Citation Nr: 21011069 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 16-18 955 DATE: February 26, 2021 ORDER Service connection for multiple atypical lipomas of the right buttock is denied. REMANDED Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for chronic anxiety disorder is remanded. FINDING OF FACT The preponderance of the evidence is against finding that multiple atypical lipomas of the right buttock began during active service, or is otherwise related to an in-service injury or disease, including exposure to herbicide agents. CONCLUSION OF LAW The criteria for service connection for multiple atypical lipomas of the right buttock have not been met. 38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1962 to March 1966. In April 2019, a video conference Board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran’s claims file. The issues presently before the Board as well as the issues of entitlement to service connection for bilateral neuropathy of the lower extremities, diabetes mellitus, and hypertension were previously before the Board in June 2019. Following development ordered by the Board, service connection was established for bilateral neuropathy of the lower extremities, diabetes mellitus and hypertension. Those issues are no longer on appeal, and the remaining issues have been returned for further appellate consideration. Service Connection Entitlement to service connection for multiple atypical lipomas of the right buttock The Veteran contends that service connection should be established for a skin disorder, which has been characterized as multiple atypical lipomas of the right buttock. It is asserted that this disorder is possibly related to exposure to herbicide agents while the Veteran was in service off the coast of the Republic of Vietnam (RVN). Alternatively, it is believed that this could be related to a lipoma of the ear noted in the Veteran’s service treatment records (STRs). As an initial matter, it is noted that a determination has been made that the Veteran’s exposure to herbicidal agents, including Agent Orange, is conceded based on his nautical service in the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23. See May 2020 VA Memorandum. 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). Disease associated with exposure to certain herbicide agents, listed in 38 C.F.R. § 3.309, will be considered to have been incurred in service under the circumstances outlined in that section even though there is no evidence of such disease during the period of service. If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. While the list of diseases includes Chloracne or other acneform disease consistent with chloracne it does not include non-malignant skin disease such as lipoma. 38 C.F.R. § 3.309(e). However, aside from these presumptive provisions, service connection might be established by satisfactory proof of direct service connection. See Combee v. Brown, 34 F.3rd 1039 (Fed. Cir. 1994). Thus, 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. The Board concludes that, while the Veteran has had diagnoses of multiple lipomas of the right buttock and right hip, and evidence shows that he was exposed to herbicide agents and he had a lipoma excised in service, the preponderance of the evidence weighs against finding that the Veteran’s current disability began during service or is otherwise related to an in-service injury, event, or disease. Review of the Veteran’s STRs shows that in August 1964 he was treated for removal of a cyst of the left earlobe. On examination for separation from service, and on reserve examination in March 1968, clinical evaluation of the skin was normal. An examination was conducted by VA in December 2020. At that time, the diagnosis was atypical lipoma, asymptomatic on examination. The date of diagnosis was listed as 1990. The Veteran reported that he had developed a large and recurrent lipoma on the right lateral hip and buttock area, and that he had had four surgeries to remove the lipoma, the last being in 2010. The condition was stated to have resolved. After examination and review of the record, the examiner opined that it was less likely than not that an “atypical lipoma” had been incurred in or caused by the in-service injury, event or disease, including the cyst for which the Veteran was treated in 1964. The examiner explained that the lipoma that was removed in 1964 was from the left ear and that the Veteran’s present history of recurring atypical lipomas was first demonstrated in 1990. Medical records further outlined removal of the lipoma in 1997, 2001, and 2011. The examiner additionally explained that Agent Orange exposure was not an established etiological factor for atypical lipomas. Treatment records show the Veteran was not diagnosed with an atypical lipoma until 1990, many years after his separation from service. While he is competent to report having experienced symptoms lipoma intermittently since service, he has not actually done so and is not, in any event he is not competent as a lay person to provide a diagnosis in this case or determine that his present symptoms/disability are related to the cyst excision that he underwent while on active duty, or that they are related to herbicide agents exposure. The questions involved in this case are medically complex, as they require knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). It appears that the Veteran’s main contention is that this disorder is related to his exposure to herbicide agents while on active duty. While he is presumed to have been so exposed, there is no presumption regarding this disability and exposure to herbicide agents. Further, the VA examiner opined that the Veteran’s repeated lipomas were not at least as likely as not related to an in-service injury, event, or disease. The rationale was that the in-service cyst of the left ear was unrelated to the lipomas that developed many years later. The examiner also explained that Agent Orange exposure was not an established etiological factor for atypical lipomas. The examiner’s opinion is probative because it is based on an accurate understanding of the Veteran’s medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Additionally, there is no competent evidence to the contrary. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for service connection for asymptomatic lipomas, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to service connection for ED is remanded. The Veteran seeks service connection for ED. His contentions include that the disorder may be secondary to a service-connected disease or disability. In December 2020, the Veteran was provided a VA examination. The examiner, in pertinent part, provided an opinion that the claimed ED was less likely than not proximately due to or the result of the Veteran’s service-connected diabetes mellitus. The examiner explained because the ED occurred after a transurethral resection of the prostate (TURP), it was less likely than not proximately due to or the result of the diabetes mellitus. This opinion does not, however, address the question of whether the Veteran’s ED has been aggravated by his diabetes mellitus. “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). Under these circumstances, an addendum opinion is necessary. Entitlement to service connection for a chronic anxiety disorder is remanded. In August 2020, the Veteran was provided a VA examination wherein an unspecified anxiety disorder was diagnosed. The examiner opined, in pertinent part, that the Veteran’s claimed ED was at least as likely as not proximately due to or the result of his service-connected conditions. As rationale for that opinion, the examiner noted that the Veteran reported anxiety due to his medical conditions (status post TURP and subsequently ED). The examiner also noted that, according to the Veteran’s postservice treatment records, in November 2013, he was noted to have multiple medical problems related to medical problems, and was prescribed medication for a diagnosis of anxiety at that time. The examiner further observed that the Veteran’s medical condition resulting in multiple surgeries for the removal of tumors and treatment of prostate cancer could reasonably cause symptoms of anxiety. Given that the August 2020 VA examiner’s opinion relates the Veteran’s chronic anxiety disorder, in part, to his ED, which is being remanded herein for additional development, the Board finds that the claim for service connection for a chronic anxiety disorder is inextricably intertwined and must also be remanded. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s ED is at least as likely as not aggravated beyond its natural progression by his service-connected diabetes mellitus. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joseph P. Gervasio 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.