Citation Nr: 18152933 Decision Date: 11/26/18 Archive Date: 11/26/18 DOCKET NO. 15-10 597 DATE: November 26, 2018 REMANDED The issue of entitlement to a compensable rating for prostate cancer residuals, to include the propriety of the rating reduction from 100 percent to 0 percent, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1968 to December 1970. This matter is before the Board following his appeal of an April 2013 rating decision. The issue of entitlement to a compensable rating for prostate cancer residuals is remanded. The Veteran contends that the reduction in rating for his prostate cancer residuals from 100 percent to 0 percent, effective July 1, 2013, was incorrect, and that a compensable rating is warranted based on urological symptoms. Initially, private treatment records are outstanding and relevant to the nature and severity of the Veteran’s prostate cancer residuals. During February 2011 treatment, the Veteran reported that he received private treatment for urological problems. Additionally, in February 2013, it was noted that, while the Veteran’s primary care physician was at the VA, he went to the Cancer Center for urology treatment. The record also supports that, since his diagnosis, he has been followed privately by the Riverview Cancer Center for prostate cancer, including follow-up treatment every six months. However, only limited private records have been obtained. Additionally, no VA treatment records dating prior to February 2011 or since January 2015 have been associated with the claims file. Thus, remand is necessary to obtain relevant outstanding records. The Board also finds that a new examination and/or opinion is necessary to clarify whether the Veteran has urological residuals from his prostate cancer treatment. In this regard, a January 2015 VA examiner determined that the Veteran’s urinary frequency and erectile dysfunction were not related to prostate cancer or his treatment for the same. The examiner based that opinion on evidence that the Veteran experienced erectile dysfunction and urinary symptoms, including frequency, prior to his diagnosis of prostate cancer in 2011. The examiner further attributed the Veteran’s urinary symptoms to benign prostate hypertrophy. The Board notes that a January 2011 private treatment record does indicate that the Veteran was experiencing urinary symptoms prior to his diagnosis of prostate cancer, including diminished force of stream, some hesitancy, and nocturia two times per night; however, the Veteran also reported in January 2011 that those symptoms had improved with medication, notably prior to treatment for prostate cancer. Then, in June 2011, it was noted that the Veteran had developed some (minimal) urinary frequency and urgency after radiation, though it was noted to have resolved by September 2011. The Veteran also reported at that time that his erectile dysfunction had been a longstanding problem but, perhaps, was “somewhat more problematic since radiation.” The Veteran then again reported symptoms, including frequent urination, in December 2011, and reported that it had been an issue since prior to his prostate cancer diagnosis. He also reported nocturia with waking two to three times per night. However, during a subsequent January 2013 VA examination, there were no reports or findings of urinary dysfunction. Most recently, a private provider offered an opinion in April 2015 that the Veteran’s urinary symptoms were likely related to the treatment he had for prostate cancer, and that the Veteran had a component of chronic radiation cystitis. Given the conflicting evidence of record, the Board finds that an examination and medical opinion are necessary to determine the exact nature and current severity of any prostate cancer residuals. The matter is REMANDED for the following action: 1. Ask the Veteran to provide the names and addresses of all medical care providers, both VA and private, who have treated him for his prostate cancer, urological problems, and/or erectile dysfunction, both prior to and since the 2011 diagnosis of prostate cancer. After securing the necessary releases request any relevant records identified, to include records from Riverview Cancer Center and Urology Specialists of Wisconsin. If any requested records are unavailable, the Veteran should be notified of such. Additionally, updated VA treatment records from January 2015 should be obtained. 2. After the above has been completed to the extent possible, schedule the Veteran for a VA examination to determine the nature and severity of any prostate cancer residuals. Following examination of the Veteran and a review of the claims file, the examiner should identify all prostate cancer residuals and the severity of any residuals found throughout the period on appeal. Specifically, the examiner should address whether the Veteran has any voiding function or erectile dysfunction that was either caused or aggravated by prostate cancer or its treatment. In providing the foregoing, the examiner should address the evidence of improvement in urinary symptoms reported in January 2011, prior to the prostate cancer treatment; the June 2011 notations that the Veteran develop urinary symptoms after radiation; the Veteran’s September 2011 report that his erectile dysfunction had become more problematic since radiation; and, the conflicting January 2015 VA and April 2015 private opinions regarding the Veteran’s urinary symptoms. The examiner should explain the medical basis for the conclusion reached. S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Fagan, Counsel