opined that the Veteran's pancreatitis is not at least as likely as not related to an in-service injury, event, or disease. The rationale was that he was first diagnosed in 2015. The examiner reported that there was no evidence that the Veteran had the condition of pancreatitis in service. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board acknowledges that the Veteran had abdominal complaints during service. However, he is currently service-connected for gastrointestinal reflux disease (GERD) with hiatal hernia and diverticulitis. No medical professional has related his in-service complaints to pancreatitis. Regarding service connection as secondary to service-connected disabilities, the January 2020 VA examiner also provided multiple opinions addressing whether pancreatitis is secondary to any of the Veteran's service-connected disabilities. The Veteran is service-connected for hairy cell leukemia, psychiatric, cervical spine, bilateral upper extremity peripheral neuropathy, lumbar, gastrointestinal, kidney stone, left ilioinguinal nerve damage, right great toe tendonitis, vertigo, bilateral lower extremity peripheral neuropathy and radiculopathy, right hand, bilateral inguinal hernias, erectile dysfunction, migraine headaches, and right great toe hallux rigidus disabilities. At the time of the January 2020 examiner's opinions, the Veteran was not service connected for his psychiatric disability, and no opinion regarding pancreatitis being secondary to that disability was obtained. However, as the Veteran does not contend, nor does the evidence suggest, that pancreatitis is secondary to the psychiatric disability, remand for an additional medical opinion is not necessary. The January 2020 VA examiner opined that the Veteran's pancreatitis is not proximately due or the result of, or is aggravated beyond its natural progression, by the Veteran's service-connected disabilities acting separately or combined. Discussing each service-connected disability, the rationale was that that the claimed disorder of pancreatitis is a separate entity entirely from the service-connected disabilities, and unrelated to them. The examiner reported that for each separate service-connected disability, there was no evidence or research found that that condition caused the pancreatitis. Regarding aggravation, the examiner further opined that the medical evidence is not sufficient to support a determination of a baseline level of severity. The examiner reported that there was no credible evidence that shows that the Veteran's pancreatitis was aggravated beyond its natural progression by each service-connected disability. The examiner discussed the multiple etiologies, including gallstones, alcohol, hypertriglyceridemia, post-endoscopic retrograde, genetic risk, medications, and pancreatic duct injury. The examiner's opinions are probative, because they are based on an accurate medical history and provide explanations that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The Veteran believes his pancreatitis is related to an in-service injury, event, or disease, or is proximately due to or the result of, or is aggravated beyond its natural progress by a service-connected disability. The Veteran in this case is not competent to provide a nexus opinion regarding this issue because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4; see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the January 2020 VA examiner's opinions. 2. Anal abscess The Veteran contends that he has an anal abscess that is either due to service or that is secondary to his service-connected diverticulitis. Regarding service connection on a direct basis, the question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. As for service connection on a secondary basis, the question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by service-connected disability. The Board concludes that, while the Veteran was diagnosed with an anal abscess during this appeal, the preponderance of the evidence weighs against finding that the Veteran's anal abscess began during service or is otherwise related to an in-service injury, event, or disease. The preponderance of the evidence also weighs against finding that an anal abscess is proximately due to or the result of, or is aggravated beyond its natural progress by service-connected disability. Beginning with service connection on a direct basis, VA treatment records show the Veteran was not diagnosed with an anal abscess until June 2013, years after his separation from service. The Veteran has not reported experiencing symptoms associated with an anal abscess since service. Even if he had, he does not have the training or credentials to provide a diagnosis in this case or determine that any reported symptoms were manifestations of an anal abscess. Jandreau, 492 F.3d at 1377 n.4. Further, the January 2020 VA examiner opined that the Veteran's anal abscess is not at least as likely as not related to an in-service injury, event, or disease. The rationale was that before 2013, there was no prior history of a perianal abscess. Per the Veteran's history, he had a 2 to 3 month history of the mass prior to surgery in June 2013. The examiner reported that it was not seen on a colonoscopy one month prior to surgery, indicating that there was no obvious colonic fistula or infected diverticula/hemorrhoid causing the perianal mass. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at304. Regarding service connection as secondary to service-connected diverticulitis, an April 2016 VA examiner opined that it is not at least as likely as not proximately due or the result of, or aggravated beyond normal progression, by the service-connected diverticulitis. The rationale was that diverticulitis is caused by inflammation of diverticula, which is a sac-like protrusion of the colon wall. They were not pathophysiologically related to perianal abscess, a collection of purulent material that arises from the glandular crypts on the anus or rectum. The examiner referred to a medical article concerning perianal abscesses in support of their opinion. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The Veteran believes his anal abscess is related to an in-service injury, event, or disease, or is proximately due to or the result of, or is aggravated beyond its natural progress by the service-connected diverticulitis. The Veteran in this case is not competent to provide a nexus opinion regarding this issue because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4. Consequently, the Board gives more probative weight to the VA examiantion opinions. 3. Bilateral eye swelling 4. Blurred vision The Veteran contends that he has bilateral eye swelling and blurred vision that are either due to service or that is secondary to his service-connected hairy cell leukemia. Regarding service connection on a direct basis, the question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. As for service connection on a secondary basis, the question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by, a service-connected disability. The Board concludes that, while the Veteran was diagnosed with prolapsed orbital fat and age-related nuclear sclerotic cataracts during this appeal, and service treatment records reflect complaints of itch, burning/swelling and bilateral lattice degeneration, the preponderance of the evidence weighs against finding that those diagnoses began during service or are otherwise related to an in-service injury, event, or disease. The preponderance of the evidence also weighs against finding that they are proximately due to or the result of, or is aggravated beyond its natural progress, by service-connected hairy cell leukemia. Beginning with service connection on a direct basis, VA treatment records show the Veteran was not diagnosed with brow ptosis, floppy eyelid syndrome with significant prolapse of orbital fat until March 2013, and age-related nuclear sclerosis cataract until April 2014, both years after his separation from service. The Veteran has not reported experiencing symptoms associated with those disorders since service. Even if he had, he does not have the training or credentials to provide a diagnosis in this case or determine that any reported symptoms were manifestations of his brow ptosis and cataracts. Jandreau, 492 F.3d at 1377 n.4. Further, the January 2020 VA examiner opined that the Veteran's blurred vision and eye swelling are not at least as likely as not related to an in-service injury, event, or disease. The rationale was that post-service treatment records documented diagnosis and treatment of prolapsed orbital fat (blepharoptosis in eyelids) and age-related cataracts. Regarding the prolapsed orbital fat, the examiner opined that the condition was age-related. For both the prolapsed orbital fat, and the age-related cataracts, the examiner reported that there was no known association in literature between those diagnoses and the in-service history of itching, burning/swelling under his eyes or the bilateral lattice degeneration. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. Regarding service connection as secondary to service-connected hairy cell leukemia, an April 2016 VA examiner opined that the Veteran's blurred vision and eye swelling are not at least as likely as not proximately due or the result of, or aggravated beyond normal progression, by the service-connected hairy cell leukemia. The rationale was that there was no known association in literature between prolapsed orbital fat and age-related cataracts, and hairy cell leukemia. The examiner referred to a medical article concerning hairy cell leukemia in support of their opinion. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The Veteran believes his bilateral eye swelling and blurred vision are related to an in-service injury, event, or disease, or are proximately due to or the result of, or are aggravated beyond its natural progress by the service-connected hairy cell leukemia. The Veteran in this case is not competent to provide a nexus opinion regarding this issue because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4. Consequently, the Board gives more probative weight to the April 2016 and January 2020 VA examiner's opinions. 5. Gallbladder disorder The Veteran contends that he has a gallbladder disorder that is either due to service or that is secondary to his service-connected hairy cell leukemia. Regarding service connection on a direct basis, the question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. As for service connection on a secondary basis, the question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by, a service-connected disability. The Board concludes that, while the Veteran has residuals of gallbladder removal, and service treatment records reflect abdominal complaints, the preponderance of the evidence weighs against finding that the Veteran's gallbladder disorder began during service or is otherwise related to an in-service injury, event, or disease. The preponderance of the evidence also weighs against finding that it is proximately due to or the result of, or is aggravated beyond its natural progress by, service-connected hairy cell leukemia. Beginning with service connection on a direct basis, VA treatment records show the Veteran had his gallbladder removed in September 2011, years after his separation from service. While the Veteran is competent to report having experienced symptoms of abdominal problems since service, he does not have the training or credentials to provide a diagnosis in this case or determine that these symptoms were manifestations of a gallbladder disorder. Jandreau, 492 F.3d at 1377 n.4. Further, the January 2020 VA examiner opined that the Veteran's gallbladder removal is not at least as likely as not related to an in-service injury, event, or disease. The rationale was that based upon the Veteran's service and post-service treatment records, and lack of findings on his December 2004 hairy cell leukemia examination and history, the fact was that his abdominal pain was not typical of cholecystitis, but typical of diverticulosis pain. It appears he developed gallbladder disease after retirement sometime, and was not found to have disease until over two years after retirement. The examiner considered the Veteran's abdominal complaints in service, and related such to his service-connected diverticulitis. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. Regarding service connection as secondary to service-connected diverticulitis, an April 2016 VA examiner opined that the Veteran's gallbladder disorder is not at least as likely as not proximately due or the result of, or aggravated beyond normal progression, by the service-connected hairy cell leukemia. The rationale was that gallstone disease was one of the most common and costly of all digestive diseases. They reported that age is a major risk factor. The examiner also discussed other risk factors. The examiner concluded that since the Veteran's gallbladder surgery was secondary to cholelithiasis (gallstone formation), and risk factors for gallstones did not include leukemia or cancers, it was less likely that it was proximately due to aggravated beyond natural progression by his hairy cell leukemia. The examiner referred to a medical article concerning gallstones in support of their opinion. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The Veteran believes his gallbladder disorder is related to an in-service injury, event, or disease, or is proximately due to or the result of, or is aggravated beyond its natural progress by the service-connected hairy cell leukemia. The Veteran in this case is not competent to provide a nexus opinion regarding this issue because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4. Consequently, the Board gives more probative weight to the VA examiantion opinions. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Barstow, 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.