Citation Nr: 18158108 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 16-30 630 DATE: December 14, 2018 REMANDED Entitlement to a higher rating for urethral stricture disease (USD) which is evaluated as 10 percent disabling from July 2, 2007, 20 percent disabling from May 1, 2008, and 0 percent disabling from March 1, 2013 is remanded. Entitlement to a compensable disability rating for erectile dysfunction is remanded. Entitlement to a 10 percent evaluation based upon multiple, noncompensable, service-connected disabilities from March 1, 2013 is remanded. REASONS FOR REMAND 1. Evaluation of urethral stricture disease (USD), which is evaluated as 10 percent disabling from July 2, 2007, 20 percent disabling from May 1, 2008, and 0 percent disabling from March 1, 2013 is remanded. An April 2013 rating decision granted service connection for USD with an assigned 10 percent disability rating from July 2, 2007; a 20 percent rating from May 1, 2008; and a noncompensable rating from March 1, 2013. The RO assigned the ratings based on VA examinations conducted in May 2008, March 2013 and April 2016; however, the Board finds that the VA examinations are not adequate to determine the severity of the Veteran’s USD, and finds that another VA examination is necessary. In this regard, the RO assigned a noncompensable rating (reduced from 20 percent) effective March 2013 based on the March 2013 VA examination that noted that the Veteran has no voiding dysfunction. A subsequent April 2016 VA examination shows that the Veteran has evidence of obstructive voiding symptomatology noted as urinary hesitancy; markedly slow stream; weak stream; and decreased force of stream, which if combined with either (1) post-void residuals greater than 150 cubic centimeters (cc’s); (2) uroflowmetry; markedly diminished peak flow rate (less than 10 cc’s per second); (3) recurrent urinary tract infections secondary to obstruction; or (4) stricture disease requiring periodic dilatation every 2 to 3 months, could warrant a higher 10 percent rating. Although the April 2016 VA examination notes that the Veteran does not have recurrent urinary tract infections and does not require dilation, the examination does not indicate whether the Veteran has post-void residuals greater than 150 cc’s or markedly diminished peak flow rate less than 10 cc’s per second. As such, remand for a VA examination that evaluates the severity of the Veteran’s USD, to include post-void residuals and peak rate, is required. 2. Evaluation of erectile dysfunction, which is currently 0 percent disabling is remanded. The Veteran contends that a compensable rating is warranted for erectile dysfunction. Although, an April 2016 VA examination noted that the Veteran’s penis was “normal”, another VA examination is necessary in light of the recent decision, Williams v. Wilkie, No. 16-3252; 2018 U.S. App. Vet. Claims LEXIS 1037 (August 7, 2018). In Wilkie, the Court of Appeals for Veterans Claims (CAVC) held that the term “deformity” in the diagnostic criteria historically applied to erectile dysfunction (ED) by analogy, DC 7522, which awards a 20 percent disability rating for a “penis, deformity, with loss of erectile power,” should be given its ordinary meaning “a distortion of the penis, either internal or external.” As the record does an include information sufficient to determine whether there is “internal distortion of the penis” as discussed by the CAVC, a remand for a VA examination addressing that question is necessary. 3. Entitlement to a 10 percent evaluation based upon multiple, noncompensable, service-connected disabilities from March 1, 2013 is remanded. With respect to the claim for entitlement to a 10 percent evaluation based upon multiple, noncompensable service-connected disabilities, the Board notes that if either of the increased rating claims are granted, it would directly impact the adjudication of this claim. See 38 C.F.R. § 3.324. Therefore, remand of this issue is necessary as this issue is inextricably intertwined with the service connection claims and increased rating claims that are remanded herein. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). In light of the remand, updated VA treatment records should be obtained and associated with the claims file. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Then, schedule the Veteran for a VA examination to determine the current severity of his urethra stricture disability. The claims file must be reviewed by the examiner. All indicated studies, tests, and evaluations must be conducted, and all findings reported in detail. The examiner should cite to the medical and competent lay evidence and must provide a detailed rationale for all conclusions reached. 3. After completing directive #1, schedule the Veteran for a VA examination regarding erectile dysfunction. The examiner is asked to conduct a physical examination and note in examination findings whether the Veteran currently has internal or external deformity of the penis. The examiner should cite to the medical and competent lay evidence and must provide a detailed rationale for all conclusions reached. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Hemphill, Associate Counsel