Citation Nr: 21041908 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 18-19 541 DATE: July 10, 2021 ORDER Service connection for hemorrhoids, to include as due to service-connected Lyme disease, is denied. Service connection for a bowel condition (also claimed as chronic gastroenteritis), to include as due to service-connected Lyme disease, is denied. REMANDED Entitlement to service connection for a left shoulder condition, to include as due to service-connected Lyme disease, is remanded. Entitlement to service connection for a right shoulder condition, to include as due to service-connected Lyme disease, is remanded. Entitlement to service connection for a left hand condition, to include as due to service-connected Lyme disease, is remanded. Entitlement to service connection for a right hand condition, to include as due to service-connected Lyme disease, is remanded. Entitlement to service connection for a left elbow condition, to include as due to service-connected Lyme disease, is remanded. Entitlement to service connection for a right elbow condition, to include as due to service-connected Lyme disease, is remanded. Entitlement to service connection for a left knee condition, to include as due to service-connected Lyme disease, is remanded. Entitlement to service connection for a right knee condition, to include as due to service-connected Lyme disease, is remanded. Entitlement to service connection for a left ankle condition, to include as due to service-connected Lyme disease, is remanded. Entitlement to an initial compensable rating for allergic rhinitis is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had a diagnosis of hemorrhoids at any time during the pendency of the claim. 2. The preponderance of the evidence of record is against finding that the Veteran has had a diagnosis of any bowel condition at any time during the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for service connection for hemorrhoids are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a bowel condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Navy from April 2008 to February 2015. In January 2021, the Veteran testified at a videoconference hearing before the undersigned, and a transcript of that hearing is of record. The Board notes that the Veteran also appealed an issue of entitlement to service connection for heartburn. In March 2018, during the pendency of appeal, the RO granted service connection for gastroesophageal reflux disease (GERD), claimed as heartburn. Because the Veteran was awarded service connection, this issue is no longer on appeal before the Board. See generally Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or an injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). A disability also may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disability or if it is aggravated by a service-connected disability. 38 C.F.R. § 3.310(a) and (b). See also Allen v. Brown, 7 Vet. App. 439 (1995). 1. Service connection for hemorrhoids. 2. Service connection for a bowel condition. The Veteran contends that he had hemorrhoids in service, which had continued since separation, and which could have been caused by his military job or his Lyme disease. He also contends that the claimed bowel condition is due to his Lyme disease. See the January 2021 Board hearing transcript. The Board finds that the Veteran does not have any diagnoses relevant to the claimed hemorrhoids or bowel condition. In February 2015, the Veteran had a series of VA examinations upon separation from active service. In an intestinal conditions examination, Veteran denied having a bowel condition. He also denied having any current symptoms. In a rectum and anus conditions examination, the Veteran reported that he had hemorrhoids in 2011, with current symptoms of occasional episodes of rectal itching and burning. On examination, the Veteran did not have any findings, signs, or symptoms attributable to any relevant diagnosis, including internal or external hemorrhoids. Laboratory testing indicated that the Veteran's hemoglobin, hematocrit, white blood cell count, and platelets were all within normal limits. The examiner indicated that the Veteran did not have an intestinal condition, including any bowel condition, nor did he have hemorrhoids. VA and private treatment records dated during the period of appeal are silent for mention of any complaints, diagnosis, or treatment of hemorrhoids or a bowel condition. As such, the Board finds that the Veteran does not have any diagnoses relevant to the claimed hemorrhoids or bowel condition, and has not had a relevant diagnosis at any time during the pendency of the claims. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Board has also carefully considered Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018); however, the Veteran's reported symptoms of hemorrhoids were not found to cause functional impairment and he denied having any symptoms of a bowel condition. In sum, this is not a situation where there is functional impairment without a formal diagnosis. See Saunders, 886 F.3d at 1361. The Veteran contends that service connection is warranted for hemorrhoids and a bowel condition, but the Board cannot rely on his assertions regarding medical diagnoses. The issues are medically complex, as they require specialized medical education and training. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence, which notes that the Veteran does not have any diagnoses relevant to the claimed hemorrhoids or bowel condition. Even if the Veteran was diagnosed with hemorrhoids in service in 2011, a Periodic Health Assessment dated in July 2012 is silent for mention of hemorrhoids or relevant symptoms, and he denied having them in reports of medical history taken in July 2013 and January 2015. In a May 1990 service separation examination, however, the Veteran's head, face, and neck were found to be clinically normal, and he was not noted to have any residuals of the fall. Moreover, as noted above, results of a March 2019 VA TBI residuals examination indicated that the Veteran did not have, nor had he ever had, a TBI or residuals of a TBI. Without competent evidence of relevant diagnosed disorders, service connection for the claimed disorders cannot be awarded. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) ("In the absence of proof of a present disability, there can be no valid claim."); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004) (holding that service connection requires a showing of current disability). As the preponderance of the evidence is against the Veteran's claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a left shoulder condition is remanded. 2. Entitlement to service connection for a right shoulder condition is remanded. 3. Entitlement to service connection for a left hand condition is remanded. 4. Entitlement to service connection for a right hand condition is remanded. 5. Service connection for a left elbow condition is remanded. 6. Service connection for a right elbow condition is remanded 7. Service connection for a left knee condition is remanded. 8. Service connection for a right knee condition is remanded. 9. Service connection for a left ankle condition is remanded. The Veteran contends that the claimed bilateral shoulder and bilateral hand, bilateral elbow, bilateral knee and left ankle conditions are residuals of his service-connected Lyme disease. See the January 2021 Board hearing transcript. In a series of November 2020 VA examinations, the Veteran was found to have diagnoses of bilateral shoulder degenerative arthritis and bilateral hand bursitis. No opinion on the nature and etiology of the shoulder or hand diagnoses was provided. He was not found to have diagnoses related to the knees, elbows or left ankle. In January 2021, a private nurse practitioner, B.R., submitted a letter indicating that "other diagnosis as arthritis and neuropathy" can be caused by lymes disease." A private physician, Dr. O.D., dated in February 2020 and submitted in February 2021, indicated inflammatory arthralgias or myalgias and/or arthritic and joint symptoms could be effects of Lyme disease. He opined that given the Veteran's known exposure to Lyme disease and "unexplained recurrent and chronic debilitating arthralgias... can be secondary to his prior infection." The private opinions submitted in January 2021 do not contain diagnoses or treatment records, and both are speculative regarding the relationship between Lyme disease and arthralgias/myalgias. See Black v. Brown, 5 Vet. App. 177, 180 (1993) (finding medical opinions inadequate when they are not supported by medical evidence); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992) (observing that "may or may not" opinions are more common in opinions from treating providers and they cannot be given probative value). These opinions do, however, suggest a possible functional impairment and link. As such, the Board finds that the evidence of record supports the need for VA medical opinions on the issues of service connection for the claimed bilateral shoulder and bilateral hand conditions. See McLendon v. Nicholson, 20 Vet. App. 79 (2006), 38 U.S.C. § 5103A(d). 10. Increased rating for allergic rhinitis is remanded. The Veteran was most recently examined for his service-connected allergic rhinitis in December 2017. He reported symptoms of a runny nose and daily congestion. The examiner indicated there was not a greater than 50 percent obstruction of the nasal passage on both sides, complete obstruction on either side, permanent hypertrophy of the nasal turbinates, or nasal polyps. In the February 2021 Board hearing, the Veteran testified that a current examination would result in different findings, maybe of a 50 percent obstruction or polyps. Thus, due to evidence of potentially worsening symptomatology, the Board finds that a new VA examination is necessary. The matters are REMANDED for the following action: 1. Contact the VA examiner who conducted the November 2020 VA joint examinations (or if he or she is no longer available, a suitable replacement) and ask the examiner to review the record and prepare a medical opinion. The entire claims file, including a copy of this REMAND, must be reviewed by the examiner. The examiner should opine on the following: a) whether it is at least as likely as not that any diagnosed shoulder and/or hand condition is proximately due to the service-connected Lyme disease. If not, did any shoulder and/or hand condition increase in severity beyond its natural progression by the service-connected Lyme disease? b) The examiner should opine as to whether the Veteran has a current disability of the bilateral elbows, knees and left ankle. If there is no current diagnosis, the examiner should opine as to whether there is functional impairment of the bilateral elbows, knees and left ankle. c) If there is a current diagnosis or functional impairment, the examiner should opine as to whether it is at least as likely as not due to the service-connected Lyme disease. A thorough rationale should be provided for all opinions expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. If the examiner determines that further examination is necessary in order to render any requested medical opinion, the AOJ should schedule the Veteran for such an examination. 2. Schedule the Veteran for a VA examination to determine the current severity and manifestations of the service-connected allergic rhinitis. The examiner(s) should review the claims file and should note that review in the report. Any and all studies, tests, and evaluations deemed necessary by the examiner(s) should be performed. Based on this review, the examiner is asked to provide an assessment of the current nature of the allergic rhinitis, including all symptoms attributable to the condition and their severity. The examiner should also describe the functional impact of the disability. A fully articulated medical rationale for each opinion expressed must be set forth in the medical report. If for any reason the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Nelson 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.