Citation Nr: 21032877 Decision Date: 05/28/21 Archive Date: 05/28/21 DOCKET NO. 18-31 200 DATE: May 28, 2021 ORDER Service connection for an anal disability, to include anal fissure, anal pain, and anal fistula, is granted. FINDING OF FACT The Veteran's anal disability, to include anal fissure, anal pain, and anal fistula, is at least as likely as not related to service. CONCLUSION OF LAW The criteria for service connection for an anal disability, to include anal fissure, anal pain, and anal fistula, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 2006 to May 2007 in the U.S. Marine Corps. This matter comes before the Board of Veterans' Appeals (Board) from an April 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in February 2020. A copy of the hearing transcript is of record. The Veteran contends that his anal fissure and anal fistula are related to service. Alternatively, the Veteran contends that his anal fissure and anal fistula are related to his service-connected hemorrhoids. Service connection may be granted for 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. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Service connection is also warranted for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). The Veteran underwent a VA examination in December 2020. The examiner noted that the Veteran has a history of internal or external hemorrhoids, anal/perianal fistula, and anal fissure. Regarding symptoms, the examiner noted that the Veteran has rectal discomfort daily, some blood occasionally with wiping with toilet paper after bowel movements, discomfort with sitting due to pain, and fissures due to his internal or external hemorrhoids. Additionally, the examiner noted that the Veteran has leakage that necessitates wearing of a pad, occasional moderate leakage, and occasional involuntary bowel movements due to anal/perianal fistula and impairment of rectal sphincter control. Accordingly, the Board finds that the first element of service connection is established. Regarding the second element, the Veteran's service treatment records show that he was treated for bloody stools, rectal bleeding, and hemorrhoids during service. Accordingly, the second element of service connection is established. Regarding the third element, nexus, the December 2020 examiner opined that the Veteran's bloody stools during service were a symptom of all of his diagnosed anal conditions. The examiner explained that it is well documented within the Veteran's medical records that he was evaluated for rectal bleeding in 2008 and was diagnosed with hemorrhoids and rectal fissure. Additionally, the examiner stated that the fissure failed to close with medical treatment and required surgical closure in 2009. The examiner also stated that in 2015, the Veteran had increased symptoms and was found to have rectal fistula, which was a risk factor from the rectal fissure, and had surgical repair for the fistula in 2016. Finally, the examiner stated that the Veteran's hemorrhoids, fissure, and fistula all contribute to impaired sphincter control and rectal bleeding. The examiner concluded that the Veteran's impaired sphincter control is at least as likely as not related to service. The Board notes that a VA opinion was obtained in April 2018 and an addendum VA medical opinion was obtained in April 2020. The April 2018 VA examiner opined that the Veteran's anal condition, to include anal fissure, anal pain, and anal fistula, is less likely than not related to service or his service-connected hemorrhoids. The examiner stated that the Veteran was diagnosed with bloody stools and was found to have a small non-thrombosed hemorrhoid during service and treatment was conservative including an anal suppository. The examiner concluded that it is highly unlikely that the treatment caused any further anal problems. Additionally, the April 2018 VA examiner opined that while the Veteran's hemorrhoids are likely to be a contributing factor to the Veteran's anal fissure, anal pain, and anal fistula, it can be no more than speculative to contend that hemorrhoids are a major factor. The April 2020 VA clinician opined that the Veteran's anal disability, to include anal fissure and fistula with repair, was less likely than not aggravated beyond its natural progression by his service-connected hemorrhoids. The clinician's rationale stated that hemorrhoids are not known to cause fissures or fistulas and the Veteran's disability is more likely related to his bowel habits with increased straining. (Continued on the next page) Based on the foregoing, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran's anal disability, to include anal fissure, anal pain, and anal fistula, is related to service. If the evidence is supportive or is in relative equipoise, then the veteran prevails. See 38 C.F.R. § 3.102. Accordingly, service connection for an anal disability, to include anal fissure, anal pain, and anal fistula, is granted. 38 C.F.R. § 3.303. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kernen, 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.