Citation Nr: 21040397 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 17-40 041 DATE: July 3, 2021 ORDER Service connection for anxiety and depression is granted. Service connection for hemorrhoids and rectal bleeding is denied. VETERANS CONTENTIONS The Veteran contends that he developed hemorrhoids while in service due to marching, straining, and carrying heavy objects. He contends that he was treated while in Hanau, Germany, but his symptoms became worse and lead to many years of suffering that only continued because of a botched VA hemorrhoid surgery. With respect to his claimed acquired psychiatric condition, the Veteran contends that he experienced depression secondary to post traumatic stress disorder. FINDINGS OF FACT 1. The Veteran's psychiatric symptomatology, including symptoms of anxiety and depression is attributable to his PTSD diagnosis. 2. The Veteran did not acquire hemorrhoids while in active duty service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for anxiety and depression are met. 38 U.S.C.A. § 1110 (2012); 38 C.F.R. § 3.310. 2. The criteria for entitlement to service connection for hemorrhoids and rectal bleeding are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a) REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from September 1964 to September 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). It was previously before the Board in March 2019 and March 2021; both times it was remanded for further development. Service Connection To establish service connection, a showing of competent medical, or in certain circumstances, lay evidence must confirm (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 116667 (Fed. Cir 2004). A layperson is competent to report on the onset and continuity of his current symptomatology. See 38 C.F.R. § 3.159(a)(2); Layno v. Brown, 6 Vet. App. 465, 470 (1994); Charles v. Principi, 16 Vet. App. 370, 374-75 (2002) (a layperson is competent to observe tinnitus). 1. The issue of entitlement to service connection for an acquired psychiatric disorder other than PTSD Here, the Veteran was afforded one VA examination specific to his claim for service connection for an acquired psychiatric disorder other than PTSD in October 2020. While the psychologist determined that the Veteran had no other mental disorder beside PTSD, the psychologist concluded that the Veteran's current symptoms of anxiety and depression were subsumed by and best explained by a PTSD diagnosis. The psychologist opined that the claimed condition was at least as likely as not incurred in or caused by the claim inservice injury, event or illness and explained that the Veteran's symptoms of anxiety and depression are related to the diagnosis of PTSD incurred during service. Thus, the evidence is in relative equipoise in showing that the Veteran has current psychiatric disorders, other than PTSD, anxiety and depression, which had their clinical onset due to the service-connected PTSD. In such cases, reasonable doubt is resolved in the Veteran's favor and service connection for anxiety and depression is warranted. The Board expresses no opinion regarding the severity of the disorder. The RO will assign an appropriate disability rating on receipt of this decision. Ferenc v. Nicholson, 20 Vet. App. 58 (2006) (discussing the distinction in the terms "compensation," "rating," and "service connection" as although related, each having a distinct meaning as specified by Congress). 2. The issue of entitlement to service connection for hemorrhoids and rectal bleeding With respect to the issue of entitlement to service connection for hemorrhoids and rectal bleeding, the Veteran has been diagnosed with hemorrhoids. See 1/3/2020 CAPRI. In furtherance of his claim of service connection for the same, he was afforded two VA examinations with opinions and one addendum opinion. See 1/30/2020 C&P examination; 11/4/2020 C&P examination; 3/24/2021 C&P examination. Compensation is payable for any disability which is caused by VA hospitalization, medical or surgical treatment, vocational rehabilitation, compensated work therapy program (CWT), or as the result of having submitted to a VA medical examination. 38 U.S.C.§ 1151. The evidence must show that the Veteran's additional disability is actually the result of VA care. Specifically, carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the Department in furnishing the hospital care, medical or surgical treatment, or examination must be shown; or the proximate cause of disability must be an event not reasonably foreseeable. Id. For training and rehabilitation services or compensated work therapy program, it must be shown that the Veteran's participation in an essential activity or function of the training, services, or CWT program provided or authorized by VA proximately caused the disability. Id. Merely showing that a Veteran has additional disability is not sufficient to establish causation. Id. Because the Veteran contended that he experienced a "botched" VA hemorrhoid surgery, an examination was conducted to investigate whether the Veteran was entitled to disability compensation pursuant to 38 U.S.C.§ 1151. See 1/30/2020 C&P examination. However, the examiner opined that it was less likely than not that the Veteran's hemorrhoids and rectal bleeding were caused or became worse as a result of the VA treatment at issue; or that the claimed disability resulted from carelessness, negligence, lack of skill, or similar incidence of fault on the part of the attending VA personnel; or resulted from an incident that could have been reasonably foreseen by a reasonable healthcare provider; or VA failure to timely diagnose or properly treat allowing the condition to progress. Therefore, compensation pursuant to 38 U.S.C. § 1151 is denied. The Veteran was afforded a VA examination in November 2020 which the Board has already deemed inadequate due to failure on the part of the examiner to consider the Veteran's lay statements which related his hemorrhoids to in-service lifting activities. See 3/3/2021 BVA Decision. However, a negative nexus VA addendum medical opinion was then provided in March 2021. The record and lay statements were considered in the development of that opinion which stated that 1967 service treatment records show no rectal findings, and had generator lifting caused the Veteran's hemorrhoids, they would have been noted on that examination particularly if they were provoked by excess and traumatic straining while lifting. See 8/31/1971 STR; 3/24/2021 C&P Examination. That VA opinion was fully articulated and supported by reasoned analysis; therefore it is afforded significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board acknowledges the Veteran's contentions related to hemorrhoids while in service however, because service treatment records reveal a normal rectal area and the record is devoid of any evidence regarding the alleged treatment in Hanau, Germany, those contentions are afforded minimal probative weight. Thus, entitlement to service connection for hemorrhoids is denied. G. Jackson Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Z. Sloley, 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.