Decision Date: 09/01/95 Archive Date: 08/31/95 DOCKET NO. 93-19 859 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUE Entitlement to service connection for prostate disability. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Frank L. Christian, Counsel INTRODUCTION The veteran served on active duty from October 1954 until service retirement in August 1975. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of May 1992 from the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the RO erred in denying service connection for his currently manifested prostate disorder; that his service medical records reflect treatment for prostate and associated disorders throughout his period of active service; and that he has submitted medical evidence establishing continuity of postservice treatment for a chronic, recurrent prostate disorder. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence is at least in equipoise and thus supports a grant of service connection for a prostate disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the instant appeal has been obtained by the RO. 2. The veteran's service medical records establish that a genitorinary disability was manifest on a number of occasions during active service; clinical and other data establish continuity of treatment for prostate disability following service separation. 3. The veteran's currently manifested prostate disability may not be dissociated from the signs and symptoms of prostatitis shown during active service. CONCLUSION OF LAW Chronic prostate disability was incurred during active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303(b) and (d) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is plausible and is thus "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991), which mandates a duty to assist the veteran in developing all pertinent evidence. The Board's review of the claims file shows that the RO has obtained the veteran's complete service medical records, as well as medical evidence from all sources identified by the veteran. In addition, he has been afforded a personal hearing on appeal. On appellate review, we see no areas in which further development might be productive. In order to establish service connection for a claimed disability, the facts, as shown by evidence, must demonstrate that a particular disease or injury resulting in current disability was incurred during active service or, if preexisting active service, was aggravated therein. 38 U.S.C.A. §§1110, 1131 (West 1991). Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1994). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of the chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1994). The veteran's service entrance examination, conducted in October 1954, disclosed no abnormalities of the genitourinary system. A report of periodic medical examination in July 1957 disclosed no pertinent abnormalities. Service medical records dated in September 1957 show that the veteran was seen for complaints of dysuria and a penile discharge and was referred to the urology clinic. A report of periodic medical examination in October 1957 disclosed no abnormalities of the genitourinary system. Records dated in January 1958 show that the veteran was seen with complaints of a yellowish penile discharge after having unprotected sex and was treated with Tetracycline and Penicillin. A report of periodic medical examination in September 1960 disclosed no pertinent abnormalities. In August 1961, the veteran was treated for complaints which included dysuria and suprapubic discomfort. The clinical impression was cystitis and medications included Pyridium. In November 1961, the veteran complained of aching testicles with occasional dysuria of two weeks' duration without discharge. The clinical impression was possible strain (anxiety?). Urinalysis was negative. A report of periodic medical examination in December 1962 disclosed no pertinent abnormalities. In March 1963, the veteran complained of urinary burning in the mornings. The clinical impression was possible cystitis and his medications included Pyridium. A report of periodic medical examination in July 1965 disclosed no abnormalities of the genitourinary system. An entry in July 1966 cited complaints of aching in the testes and back and post urinary dribbling of several weeks' duration without dysuria or nocturia. The prostate was boggy and large. The clinical impression was prostatic congestion, and prostatic massage was administered at that time and again in August 1966. A report of periodic medical examination in August 1966 disclosed no abnormalities of the genitourinary system. The veteran was again seen in the urology clinic in September 1966 for prostatic massage and reported no longer having genitourinary symptoms except when drinking. A report of periodic medical examination in October 1968 disclosed no abnormalities of the genitourinary system. In February 1970, the veteran was seen for complaints of urinary burning, and was treated with Tetracycline. He was again seen in May 1970 with complaints of a painful left testicle, and was again treated with Tetracycline. Service medical records dated in April 1971 show that the veteran was seen for complaints of dysuria and suprapubic pain. A prior history of prostatitis in Korea was noted. His prostate was boggy and tender, and the diagnosis was prostatitis. He was treated with prostate massage and Tetracycline. He was seen on two occasions in May 1971 for follow-up treatment for prostatitis. He continued to complain of dysuria and low back pain and examination disclosed that his prostate was boggy and tender. Treatment with prostate massage and antibiotics continued. A report of periodic medical examination in October 1971 disclosed no abnormalities of the genitourinary system. During the course of periodic medical examination in August 1973, a digital rectal examination disclosed no rectal masses and the prostate was not enlarged. A report of service retirement examination, conducted in April 1975 noted that the veteran's prostate was within normal limits. An entry dated in June 1975 noted that the veteran's sexual partner was being treated for trichomonas. Outpatient clinic records from Fort McPherson Army Hospital dated from January 1977 to May 1977, show that the veteran was seen in January 1977 with complaints of flank pain, painful urination, and testicular pain. The clinical impression was possible cystitis, pyelitis or urethritis, and he was treated with Pyridium. In March 1977, the veteran was again seen for complaints of dysuria and flank pain. The clinical impression was cystitis, pyelitis, and urethritis. In April 1977, the veteran complained of recurrent dysuria. The prostate was nontender. In May 1977, examination disclosed no urethral discharge and the veteran was asymptomatic. The clinical impression was resolved prostatic congestion. In September 1977, the veteran was seen for complaints of pain on urination, without discharge. He was seen in the urology clinic in December 1977 with similar complaints, and a diagnosis of a chronic prostate problem was shown. Another entry in December 1977 noted the veteran's complaints of back pain after voiding, and his prostate was shown to be 10-15 grams in size. The clinical impression was mild prostatic congestion. In May 1978, the veteran's prostate was shown to be two plus, boggy and tender. In January 1981, the veteran complained of groin pain, and the clinical assessment was prostatitis versus urethritis. In March 1981, the veteran was seen for complaints of urethral discharge, following unprotected sex. The clinical assessment was history of recurrent urethritis, nonspecific. The veteran was treated for nonspecific urethritis with Tetracycline. In June 1981, the veteran was seen in the urology clinic. The clinical impression was chronic prostatitis, and he was treated under a prostatitis regime. In July 1982, the veteran was seen for complaints of right testicle pain, back pain, and penile pain following urination. The clinical impression was recurrent prostatitis. In October 1982, the veteran was seen for a chronic prostate problem, and the clinical assessment was rule out chronic prostatitis/epididymitis. He was treated with antibiotics. On examination in November 1982, the clinical impression was recurrent prostatitis. Thereafter, records dated in December 1982, February 1983, May 1983, August 1983, December 1983, May 1984, November 1984, July 1984, October 1984, April 1985, June 1985, January 1987, May 1987, and November 1987, reflect treatment of the veteran for conditions variously diagnosed as prostatitis, chronic prostatitis, chronic recurrent prostatitis and prostatitis, with dysuria. Examinations during the indicated period consistently disclosed that the veteran's prostate was boggy and tender. A report of VA examination, conducted in October 1977, disclosed that examination of the genitourinary system, including the prostate, was negative. Private treatment records from Sam O. Atkins, M.D., dated from August 1988 to July 1992 reflect consistent and ongoing treatment of the veteran for prostatitis and for prostate enlargement with hypertrophy, symptomatic. In October 1990, the veteran underwent a transcystoscopic dilation of the prostate (uroplasty). A personal hearing on appeal was held at the RO in September 1992. The veteran testified that he was treated during active service for a prostate disorder, manifested by pain on urination and pain in the testicles and groin area. He stated that he was seen on several occasions and was treated with Tetracycline. He further called attention to treatment at Fort McPherson Army Hospital in approximately 1977 or 1978 for a chronic prostate problem. The Board finds that the veteran's testimony regarding inservice and postservice treatment for a prostate disorder is credible and is confirmed by the medical evidence of record. Although there were negative findings on VA medical examination in October 1977, reports of examination at Fort McPherson Army Hospital in December 1977 reflect clinical findings of prostatic congestion, while records dated in May 1978 showed that the veteran's prostate was tender and boggy. The Board finds that the veteran's service medical records reflect objective clinical findings of symptoms associated with prostatitis, as well as diagnoses of chronic, recurrent prostatitis, during active service in the 1950's, the 1960's, and the 1970's. We further find that the current medical evidence of record establishes continuity of treatment for chronic recurrent prostate disability, commencing as early as 16 months following service retirement, and continuing almost without interruption since that time. In the Board's judgment, the veteran's symptoms, findings and diagnoses of prostatitis following service retirement cannot be dissociated from like symptoms, findings and diagnoses recorded during active service. Accordingly, and with resolution of reasonable doubt in the veteran's favor, service connection for chronic prostate disability is granted. ORDER Service connection for chronic prostate disability is granted. ROBERT E. SULLIVAN Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). 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