Citation Nr: 21008003 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 15-32 284 DATE: February 11, 2021 ORDER Service connection for a lower gastrointestinal (GI) bleed, to include as secondary to service-connected disabilities, is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s lower GI bleed is due to a disease or injury in service or secondary to his service-connected disabilities. CONCLUSION OF LAW The criteria for service connection for a lower GI bleed are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Navy from June 1969 to June 1971. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a videoconference Board hearing in December 2018; a transcript is of record. This matter was subsequently remanded by the Board in January 2020 for additional development. This matter has now returned to the Board for appellate consideration. The Board finds there has been substantial compliance with its prior remand directives. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). The Veteran was provided with an examination for his claim on appeal. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must generally be 1) evidence of a current disability; 2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and 3) causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disability, which is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either caused or aggravated by a service-connected disease or injury. Allen v. Brown, 7 Vet. App. 43, 448-49 (1995). The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990). Entitlement to service connection for a lower gastrointestinal bleed, to include as secondary to service-connected disabilities. The Veteran asserts service connection for a lower GI bleed, to include as due to service-connected disabilities and the accompanying treatment. The Board concludes that, while the Veteran has a diagnosis of a lower GI bleed during the period on appeal, the preponderance of the evidence is against finding it is related to service. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), 3.309(a). He has a diagnosis of a lower GI bleed during the period on appeal. As such, the first element of service connection is met. He testified at the Board hearing in December 2018 that he developed rectal bleeding after radiation therapy. In this regard, the Board acknowledges the Veteran’s belief that his disability is secondary to his service-connected prostate cancer treatment, but he is not competent to opine on the nexus as it requires specialized knowledge of multiple systems and corresponding treatment. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As such evidence is not competent, the Board does not find that it is relevant or probative of the matter on appeal. A negative nexus opinion was provided in August 2020. The examiner found that it was less likely than not that his lower GI bleeding was incurred in or caused by service or proximately due to or aggravated by any service-connected disability. The examiner stated that the Veteran did not have a history of lower GI bleeding in in service or within one year of separation. In support, the examiner noted that he did not have rectal bleeding until April 2016 as evidenced by him presenting to a civilian Emergency Room for bleeding. The examiner reported the ER physician stated it was likely due to radiation therapy; however, a later workup found that it was caused by internal hemorrhoids and not caused by or aggravated by radiation therapy.   The Board finds this opinion to have great probative value and it carries much weight. The examiner thoroughly reviewed the medical records as reported above, and found the cause of the Veteran’s lower GI bleeding was due to his non service-connected hemorrhoids rather than radiation therapy for his service-connected prostate cancer. The Board finds the VA medical doctor’s rationale to be logical and supported. The Veteran has submitted private medical records as well. In April 2016, records state that his lower GI bleed was likely due to prior radiation therapy, but a follow-up was needed. However, the Board finds this statement to have no probative value as it was speculative without appropriate testing. Other private medical records, in November 2016, reported that following a colonoscopy, his rectal bleeding was felt to be related to hemorrhoids. After review of the competent and probative evidence, the Board finds that the preponderance of the evidence is against service connection for a lower GI bleed. The competent and highly probative 2020 VA opinion stated that his lower GI bleeding was due to internal hemorrhoids, which the Veteran is not service connected for, as shown by testing in 2016. Additionally, there is no positive nexus opinion for service connection that it probative and carries anything more than low weight. Indeed, the Board acknowledges the 2016 emergency room statement, but has found it is not entitled to probative weight as it is speculative and not based on medical testing. Moreover, the Board acknowledges the Veteran’s belief that his lower GI bleeding was due to radiation therapy. However, he is not competent to provide a nexus statement in a matter involving the gastrointestinal system. As such, statements in this regard lack weight. (Continued on the next page)   Therefore, the preponderance of the evidence is against a finding that the Veteran’s disability is related to his service or secondary to his service-connected disabilities. The available competent and probative evidence weighs against a nexus to service. As such, reasonable doubt does not arise, and the appeal is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Morales, 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.