Citation Nr: 22016151 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 19-22 013 DATE: March 21, 2022 ORDER Service connection for anemia is granted. FINDING OF FACT Amenia was caused or worsened in severity by service-connected hemorrhoids and/or hiatal hernia. CONCLUSION OF LAW The criteria for service connection for anemia are met. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from September 1981 to September 2001, including foreign service. For his meritorious service, the Veteran was awarded (among other decorations) the Army Commendation Medal and Army Achievement Medal. He offered testimony during a February 2022 virtual hearing before the undersigned Veterans Law Judge. Secondary Service Connection The Veteran is currently pursuing secondary service connection for anemia. The Board will limit its analysis accordingly. Service connection may be warranted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Here, there is clear evidence of a current disability. The Veteran was diagnosed with anemia during August 2016 VA examination, and contemporaneous VA treatment records frequently cite to his history of such. Thus, the first element of secondary service connection is met. Next, the Veteran associates his anemia with either a hiatal hernia or hemorrhoids, both of which he is service-connected for. Thus, the second element is also met, and service connection may be awarded upon the finding of a causal nexus between the Veteran's non- and service-connected disabilities. There is conflicting evidence on this point. Of note, the August 2016 VA examiner opined that the Veteran's anemia was less likely than not proximately due to or the result of his service-connected conditions. By way of rationale, the examiner noted that the Veteran showed anemia which onset in approximately 2015. The source of his anemia was less likely his GERD or hemorrhoids, as he had a colonoscopy performed in 2009 which showed non-bleeding internal hemorrhoids; additionally, his hemoglobin did not drop more than two standard deviations below the mean until 2015. The Veteran also denied symptoms of spitting up blood or blood in his stool. Thus, the source of his anemia was more likely his hyperplastic polyp which was removed in April 2016, or a possible upper gastrointestinal source such as an ulcer. At that time, the Veteran was advised to follow up with his primary care provider to fully assess the source of his anemia. Nonetheless, the VA examiner concluded that the Veteran's anemia was not caused or aggravated by his non-bleeding internal hemorrhoids, which have been stable since 2009, or by his GERD. In contrast, an April 2016 VA esophageal and rectum examiner explicitly reported anemia as an additional diagnosis pertaining to the Veteran's GERD and/or hernia. In the accompanying remarks, the examiner noted that current labs showed anemia, which was at least as likely related to the GERD and hemorrhoids, as both diagnoses increase the risk for bleeding with the subsequent development of anemia. See also VA treatment records (repeatedly noting the Veteran's history of anemia in association with a recent colonoscopy to assess bleeding hemorrhoids, but which could also be from "rectal polyps"). The above opinions are afforded equal probative value in this case. Importantly, both were offered by medical professionals with the expertise to competently assess the etiology of the Veteran's anemia, with accompanying rationales based upon review of the Veteran's medical records and his contemporaneous evaluation. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that the probative value of a medical opinion comes from the "factually accurate, fully articulated, sound reasoning for the conclusion"). Moreover, there is no evidence that either examiner was unaware of the Veteran's complete medical history; misstated any relevant fact in providing their opinion; or misapplied the standards for establishing a secondary causal connection in this case. As such, the competent evidence is in relative equipoise (at least approximately balanced) as to whether the Veteran's anemia is secondarily related to his service-connected GERD and/or hernia. Thus, consistent with VA regulations, the Veteran's claim prevails and secondary service connection for anemia is hereby granted. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Kovarovic, 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.