Citation Nr: 21014224 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 18-41 095 DATE: March 11, 2021 ORDER Entitlement to service connection for an abdominal scar is denied. FINDING OF FACT The Veteran’s abdominal scar is not secondary to his service-connected prostate cancer, and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for an abdominal scar, as due to service- connected prostate cancer, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 1966 to May 1969. This appeal comes before the Board of Veterans Appeals (Board) from an April 2018 rating decision of a VA Regional Office (RO). In June 2020, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge sitting at the Central Office in Washington, D.C. A transcript of the hearing is of record. During the hearing in June 2020, the Veteran and his representative indicated that that in seeking service connection for an abdominal scar, the Veteran asserts that the scar is the result of surgery at the VA in 2010 for a nonservice connected disability and should be granted as if service-connected under 38 U.S.C. §1151. Claims for service connection are separate and distinct from claims for compensation under 38 U.S.C. § 1151. Anderson v. Principi, 18 Vet. App. 371 (2004). The Board notes that the Veteran filed a separate claim for compensation under 38 U.S.C. §1151 in January 2021. To date, no rating decision has been issued addressing said claim. The Veteran did not withdraw the claim for service connection and therefore the Board will address that claim below. In February 2021, additional evidence was associated with the claims file that has not yet been considered by the RO. However, the Veteran waived initial RO consideration of that evidence. Entitlement to service connection for an abdominal scar 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; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the claimed in-service disease or injury and the present disability. See, e.g., Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). 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 (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). As noted above, the Veteran has clarified that his abdominal scar is related to a surgical procedure he underwent at a VA facility for a nonservice connected disability. However, based on the Veteran’s testimony during his June 2020 hearing, his claim has been developed based on his abdominal scar being related to an exploratory surgical procedure to assess whether his service-connected prostate cancer had spread. When this matter was last before the Board in September 2020, it was remanded to obtain an addendum medical opinion. The Board found that a previous March 2018 VA examination was incomplete for adjudicative purposes, as the examiner did not address whether the Veteran’s abdominal surgery was related to, or secondary to his service-connected prostate cancer. The Veteran was afforded an addendum medical opinion in September 2020. The examiner concluded that the Veteran’s claimed abdominal scar was not related to his service-connected prostate cancer, to include exploratory surgery to assess the possible spread or recurrence of his prostate cancer. As rationale, the examiner detailed the history leading up to the January 2011 surgery that caused the Veteran’s claimed abdominal scar. The examiner noted that in November 2010 the Veteran had a positive fecal occult blood testing and was sent for a screening colonoscopy. The Veteran then underwent the screening colonoscopy, which resulted in the removal of 9 polyps. However, during the colonoscopy, an ulcerated lesion was discovered which could not be removed. As a result, the Veteran had a sigmoidectomy in January 2011 which resulted in a 43 centimeter scar. Based on the above history, the examiner indicated that he could say with certainty that the surgical procedure which resulted in the abdominal scar was motivated by a positive fecal occult blood test. The examiner indicated that the surgeon’s main concern was colonic cancer, rather than any concern related to the Veteran’s service-connected prostate cancer. The examiner noted that in the medical records related to the Veteran’s January 2011 surgery, there was no mention of the Veteran's history of prostate cancer and prostatectomy that he underwent in September 1997. Additionally, the examiner noted that at the time of the procedure, the Veteran’s PSA value was 0.13; which would not indicate any suspicion for regrowth of the prostate cancer. Further, the examiner noted that subsequent PSA readings in 2012 did not show increased PSA values. Finally, as to the Veteran’s statement that his surgeon told him the January 2011 surgery was related to possible spread of the prostate cancer, the examiner noted that there was no evidence of such conversation in the medical records. The Board finds that the September 2020 examiner’s opinion is highly probative, as it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Moreover, the Board notes that there is no medical opinion of record to refute the findings of the September 2020 examiner. While the Board has considered the Veteran’s contentions that his abdominal scar is related to his service-connected prostate cancer, he is not competent to provide a nexus opinion in this case. The issue is medically complex, and falls outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. (Continued on the next page)   The Board finds that as the preponderance of the evidence is against a finding that the Veteran's abdominal scar is caused by or related to his service-connected prostate cancer, the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the competent, probative evidence is against the claim, the doctrine is inapplicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Marsh II, 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.