Citation Nr: 21014582 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 14-35 048A DATE: March 15, 2021 ORDER Entitlement to service connection for hemorrhoids is denied. FINDING OF FACT The probative and competent evidence of record does not show that the Veteran’s hemorrhoids are related to service. CONCLUSION OF LAW The criteria for service connection for hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5107 (b) (2012); 38 C.F.R.§§ 3.102, 3.303, 3.304, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1969 to September 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in October 2016. A transcript of the hearing is of record. The Board remanded this matter in April 2018, May 2020, and October 2020. The Board finds there has been substantial compliance with its October 2020 remand directives. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that there was no Stegall (Stegall v. West, 11 Vet. App. 268 (1998)) violation when the examiner made the ultimate determination required by the Board’s remand.) Entitlement to service connection for hemorrhoids Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C.§ 1110 (2012); 38 C.F.R.§ 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service (nexus). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When a claimant seeks benefits and the evidence for and against the claim is in relative equipoise, the claimant prevails. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for a claim to be denied. Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran asserts that his hemorrhoids are related to service. Specifically, the Veteran said that he developed bleeding during basic training that he believed was due to hemorrhoids. He did not seek treatment for the bleeding because his sergeant forbade him from leaving training. He further stated that the condition had continued through the present and that he developed hemorrhoids 3 to 4 times per year. Service treatment records are silent for complaints, treatment, or diagnosis of hemorrhoids. VA treatment records showed normal colonoscopies in 1999 and January 2002. In a March 2004 VA treatment record, a history of hemorrhoids was noted. In an October 2012 VA treatment record, it was noted that the Veteran’s last colonoscopy was 8 years ago and there were no significant findings. The Veteran was afforded VA examinations in December 2018 and October 2019. VA opinions were provided in October 2019, July 2020, and January 2021. The Board notes that the May 2020 remand found the December 2018 and October 2019 VA examinations to have conflicting diagnoses for hemorrhoids. Specifically, the December 2018 VA examiner found a current diagnosis of hemorrhoids; however, the October 2019 VA examiner did not find a current diagnosis and referred to only the diagnosis in 2004. Moreover, the October 2019 VA examiner did not address whether an opinion could be provided based on the history provided by the Veteran. Additionally, the July 2020 VA examiner did not consider and discuss the Veteran’s colonoscopies in 1999, 2001, and 2002. The Board notes that following remand, the Veteran did not submit these private treatment records. Regardless, the Board finds the July 2020 VA opinion inadequate because it is based wholly on a lack of contemporaneous treatment records. Nonetheless, the Board will discuss the adequate findings in these VA examinations and opinions. In the December 2018 VA examination, the Veteran said that his hemorrhoids started with rectal bleeding in 1969. He said that he informed his sergeant at the time, but now his hemorrhoids were better and only occurred every 4 months. In an October 2019 VA examination, the Veteran said he started having issues with hemorrhoids in basic training but did not have any medical evaluations for the because he was not allowed to go to sick call. He said his hemorrhoids were so bad they were bleeding. He saw a doctor for the hemorrhoids 2 years after service and continue to have problems with flare ups. The Veteran reported he had flare ups 2 to 3 times per month and they lasted 3 to 4 days. He denied any hemorrhoid surgeries and said his last colonoscopy was 6 to 7 years ago. As stated above, the separate October 2019 VA opinion and July 2020 VA opinion was determined to be inadequate. In a January 2021 VA opinion, the examiner opined that the Veteran’s hemorrhoids were less likely than not related to service. The examiner said that all available records were reviewed including all lay statements. While the Veteran’s lay statement conveyed onset of the hemorrhoid condition during service, there were no documented signs/symptoms/complaints consistent with a diagnosis of hemorrhoids found in the medical records during service. The examiner stated that while lay statements provide important information they did not, in and of themselves, provide evidence of a diagnosis. Colorectal screening note showed the Veteran underwent colonoscopy/flexible sigmoidoscopy in 1999, 28 years post service at an outside facility and the results were negative. Colonoscopy/flexible sigmoidoscopy was an objective study and if hemorrhoids were present, they would have been seen at the time. The examiner concluded that the hemorrhoid condition was noted post service in the claims file in 2004, and was less likely than not related to service. A nexus had not been established. Additional post-service treatment records are silent for any evidence showing a nexus between the Veteran’s hemorrhoids and service. Overall, the Board finds that the evidence does not show that the Veteran’s hemorrhoids are related to service. The Board finds the January 2021 VA examiner’s opinion highly probative as it was based on a review of the claims file. Based on a thorough review of the record, the examiner provided a negative nexus opinion. The Board notes that the VA examiner’s opinion is partially based on a lack of contemporaneous medical evidence. The Board also notes that this is not an absolute bar to service connection. However, the VA examiner’s opinion combined with the record as a whole is highly probative. There is no evidence following separation from service that the Veteran had been treated for hemorrhoids until 1999, over 20 years following separation from service. The Veteran himself asserted at times that his hemorrhoid condition improved and was not constant. This overall evidence would suggest that there is no chronicity of a hemorrhoids condition from separation from service. Additionally, upon separation from service, there was no indication that the Veteran suffered from hemorrhoids. The Board acknowledges the Veteran’s lay opinion. However, although the Veteran is competent to discuss his symptoms, he is not competent to provide the etiology of his hemorrhoids. This requires medical expertise. Therefore, the Board finds the January 2021 VA opinion in conjunction with the evidence as a whole as more probative, and there are no medical opinions to the contrary. Therefore, the Board finds that the preponderance of the evidence is against the Veteran’s claim and entitlement to service connection for hemorrhoids is not warranted. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Saudiee Brown 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.