Citation Nr: 21013482 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 16-43 580 DATE: March 9, 2021 ORDER Entitlement to service connection for hemorrhoids as secondary to duodenal ulcer is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s hemorrhoids were either proximately caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for hemorrhoids have not been met. 38 U.S.C. § 1110, 1131, 1154, 5107; 38 C.F.R. § 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from February 1950 to May 1951. This appeal comes to the Board of Veterans’ Appeals (Board) from a rating decision dated July 2014 issued by a Department of Veterans Affairs (VA) Regional Office. The Veteran timely appealed. The Veteran’s appeal has previously been before the Board. In October 2020, the Board remanded the Veteran’s hemorrhoids claim to the Agency of Original Jurisdiction (AOJ) for additional development. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Service Connection In order to prevail on the issue of entitlement to secondary service connection, there must be: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence, generally medical, establishing a connection between the service-connected disability and the current disability. 38 C.F.R. § 3.310; Wallin v. West, 11 Vet. App. 509, 512 (1998). Entitlement to service connection for hemorrhoids as secondary to duodenal ulcer The Veteran seeks entitlement to service connection for hemorrhoids as secondary to his duodenal ulcer. The Veteran, his representative, and the record raise no other theory of service connection. As a result, the Board will limit its analysis to the theory advanced by the Veteran. Robinson v. Peake, 21 Vet. App. 545, 552-56 (2008). Following a thorough review of the Veteran’s medical records, the Board finds that he is not entitled to an award of service connection. As an initial matter, the Board finds that the Veteran has satisfied the first element of secondary service connection, a current disability. A review of the Veteran’s November 2020 VA examination shows the Veteran has internal or external hemorrhoids that were diagnosed in 2010. See VA Examination dated November 2020. Therefore, the Board finds that the Veteran has satisfied the first prong of service connection, the existence of a current disability. As to evidence of a service-connected disability, the Veteran is service-connected for a duodenal ulcer. Therefore, the Board finds that the Veteran has satisfied the second prong of service connection on a secondary basis: evidence of a service-connected disability. Turning next to evidence of a causal relationship between the service-connected disability and the current disability, the Board finds the most probative evidence does not support a nexus. After completing a review of the file and a physical examination of the Veteran, the July 2014 examiner opined that the Veteran’s hemorrhoids were “not caused by duodenal ulcers, nor are they aggravated by them. Hemorrhoids are caused by increase in pressure from factors such as straining, pregnancy, obesity.” As noted by the Board in the prior remand, the examiner did not provide any rationale regarding aggravation. To this point, the Board finds that the July 2014 VA examiner’s opinion is adequate with regard to the “causation” prong under Allen and 38 C.F.R. §3.310, but not the aggravation prong. In a November 2020 opinion consequent to the Board’s remand, a VA examiner concluded that the Veteran’s hemorrhoids were less likely than not aggravated beyond its natural progression by his duodenal ulcers. As rational, the examiner provided: Veteran started experiencing hemorrhoids while in active duty as he was suffering from duodenal ulcers. Veteran has tried [over-the-counter] creams all these years with minimal relief. Veteran had a colonoscopy March 3, 2010 which demonstrated internal non bleeding medium sized hemorrhoids. Veteran continued to experience hemorrhoids and uses [over-the-counter] creams and suppositories at least twice a week. Unfortunately, there are no STRs while in active service nor immediate service duty. In a separate section of the examination, it was noted that the opinion should consider the effects of any medication prescribed or taken to treat the ulcer. The examiner provided the same opinion articulated above and added, “There is no known scientific or medical literature that support ulcers aggravate hemorrhoids. Therefore, Veteran’s hemorrhoids are not aggravated by the ulcer.” The evidence of record does not show any positive nexus evidence that would support a causal relationship between the Veteran’s hemorrhoids and a service-connected disability. The Board finds the opinions of the July 2014 and November 2020 VA examiners, when read in tandem, to be probative, as they provided clear conclusions with supporting data, and reasoned medical explanations connecting the two. The examiners provided clear conclusions and rationales for both causation and aggravation. Accordingly, the Board places great probative value on the opinions reached by these examiners. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Although the Veteran is competent to report symptoms and experiences that are observable to an ordinary person, there is no indication that he has the medical qualifications or experience necessary to offer an expert opinion on a matter of whether a nexus exists between his hemorrhoids and his service-connected duodenal ulcer. Layno v. Brown, 6 Vet. App. 465, 470 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). The probability that a relationship exists between his hemorrhoids and his service-connected duodenal ulcer is a matter of medical complexity and not the proper subject of lay testimony. His opinion, no matter how sincere, is not competent nexus evidence. (Continued on the next page)   Therefore, the Board finds the only probative nexus evidence is against a finding that the Veteran’s hemorrhoids were either proximately caused or aggravated by his service-connected duodenal ulcer. SCOTT W. DALE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Bristor 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.