Citation Nr: 21041467
Decision Date: 07/09/21	Archive Date: 07/09/21

DOCKET NO. 20-04 859
DATE: July 9, 2021

ORDER

Service connection for a left scrotum disorder is denied.

FINDING OF FACT

A left scrotum 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 left scrotum disorder have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from August 1958 to August 1961.  This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in November 2018 by a Department of Veterans Affairs (VA) Regional Office.  The Board remanded the issue for additional development in January 2021; the case now returns for further appellate review.

The Veteran contends he has a current left scrotum disorder that had its onset in service and has been continuously present since service.

Service connection may be granted for a disability resulting from 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). 

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107; 38 C.R.F. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

With respect to a current disability, an ultrasound evaluation conducted by a private physician in March 2018 revealed a mild left hydrocele.  

As for an in-service disease, injury, or incident, a February 1959 service treatment record shows the Veteran complained of masses in both scrotal sacs, with the mass in the left scrotal sac "somewhat symptomatic at times."  The Veteran described pain starting in the area of the mass in the left scrotum radiating up to the area of his umbilicus and then up to the area of his right lower chest.  Physical examination did not reveal any specific abnormality of the left scrotal content.  An October 1960 service treatment record indicates the Veteran had bilateral nodules in the epididymis, while a March 1961 service treatment record shows the Veteran reported a growth on his left testicle and examination revealed a one by one movable, tender nodule apparently attached to the upper pole of the left testis.  A subsequent March 1961 service treatment record suggests the Veteran had growths on the testes since 1959.   Physical examination revealed only a sensitive head of the left epididymis, and the examiner reported that a reason for the Veteran's left scrotal pain could not be found.

Although the Veteran reported scrotal discomfort on and off, he notably refused VA physical examination of the penis, testes, epididymis, and prostate in October 2018.  The VA examiner further noted that neither the service treatment records nor the March 2018 ultrasound revealed a left epididymal cyst and, as such, the issue of a nexus opinion was moot.  

In January 2021, the Board reviewed the October 2018 VA examiner's opinion and noted the examiner failed to identify the etiology of the Veteran's reported pain as well as the mild hydrocele in the left testicle shown on the March 2018 ultrasound.  Additionally, the Board found the examiner did not address the in-service evidence of a growth on the left testicle or the left nodule attached to the upper pole of the left testis.  In sum, the Board found an addendum opinion was necessary prior to readjudication.  Additionally, as the Veteran's representative asserted that he had continually received treatment for a left scrotum disorder since service, the Board remanded the case to attempt to obtain any outstanding private treatment records.

With respect to the second directive, the record contains a January 2021 letter requesting that the Veteran provide the necessary authorization for VA to attempt to obtain all relevant, outstanding medical records.  However, the Veteran has not yet responded to such request, and a June 2021 Post-Remand Brief submitted by the Veteran's representative does not provide any additional information relating thereto.

As for the Board's first request, a VA physician provided an addendum opinion in February 2021.  Therein, the VA physician opined it is less likely than not that the Veteran has a current left scrotal abnormality.  However, the physician then clarified such finding, stating that the only current left scrotal abnormality in the record was the bilateral hydrocele.  In this regard, the physician found any clinical records leading to the ultrasound would be necessary to provide a complete list of diagnosed conditions.  Additionally, the physician explained that a hydrocele is usually easily diagnosed by examination and that a hydrocele enveloping the testicle can make palpation of the testicle itself difficult.  In this respect, the physician noted that at least two urologists had examined the Veteran in service and that each urologist was able to confidently describe the anatomy of the testicle and epididymis by palpation, without a finding of a hydrocele.  Further, the physician explained that congenital hydroceles have a persistent connection with the abdominal cavity, which had not been described in the 2018 ultrasound; more importantly, the peak age for an acquired hydrocele is 40 years old, and the 2018 ultrasound made no mention of any findings suggestive of a chronic hydrocele, which would include fibrinous lining and thickened membrane.  The physician further provided an extensive citation to medical literature regarding the general etiology of the different types of hydroceles in support of the opinion.

Upon review, the Board affords great probative weight to the February 2021 VA physician's opinion with respect to whether the Veteran has a current left scrotal disorder related to service.  In particular, the VA physician contemplated all pertinent evidence of record, to include the Veteran's relevant medical history and general medical literature, and provided a complete rationale, relying on and citing to the records reviewed.  Moreover, the physician offered a conclusion with supporting data as well as a reasoned medical explanation connecting the two.  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").  Further, the VA physician clearly considered the Veteran's specific case, providing an alternative etiology for his hydrocele.

The Board notes the February 2021 VA physician did not directly address the Veteran's lay statements regarding a continuity of symptomatology.  However, the VA physician clearly provided a thorough explanation as to why the medical evidence did not support the finding that the Veteran's current disorder, a mild hydrocele, had its onset in service based on the nature of an acquired hydrocele and the specific findings in the service treatment records.  Additionally, the VA physician cited to medical literature explaining that patients with a noncommunicating hydrocele usually have complaints of heaviness in the scrotum, scrotal pain, or an enlarging scrotal mass, which the Board notes is consistent with the Veteran's reports of his symptomatology.  

Notably, there are no medical opinions that contradict the aforementioned opinion.  In this regard, the Board has considered the Veteran's assertions as to the etiology of any current left scrotal 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).  Rather, the etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship.  Specifically, such requires knowledge of the male reproductive system.  Therefore, such matter 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).  Further, whether the symptoms the Veteran reportedly experienced during and after service are in any way related to his currently diagnosed hydrocele 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 lay opinions as to the onset and etiology of the Veteran's current left scrotal disorder are not competent evidence and, consequently, are afforded no probative weight.

Moreover, the Board notes the Veteran's repeated failure to assist in the development of his case.  Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996); Wood v. Derwinski, 1 Vet. App. 190, 193, reconsideration denied, 1 Vet. App. 406 (1991) (per curiam) (if a veteran wishes help, he cannot passively wait for it in circumstances where he may or should have evidence that is essential in obtaining the putative evidence).   Specifically, he failed to respond to the repeated request for any records reflecting treatment for a continuous left scrotal disorder and refused to undergo physical examination to facilitate an accurate determination of all current left scrotal disorders.  

In conclusion, the Board finds a left scrotal disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service.  Consequently, 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 left scrotal 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).  

 

 

MARTIN B. PETERS

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. M. Celli, 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.