Citation Nr: 21021717 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 16-18 420 DATE: April 13, 2021 ORDER Entitlement to service connection for an alcohol use disorder as secondary to the service-connected disability of hemorrhoids is denied. FINDING OF FACT The preponderance of the probative evidence of record is against a finding that the Veteran’s alcohol use disorder was caused or aggravated by a service-connected hemorrhoid disability. CONCLUSION OF LAW The criteria for service connection for an alcohol use disorder as secondary to the service-connected disability of hemorrhoids have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.301, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1968 to March 1970. This matter comes before the Board of Veterans Appeals (Board) from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office. In June 2020, the Board remanded the matter for an addendum opinion regarding the nature and etiology of the Veteran’s alcohol use disorder. That development has been completed in substantial compliance with remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The Board notes that in the June 2020 decision, the Board denied entitlement to service connection for a psychiatric disability as direct to service and secondary to his service-connected hemorrhoids. The discussion below is limited to his claim for an alcohol use disorder. 1. Entitlement to service connection for an alcohol use disorder as secondary to the service-connected disability of hemorrhoids The Veteran is claiming that his alcohol use disorder is secondary to his service-connected hemorrhoid disability. See March 2021 Appellate Brief. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. However, service connection may not be granted for alcohol dependence on the basis of in-service incurrence or aggravation. See 38 U.S.C. §§105, 1110; 38 C.F.R. §3.301. Nevertheless, service connection may still be established for alcohol dependence on a secondary basis. Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. To prevail on the issue of entitlement to secondary service connection, there must be evidence of (1) a current disability; (2) a service-connected disability; and (3) a nexus establishing a connection between the service-connected disability and current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). In making all determinations, the Board must fully consider the lay assertions of record. Likewise, the Board must assess the credibility and weight of all the evidence, including medical evidence, to determine its probative value, accounting for evidence which it finds to be more persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving the issue shall be given to the claimant. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Regarding a current disability, the Veteran was diagnosed with a mild alcohol use disorder. See August 2014 VA Examination Opinion, pg. 2. The Board notes that the August 2020 examiner did not find that the Veteran clearly had an alcohol use disorder. To the extent that the two examinations offer differing opinions regarding the existence of a diagnosed disability, the Board finds that the evidence is in equipoise. Finding the benefit of the doubt for the Veteran, the Board finds that he has been diagnosed with a mild alcohol use disorder. See Gilbert, 1 Vet. App. 49. Thus, the first element of secondary service connection has been met. Regarding a service-connected disability, he was granted service connection for hemorrhoids at 0 percent disabling in June 1970. See June 1970 Rating Decision. Therefore, the Board finds that the second element of secondary service connection is met. See Wallin, 11 Vet. App. at 512. The only question for the Board is whether there is evidence of a nexus between his alcohol use disorder and his hemorrhoid disorder—specifically, whether the alcohol disorder is proximately due to, or aggravated by, his hemorrhoid disorder. In that regard, the Veteran was afforded a VA examination in August 2014. The examiner opined that the Veteran’s alcohol use disorder has no relation to his service-connected hemorrhoid disability. The Board noted however, that in providing the negative nexus opinion, the examiner did not provide a rationale or address the causation or aggravation prongs of secondary service connection. See August 2014 VA Examination Opinion. For this reason, the Board remanded the matter for an addendum opinion that provided a clear rationale as to whether the alcohol use disorder was caused, or aggravated by, his hemorrhoid condition. See June 2020 Board Remand, pg. 13. In conjunction with the Board request, the Veteran was afforded a new examination in August 2020. The 2020 examiner opined that the Veteran’s alcohol use disorder was not caused, or aggravated by, his hemorrhoid condition. See August 2020 VA Examination Opinion, pgs. 3-4. The examiner reviewed the Veteran’s medical treatment records from 1998 to 2020 and found no evidence of alcohol or other substance abuse treatment, or other concerns associated with alcohol abuse. See id. at pg.3. The examiner noted that the Veteran’s alcohol use had improved to the point that the criteria for alcohol use disorder had not been met at any time during a period of 12 months of longer. To this extent, the 2020 examiner noted that the Veteran’s alcohol use disorder was in fact less pronounced and may have been qualified as in remission. See id. The examiner noted that according to the Veteran’s own report, his current alcohol use was “not being reported as excessive and ranged from less than monthly to 5-6 beers per year.” Id. The examiner noted that medical records contained no evidence of alcohol or other substance abuse treatment, or concerns related to excessive consumption. Although the Veteran claimed that his alcohol use disorder was related to his hemorrhoid condition, the examiner found no evidence of a relationship to his hemorrhoid condition. The examiner noted that the causes of alcohol abuse were multifactorial and were related to environment, genetics, physiology, personality, stress mental disorders and medical disorders. The examiner noted that the Veteran reported that he began drinking heavily before he entered the service and began to progressively reduce his consumption around 1980, or roughly 10 years after separation from service. The examiner also noted that the Veteran was currently in a stable marriage of 22 years, was a successful farmer and did not report a current aggravation of or indicate signs of exacerbation of an alcohol use disorder. The examiner concluded that it is not possible, based on the discussion of his medical records and lack of objective evidence of treatment for, or objective indication of alcohol use disorder, to conclude that a hemorrhoid condition either caused or aggravated an alcohol abuse disorder. The examiner then opined that it was less likely than not that his claimed alcohol use disorder was caused or aggravated by the hemorrhoid disorder. The Board finds the August 2020 examiner’s opinion to be probative because it was based on a review of the Veteran’s treatment records, the Veteran’s own statements and reports, as well as prior medical records review. The Veteran has not provided a competent medical opinion establishing a link between an alcohol use disorder and his service-connected hemorrhoid disorder. To the extent that the Veteran believes that he currently has an alcohol use disorder, that is related to his service-connected hemorrhoid disorder, this is an assertion as to an internal medical process, which extends beyond an immediately observable cause-and-effect relationship found to be beyond the competence of lay witnesses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, n. 4 (Fed. Cir. 2007). Moreover, the Board finds that diagnosing a link between any claimed alcohol use disorder and the service-connected hemorrhoids is a determination of medical complexity and is not capable of lay observation. Therefore, since laypersons are not capable of opining on matters requiring medical knowledge, the Board finds that the Veteran's opinion that he has an alcohol use disorder that was caused or aggravated by a service-connected disability is not competent evidence. Upon review of all the evidence, lay and medical, the Board finds that the weight of the evidence is against the conclusion that the Veteran has an alcohol use disorder that was caused or aggravated by his service-connected hemorrhoid disability. See 38 C.F.R. § 3.310; Wallin, 11 Vet. App. at 512. A.M. CLARK Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. McKenzie, 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.