Citation Nr: 21014368 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 15-18 152 DATE: March 12, 2021 ORDER Service connection for a colorectal disorder is denied. FINDING OF FACT A colorectal disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service. CONCLUSION OF LAW The criteria for service connection for a colorectal disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1976 to July 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in September 2011 by a Regional Office (RO) of the Department of Veterans Affairs (VA). In February 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In August 2019, the Board remanded the instant claim for additional development and it now returns for further appellate review. Entitlement to service connection for a colorectal disorder. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. The Veteran seeks service connection for a colorectal disorder (claimed as a colon growth) that he asserts manifested during service. Specifically, during his Board hearing, he testified that a rectal or colon growth detected during his service separation examination (identified as a firm fixed mass inside the anal ring) is still there, has gotten progressively worse as he has gotten older, and results in an obstruction when going to the bathroom; indigestion, diarrhea, and constipation (i.e., irritable bowel syndrome or diverticulitis); and pain and bleeding (i.e., hemorrhoids). Thus, the Veteran claims that service connection for such disorder is warranted. As referenced above, while the Veteran’s service treatment records are negative for any complaints, treatment, or diagnosis referable to a colorectal or intestinal disorder, his April 1980 separation examination reflects that clinical evaluation of the anus and rectum revealed a firm fixed mass inside the anal ring. Such was described as a firm fixed mass 0.5 cm in diameter about 2.5 cm inside the anal ring at about 7:00 o’clock. Post-service treatment records include a November 2008 colonoscopy report, which reflects findings indicating diverticulosis, and 2009 and 2010 VA treatment records, which reveals the Veteran’s report of ongoing abdominal pain of an undetermined etiology, despite a thorough gastrointestinal clinical workup. Further, in February 2014, it was noted that the Veteran had a diagnosis of diverticulosis as noted on colonoscopy. In the August 2019 Remand, the Board determined that a June 2011 VA examination and August 2011 opinion were inadequate to decide the instant claim. As such, the Board remanded the matter in order to afford the Veteran another VA examination so as to determine the nature and etiology of his claimed colorectal disorder. Accordingly, in November 2020, the Veteran underwent VA stomach, intestinal, and rectal examinations, during which a thorough rectal examination was conducted, and he was diagnosed with diverticulosis and hemorrhoids. However, in a corresponding medical opinion, the VA examiner concluded that it is unlikely either disorder is related to his military service, to include his documented in-service rectal mass. In this regard, she stated that such rectal mass, as described on the Veteran’s separation examination, was not present during his November 2008 colonoscopy or computerized topography (CT) abdominal scan, indicating that such in-service mass has resolved. Further, the examiner stated that such a mass could not be confused with, or mistaken for, either hemorrhoids or diverticula, which are separate clinical disorders with distinct and unrelated pathology. The Board accords the November 2020 VA examiner’s opinion addressing the etiology of the Veteran’s current colorectal disorders great probative weight as such considered all of the pertinent evidence of record, to include the statements of the Veteran and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Notably, there is no medical opinion to the contrary. The Board also considered the Veteran’s assertions as to the etiology of his colorectal disorder; however, as a lay person, he does not have the requisite training and experience necessary to address such a complex medical matter. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Moreover, while the Veteran reported a continuity of symptomatology of rectal bleeding and pain since approximately 1981, the Board notes that whether such symptoms are in any way related to his currently diagnosed colorectal disorders of diverticulosis and hemorrhoids is a matter that also requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999) (“although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with”). Accordingly, the Veteran’s opinions as to the onset and etiology of his colorectal disorder is not competent evidence and, consequently, is afforded no probative weight. In sum, given that the fact that the probative evidence of record fails to demonstrate residual impairment related to the rectal mass detected upon the Veteran’s April 1980 separation examination or a relationship between his current colorectal disorders, diagnosed as diverticulosis and hemorrhoids, and service, the Board finds that service connection for such disorder is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim for service connection for a colorectal disorder. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Northcutt, 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.