Citation Nr: 21006885 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 15-38 870 DATE: February 5, 2021 ORDER Entitlement to service connection for hemorrhoids is granted. FINDING OF FACT The Veteran’s recurring hemorrhoids disorder was at least as likely as not caused by prolonged sitting in service. CONCLUSION OF LAW The criteria for entitlement to service connection for hemorrhoids have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had qualifying service from September 1971 to September 1974; his military occupational specialty was motor transport operator (the civilian equivalent of a truck driver). See DD Form 214. In December 2018, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge. In an April 2019 Decision, the Board remanded the issue herein for further medical development; in this Decision, the Board also adjudicated three other issues that are no longer before the Board. In an August 2020 Decision, the Board remanded the issue herein for further medical development; in this Decision, the Board also adjudicated two other issues that are no longer before the Board. 1. Entitlement to service connection for hemorrhoids Direct service connection generally requires evidence showing: (1) the existence of a present disability; (2) 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Although a competent medical opinion is generally required to establish etiology, competent and credible lay evidence of chronicity and continuity of symptomology may also establish etiology. 38 C.F.R. § 3.303(b); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran generally contends that his hemorrhoid condition is etiologically related to his in-service duties of driving a tractor trailer; further, during the December 2018 Board hearing, the Veteran testified that a July 1973 service treatment record (STR) indicated bloody stool and that he has had recurring hemorrhoids at least every two months since July 1973. See December 2018 Board hearing transcript. Preliminarily, the Board acknowledges that the Veteran and those who submitted buddy statements on the Veteran’s behalf are competent to identify hemorrhoids because it is a lay-observable condition; however, the evidence does not indicate that the Veteran or any of the buddy statement sources have the medical background required to competently opine regarding any medical conclusions that are not lay observable. Jandreau, supra; Layno, supra. STR’s failed to document any reports of, treatment for, or diagnoses of hemorrhoids (see August 1971 entrance examination, August 1974 separation examination, and all other STR’s). Notably, although during the December 2018 Board hearing, the Veteran testified that a July 1973 STR indicated bloody stool, the Board has carefully reviewed that handwritten record and determined that it most likely indicates that there were no bloody stools; the Board’s assessment is consistent with the December 2019 VA examiner’s assessment that the July 1973 STR specifically indicates “no bloody stools.” Nevertheless, the Board finds that prolonged sitting when driving is consistent with the circumstances of the Veteran’s duties as a motor transport operator. In the August 2014 VA Form 21-526, the Veteran reported hemorrhoids onset as March 1972 and noted that he reported the issue upon separation, but was forced to retract his statement if he wanted to go home. In October 2014 Buddy Statements, LC (the Veteran’s sister) and JN (the Veteran’s mother) wrote that the Veteran’s hemorrhoids occurred after service and from driving a tractor trailer in the service; notably, no further description of symptoms/treatment or rationale was provided by these sources. In a September 2014 Buddy Statement, SN (the Veteran’s brother) wrote that the Veteran’s struggled with and complained of hemorrhoids when he left the service in 1974, but did not want to seek medical attention at that time because he thought other servicemembers with worse injuries needed more attention; SN also noted that the Veteran drove almost 100,000 miles while in the service. In an October 2014 Buddy Statement, SN (the Veteran’s spouse) wrote that she met the Veteran in 1999, she married the Veteran in 2000, the Veteran uses hemorrhoid medicine, the Veteran takes fiber supplements, and the Veteran sometimes spots on his underwear; SN also noted that the Veteran told her that he got the hemorrhoids from sitting for hours and days at a time while driving in the service. In the August 2015 Notice of Disagreement, the Veteran reported that “statistics” from truck drivers around the world indicates that hemorrhoids is among the most frequently occurring medical issues related to truck driving. During the December 2018 Board hearing, the Veteran testified that: he began noticing hemorrhoids in service with periodic flare-ups that eventually worsened and, although he was examined during service for this issue, he did not have a flare-up at the time of examination; he reported hemorrhoids to the clerk upon separation, but that he was forced to retract his statement so that he could go home; he has had hemorrhoids at least every two months since July 1973, with flare-ups occurring more often than before, and he has consistently used hemorrhoidal cream to treat the condition; he was later prescribed a hemorrhoidal cream in 2014 by a VA provider; he did not work as a tractor-trailer driver post-separation; and this condition is “quite common” with tractor-trailer drivers because they are sitting all day. In the April 2019 Decision, the Board remanded the issue herein to examine the etiology of this condition, while considering the lay contentions. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In a November 2019 Statement, the Veteran reiterated that he reported hemorrhoids to the clerk upon separation, but that he was forced to retract his statement so that he could go home. In a December 2019 VA examination, the Veteran contended that: he reported hemorrhoids upon separation, but that he was forced to retract his statement so that he could go home; he drove over 100,000 miles in service and that hemorrhoids are a known problem for drivers; and his hemorrhoids have continued off and on since then. After the examination and a review of the pertinent medical and lay evidence of record, the December 2019 VA examiner concluded that the hemorrhoids condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that: STR’s were silent regarding the condition and the separation examination specifically records the absence of hemorrhoids; medical records were silent regarding the condition for decades after service; and, although hemorrhoids are associated with prolonged sitting, sitting is not considered a cause of hemorrhoids developing because hemorrhoids are instead caused by deterioration of the connective tissue anchoring veins in the submucosal layer of the rectum and such deterioration is not caused by direct force such as prolonged sitting. In the August 2020 Decision, the Board remanded the issue herein to obtain an addendum etiological opinion, after finding the December 2019 VA opinion to be inadequate because the examiner relied on the absence of contemporaneous records (no evidence of hemorrhoids during active service or for decades after service) to justify the unfavorable opinion. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an “absolute bar” to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) (“Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms”). After a review of the pertinent medical and lay evidence of record, an October 2020 VA examiner rendered the addendum etiological opinion that the hemorrhoids condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that: STR’s did not confirm the existence of hemorrhoids during service; although the Veteran’s in-service duties required prolonged sitting, which is one of the known causes of hemorrhoids, the STR’s simply do not document pertinent complaints, treatment, or diagnoses at that time; and, although the Veteran is competent to report his continuous symptoms since service, there is not enough medical evidence to support his claim without resorting to mere speculation. Based on the evidence above, the Board resolves reasonable doubt in the Veteran’s favor to find that his recurring hemorrhoids condition was at least as likely as not caused by prolonged sitting in service. Specifically, the Veteran is competent to report hemorrhoid onset because it is lay observable through his senses; also, his reports of onset and continuous symptoms/self-treatment have remained consistent throughout the record, making them credible and, thus, probative. Jandreau, supra; Layno, supra. The Buddy Statements of record also help corroborate the Veteran’s contention that he has experienced hemorrhoids since separation, especially the one from his brother, who specifically remembered the Veteran complaining of hemorrhoids right after separation. Further, the October 2020 VA examiner identified prolonged sitting as one of the known causes of hemorrhoids, but concluded that the lack of medical documentation throughout the record made it difficult to corroborate the Veteran’s contentions without resorting to mere speculation. However, the Board has found the Veteran’s statements regarding continuous symptoms since service to be probative and the “Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms” (Barr, supra); as such, the Board finds that etiology has been established through the Veteran’s probative lay statements of chronicity and continuity of symptomatology. 38 C.F.R. § 3.303(b). Thus, service connection is warranted, and the Board grants the claim. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Daus, 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.