Citation Nr: 21009725 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 08-01 951 DATE: February 23, 2021 ORDER Entitlement to service connection for a testicular disability, to include chronic epididymitis with transient hydrocele, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that any testicular disability, to include chronic epididymitis with transient hydrocele, was incurred in, or is otherwise related to, his period of active service. 2. The preponderance of the evidence is against finding that any testicular disability, to include chronic epididymitis with transient hydrocele, was caused, or aggravated, by a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for a testicular disability, to include chronic epididymitis with transient hydrocele have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from September 1972 to December 1976. The Veteran testified at a videoconference hearing before the undersigned in September 2011. A copy of the transcript is of record. The Board of Veterans’ Appeals (Board) Board remanded the Veteran’s claim for additional development in November 2011, March 2013, December 2016, June 2018, and October 2020. The completed development reveals that, at the very least, substantial compliance with the remand directives was obtained. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Entitlement to service connection for a testicular disability, to include chronic epididymitis with transient hydrocele The Veteran contends that he suffers from a testicular disability that was incurred during his period of active service. During his 2011 Board hearing, the Veteran reported that he woke up from an in-service appendectomy with a swollen right testicle. He stated that he continued to have recurrent symptoms of swelling of the right testicle during his period of service, and that he has continued to have symptoms off and on since the in-service occurrence. Unfortunately, the Board is unable to grant service connection for a testicular disability, to include chronic epididymitis with transient hydrocele, as the evidence does not support a nexus between the Veteran’s period of service and any current disability. Generally, service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. To establish service connection for a disability, the Veteran must show: (1) the existence of 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 disease or injury incurred in or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 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 may also be granted for disability, which is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310(a). “When aggravation of a veteran’s non-service-connected condition is proximately due to or the result of a service-connected condition, such veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation.” Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran’s service treatment records reflect that the Veteran had treatment to his abdomen, including after his 1974 appendectomy. In June 1973, he complained of an ache near his stomach, and was diagnosed with an impression of muscle spasm. In September 1974, he underwent the appendectomy. The accompanying operation report shows that his appendix was removed, and that observation of the small bowel was normal. Approximately 4 days later, the Veteran was treated for complaints of right lower quadrant periumbilical pain. He was diagnosed with abdominal pain, cause unknown, gastroenteritis suspected, not proven. In April 1975, the Veteran was seen at the Darnell Army Hospital regarding complaints of a “knot in leg” and presented with indurated tender enlarged area in upper right thigh. He also reported complaints of occasional numbness while standing with weight on his right leg. A provisional diagnosis of lymphangitis was provided. The Veteran was referred to the surgical clinic that agreed with the diagnosis of lymphangitis. In an undated record, the Veteran sought treatment again for complaints of a mass in his upper leg. He also reported a mass in his groin area. He stated that he had received treatment at Darnell Army Hospital. An impression of a possible swollen lymph node was provided. Finally, an August 1976 Report of Medical History for the purpose of separation from service, reveals the Veteran indicated he experienced stomach, liver or intestinal trouble. He also reported a history of venereal disease. However, no other significant medical history was indicated. A concurrent Report of Medical Examination reflects normal findings for the genitourinary system, and abdomen and viscera. In June 1980, the Veteran filed a claim for service connection for a left shoulder injury and an infected tick bite. The Veteran was provided a VA examination in September 1980. At that time, the Veteran provided a present complaint related to his “testicles.” The examiner stated that with regard to his third complaint which he described as “residuals of appendectomy” that the only residual was a scar. No report of swelling was provided, and the examiner did not report any impairment related to the Veteran’s testicles. The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence in light of the entire record. A layperson is competent to report on the onset and continuity of current symptomatology based on personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if the layperson: (1) is competent to identify the medical condition, (2) is reporting a contemporaneous medical diagnosis, or (3) is describing symptoms that support a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, at 1376-77 (Fed. Cir. 2007). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. See Caluza v. Brown, 7 Vet. App. 498 (1995). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Initially, the Board notes that service connection may be awarded if a chronic disease manifests itself and is identified as such in service, or within the presumptive period under 38 C.F.R. § 3.307, and the Veteran presently has the same condition, unless the condition is clearly attributable to intercurrent causes. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309; see Walker v. Shinseki, 708 F.3d 1331, 1336 (Fed. Cir. 2013). The continuity of symptomatology provision of 38 C.F.R. § 3.303 (b) has been interpreted as an alternative to service connection for the chronic diseases listed in 38 C.F.R. § 3.309 (a). See Walker, at 1331. While the Veteran’s condition has been diagnosed as chronic epididymitis, transient hydrocele, the Board notes that chronic epididymitis is not listed under 38 C.F.R. § 3.309(a) and is not a chronic condition for the purposes of 38 C.F.R. § 3.309. As such, service connection may not be awarded based solely upon the Veteran’s reports of continuous symptomatology pursuant to 38 C.F.R. § 3.303 (b), and service connection on a presumptive basis is not warranted. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309; see Walker. Therefore, the Board finds that service connection on a presumptive basis is not warranted. Nonetheless, service connection is still available on a non-presumptive basis. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). With regard to direct service connection, the Board notes that the evidence establishes that the Veteran has a current testicular disability. The Veteran was diagnosed with an intermittent small bilateral hydrocele in a December 2011 VA examination. He was also diagnosed with acute recurrent epididymitis in an October 2019 VA examination. Accordingly, the first criteria necessary for service connection is met. Second, the Veteran’s service treatment records establish that the Veteran underwent an appendectomy during his period of service in 1974. Further, the Board notes that the Veteran is competent to report swelling and discomfort in his right testicle, after his in-service surgery and during erections. As such, the evidence establishes an in-service event. Unfortunately, the Board finds that the weight of the evidence does not provide a link between any testicular disability diagnosed during the appeal period and his period of active service. The Board notes that multiple VA medical examinations and opinions have been obtained in relation to the Veteran’s claim for service connection for a testicular disability. None of the medical opinion of record, however, provide a link between any current testicular disability and the Veteran’s period of active service, including his in-service appendectomy. Particularly, the Board finds probative the opinion of the November 2020 VA examiner. The examiner provided a thorough rationale that is supported by the evidence of record, including consideration of the lay statements provided by the Veteran. The examiner noted that the Veteran’s separation exam was negative, including the Veteran’s reports at that time, and that the September 1980 examination did not provide clinical evidence of a condition at that time. The examiner explained that based upon the lack of findings in the earlier examinations and the lack of medical documentation of a epididymitis/hydrocele until over twenty years after separation from service that it is less than at least as likely as not that the Veteran’s current condition is related to any incident of his active service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (explaining that the Board may consider “evidence of a prolonged period without medical complaint,” along with other factors in resolving a claim). As such, the Board finds the November 2020 VA medical opinion to be highly probative evidence weighing against a relationship to between any current testicular disability and the Veteran’s active service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Further, none of the medical evidence of record provides a nexus between any current testicular disability and the Veteran’s period of active service. While the Veteran has reported recurrent complaints of this condition since at least 2002, the evidence of record, including his VA treatment records, does not include a medical opinion linking his current disability to his period of service. While the Veteran the Veteran is competent to report symptoms of swelling and discomfort in his right testicle that periodically occurs, the Veteran is not competent to opine as to whether the symptoms of his small bilateral hydrocele and recurrent epididymitis are related his symptoms experienced during service or whether they are caused by any in-service activity or event. The Board would note that the 2017 VA examiner opined that the Veteran’s symptoms may be related to hormone levels, particularly testosterone, in the Veteran’s body. The Veteran has not contended, and the evidence does not show, that he has the medical expertise to provide an opinion regarding the etiology of such a condition. The Board finds that an opinion regarding the causation of the Veteran’s current disability or a link between his in-service symptoms and his current testicular symptoms is beyond the scope of a lay opinion. See Jandreau, at 1376-77. Without any competent evidence reporting a relationship between the Veteran’s current testicular disabilities and his period of service, the Board finds that the weight of the evidence is against the Veteran’s claim, and service connection on a direct basis must be denied. See 38 C.F.R. §§ 3.303, 3.304. The Board also notes that the Veteran has claimed that the condition is secondary to a ventral hernia. See September 2006 Statement in Support of Claim. The Veteran, however, is not service-connected for a ventral hernia. As such, service connection on a secondary basis with regard to a ventral hernia cannot be established. See 38 C.F.R. § 3.310. In conclusion, the Board finds after careful review of the entire record that the weight of the evidence is against the Veteran's claim of service connection for a testicular disability. In reaching this conclusion the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 53-56. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.M. Johnson, 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.