Citation Nr: 18141257 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 15-00 705 DATE: October 10, 2018 ORDER Service connection for chronic inflammatory prostatitis (CIP) is granted.   FINDING OF FACT The Veteran’s current CIP had its onset during service. CONCLUSION OF LAW The criteria for service connection for CIP have been met. 38 U.S.C. §§ 1110, 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 1972 to July 1975. The case is on appeal from a July 2012 rating decision. In July 2017, the Veteran testified at a Board hearing. Service connection for a urinary condition. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”—the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).   Facts and Analysis The Veteran contends that he has a urinary condition that onset during his military service. In this regard, in a May 2010 statement, he reported that he was treated in-service for urinary infections numerous times. During the July 2017 Board hearing, he reported that he had onset of painful urination during service and that he has continued to experience this condition ever since his discharge from service. The Veteran’s service treatment records (STRs) show that he reported experiencing flank pain, dysuria, and frequent urination in November 1974. The treatment provider noted a history of urethral discharge. A urine test conducted a few days later was noted to be negative. During a June 1975 separation examination, no relevant conditions were reported by the Veteran or noted by the examiner. The Veteran was afforded a VA examination in September 1975 that was conducted shortly after his discharge from service. The Veteran reported experiencing occasional chills starting in his kidneys that travel upward to his spine and into his head. The examiner noted that there was no tenderness present in the Veteran kidneys and that his rectal examination was negative. Subsequently, post-service VA treatment records show that the Veteran reported experiencing dysuria for two or three months in February 2009. A prostate examination conducted at such time was noted to be normal. In June 2009, the Veteran was treated by a VA emergency department for dysuria. No urinary tract infection was found at such time. In September 2010, the Veteran underwent a VA examination in regard to infectious and immune disabilities. The examiner noted a diagnosis of thymus cell lymphotropic virus (HTLV) based on a February 2010 serology test performed by VA in the course of treating the Veteran for dysuria. The examiner also noted that a urologist had found that the Veteran probably has chronic prostatitis and that he had been started on antibiotic therapy. The examiner concluded that the Veteran’s HTLV was unrelated to his dysuria. Thereafter, during VA treatment in March 2012, a physician reported that the Veteran has a long history of chronic prostatitis with persistent dysuria. Subsequently, the Veteran had two prostatic urethral polyps removed during VA treatment in June 2012. Later in June 2012, a VA physician diagnosed the Veteran with persistent dysuria and mild inflammation of the prostatic urethra. Then, in August 2014, the Veteran was afforded a VA examination in regard to this claim. During the examination, the Veteran reported a history of chronic dysuria with painful ejaculation. He reported that this condition was treated with a short course of antibiotics during service, but that the condition did not fully resolve. He reported pain in the penis and perineal area and occasional discharge. The examiner noted a 2010 diagnosis of chronic prostatitis and 2011 diagnoses of benign prostatic hyperplasia (BPH) and erectile dysfunction. The examiner also noted a history of urolithiasis. The examiner found that the Veteran’s condition is less likely than not incurred in or caused by service. She explained that chronic dysuria can have multiple etiologies and attributed the Veteran’s current dysuria to his chronic prostatitis. She also stated that his in-service symptoms are suggestive of upper urinary tract infections. Subsequently, in July 2016, a VA addendum opinion was obtained in regard to this claim. The examiner also found that the Veteran’s chronic dysuria is less likely as not due to service. The examiner reported that there was no evidence that the Veteran’s dysuria did not resolve fully during or after his discharge from service. The Board requested an expert medical opinion from the Veterans Health Administration (VHA), which was obtained in July 2018. The opinion was obtained from a VA urologist. The urologist reported that, since the claim was filed, the Veteran has experienced symptoms of urinary frequency, dysuria, and urethral discharge. He also noted that in 2014 the Veteran reported symptoms of penile and perineum pain with ejaculation. The urologist stated that such symptoms are compatible with a diagnosis of chronic prostatitis. He noted that chronic prostatitis can be bacterial or inflammatory. He explained that the Veteran’s negative urine cultures during service indicate that he has CIP. He also explained that people with CIP can go for years with little or no symptoms of the condition. In regard to the Veteran, the urologist found that his STRs document CIP symptoms during service and that his 2014 reports of pain are indicative of chronic prostatitis. He concluded that it is as likely as not that the Veteran’s CIP had its onset during service. The urologist explained that the August 2014 examiner’s opinion that the Veteran is experiencing upper urinary tract infections is ruled out by his negative urine cultures during service. He also explained that the July 2016 examiner failed to take into account that CIP tends to wax and wane. The Board finds that the July 2018 urologist’s opinion is more probative as to the nature and onset of the Veteran’s claimed condition than the other opinions of record. In this regard, he explained how the Veteran’s reported symptoms are consistent with a CIP diagnosis and why he found that such condition onset during the Veteran’s service. In addition, he explained why he disagreed with the earlier opinions of record. Therefore, the negative nexus opinions of record are outweighed by the July 2018 urologist’s opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295; 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”). The Board finds the July 2018 urologist’s opinion persuasive and that the Veteran’s claimed condition is properly diagnosed as CIP that had onset during service, particularly when reasonable doubt is resolved in the Veteran’s favor. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, service connection for CIP is warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Jimerfield, Associate Counsel