Citation Nr: 21008430 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 20-06 977 DATE: February 17, 2021 ORDER Entitlement to service connection for hemorrhoids is granted. FINDING OF FACT The evidence is at least in equipoise as to whether the Veteran has hemorrhoids that had their initial onset in service. CONCLUSION OF LAW The criteria for establishing service connection for hemorrhoids have been met. 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 March 1967 through October 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a February 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for hemorrhoids Legal Criteria Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection requires competent 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), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for certain enumerated diseases may also be established on a presumptive basis by showing that it manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). In addition, for chronic diseases listed in 38 C.F.R. § 3.309(a), such as arthritis, service connection may also be established by showing continuity of symptoms, which requires a claimant to demonstrate (1) that a condition was “noted” during service; (2) evidence of post-service continuity of symptoms; and (3) medical or, in certain circumstances, lay evidence of a link between the present disability and the post-service symptoms. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013) (holding that only those chronic diseases listed in 38 C.F.R. § 3.309 are subject to service connection by continuity of symptoms described in § 3.303(b)). The correct understanding of the “condition ‘noted’ during service” is that the condition is one that is indicative of but not dispositive of a chronic disease. Walker, 708 F.3d at 1339. In other words, continuity of symptomatology after discharge is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned, i.e., “when the fact of chronicity in service is not adequately supported.” 38 C.F.R. § 3.303(b); see also Walker, 708 F.3d at 1339-40. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.102, 4.3. In consideration thereto, the Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Factual Background and Analysis The Veteran contends that service connection for hemorrhoids is warranted. In correspondence from June 2017, August 2017 and March 2019, the Veteran asserted that his hemorrhoids had its onset during service and that symptoms of hemorrhoids have been continuous since service discharge. The record also includes third-party statements from the Veteran’s family members to include his spouse, who all observed symptoms of the Veteran’s hemorrhoid condition. At a May 1971 VA in-service examination, the Veteran reported hemorrhoids to include rectal pain and bleeding while in service. In November 2010, a private treatment record indicated the Veteran underwent treatment for internal and external hemorrhoids to include a colonoscopy and biopsy. In a January 2019 VA examination, the examiner indicated internal and external hemorrhoids including a treatment plan using over-the-counter suppositories as needed. Upon examination, the examiner observed small or moderate external hemorrhoids. The examiner opined that the hemorrhoids did not affect the Veteran’s ability to work. After a review of the evidence of record, the Board finds that service connection for hemorrhoids is warranted. The Board finds that the Veteran has a current diagnosis of hemorrhoids as reflected in September 2020 and October 2020 medical opinions from the Veteran’s private physicians as well as a November 2010 private medical record. The Board further finds that the evidence is at least in equipoise on the question of whether there was an onset of symptoms of hemorrhoids in service and since service separation, i.e., whether hemorrhoids were “incurred in” service. The Veteran served on active duty from March 1967 through October 1968. Service treatment records from August 22-28, 1967 show that the Veteran received treatment for hemorrhoids during active service. (Continued on the next page)   While hemorrhoids are not a chronic disease listed under 38 C.F.R. § 3.309(a), as indicated above, the Board has nonetheless found the evidence at least in equipoise on the question of whether the Veteran had symptoms of hemorrhoids that began during service and continued since service separation, thus tending to show direct service incurrence. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a), (d). The Board is granting service connection based on evidence, including that pertinent to service, which establishes that the symptoms of hemorrhoids began in service, and that hemorrhoids were thus “incurred in” service. The finding that the Veteran has had hemorrhoids symptoms since service is supportive of the overall direct service connection claim because it tends to show that the symptoms that began in service were the basis for the later diagnosed hemorrhoids. See Horowitz v. Brown, 5 Vet. App. 217, 221-22 (1993) (lay statements are competent on in-service and post-service symptoms - dizziness, loss of balance, hearing trouble, stumble and fall, and tinnitus - that were later diagnosed as Meniere’s disease). For these reasons, and resolving reasonable doubt in the Veteran’s favor, the Board finds that the criteria for direct service connection for hemorrhoids have been met. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Hamilton, 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.