Citation Nr: 18159483 Decision Date: 12/19/18 Archive Date: 12/19/18 DOCKET NO. 14-15 644A DATE: December 19, 2018 REMANDED Entitlement to a compensable rating for status post left varicocelectomy with left hydrocele is remanded REASONS FOR REMAND The Veteran served on active duty from October 1965 to June 1969. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, in a November 2002 rating decision, the RO granted service connection for left hydrocele and assigned a non-compensable evaluation effective from July 26, 2002. The Veteran raised a claim for increase in a May 2013 claim. In March 2014, the service-connected disability was clarified as status post left varicocelectomy with left hydrocele and a compensable rating was denied. In October 2015, the Board remanded the claim for further development. 1. Entitlement to a compensable rating for status post left varicocelectomy with left hydrocele is remanded. With regard to the claim for a compensable rating for status post left varicocelectomy with left hydrocele, remand is necessary for a medical opinion addendum. The Veteran was afforded a VA examination in January 2014, at which time the examiner diagnosed the Veteran with left varicocele repair; bilateral varicocele, small; scrotal senile angiomas; and chronic epididymitis. The examiner concluded the bilateral varicocele, small; scrotal senile angiomas; and chronic epididymitis were less likely than not a recurrence from the previously repaired and resolved left varicocele on the left side. However, no rationale was given. The examiner also found no scars related to any diagnosed condition or treatment, despite the Veteran’s contentions of scarring and bleeding associated with his service-connected disability and made no comment or diagnosis with respect to the Veteran’s reported neurological symptoms. Again, the claim was remanded by the Board in October 2015, in pertinent part, for a VA examination. The Veteran was provided with a VA examination in December 2015. Specifically, upon review of the claims file and examination, the examiner was asked to (1) describe any scars associated with the Veteran’s status post left varicocelectomy with left hydrocele; (2) evaluate the nature and etiology of any bleeding reported by the Veteran, which he has attributed to burst capillaries on the scrotum; (3) evaluate any reported neurological symptoms, to include radiating leg pain, which he has attributed to his service-connected disorder; and (4) explain the reason underlying the conclusion in the January 2014 examination that the Veteran’s diagnosed left varicocele is not related to his service-connected status post left varicocelectomy with left hydrocele. The Board finds that the December 2015 examination report is inadequate as the examiner did not offer all opinions as required by the Board’s October 2015 Remand. See Stegall v. West, 11 Vet. App. 268 (1998) (remand by the Board confers on an appellant the right to VA compliance with the terms of the remand order and imposes on the Secretary a concomitant duty to ensure compliance with those terms). In regard to the Veteran’s reports of scarring and bleeding, the examiner noted that the Veteran had an asymptomatic 2.5-centimeter thin linear mid-scrotal scar, which was well healed and nontender, associated with his status post left varicocelectomy with left hydrocele. The examiner also noted that the Veteran had multiple scattered small, hyperpigmented/dark red superficial punctuate papules and noted that they were most likely consistent with angiokeratomas. The examiner noted that none of which were actively bleeding, but instead were atraumatic and nontender and that such required further evaluation by a dermatologist. The examiner indicated that angiokeratomas are vascular tumors with keratotic elements which amy affect the scrotal skin. It was noted that angiokeratomas are a genetic disorder and is unrelated to his service connected disability, but indicated that further evaluation by a dermatologist was necessary. The record does not indicate that this additional evaluation was conducted. Secondly, the examiner did not determine the nature and etiology of the Veteran’s reports of neurological symptoms. Contrarily, the examiner noted that there were no neurological symptoms reported and associated with his status post left varicocelectomy with left hydrocele. The examiner acknowledged an October 2013 EMG in which the Veteran stated that he did not have pain in his legs and that his pain instead started from his back and goes down the back of his legs. The examiner also noted that the Veteran reported unrelated NSC bilateral lower extremity symptoms, due to NSC bilateral mononeuritis multiplex. However, the Board acknowledges that the Veteran has complained of damage to the nerve following the October 2013 EMG. See March 2015 Informal Hearing Presentation. The examiner noted that there are no neurologic symptoms reported, nor found on clinical examination associated with the Veteran’s service connected disability. Although the examiner indicated that these are two different medical conditions, the examiner did not provide a rationale for this statement or comment on the symptoms noted by the Veteran. Lastly, the Veteran has stated that the rating code used by VA in evaluating his condition does not adequately represent or consider his symptoms. The Board acknowledges that the Veteran’s disability has been rated by analogy under Diagnostic Code 7525, which relates to chronic epididymo-orchitis. In the October 2015 Remand, the RO was asked to address whether there was a more appropriate code, such as Diagnostic Code 7523 or 7524, dealing with the testis. However, the Veteran’s condition continued to be rated under Diagnostic Code 7525, with no acknowledgement as to whether another code was more appropriate in the supplemental statement of the case. The matter is REMANDED for the following action: 1. Obtain any updated VA treatment records which have not yet been associated with the claims file. 2. Schedule the Veteran for an examination by a dermatologist to evaluate the nature and etiology of any bleeding reported by the Veteran, which he as attributed to burst capillaries on the scrotum. 3. Obtain an addendum opinion from an appropriate clinician to determine the current symptoms, nature, extent, and severity of the Veteran’s condition of status post left varicocelectomy with left hydrocele. Upon review and examination, the examiner is asked to address the following: (a) The examiner is asked to evaluate any neurological symptoms reported by the Veteran, to include the pain he has reported as radiating down his legs for which he believes is related. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. Further, in forming such opinions, the examiner is asked to consider the Veteran’s lay statements of record. 4. After ensuring that the examination report is adequate and all requested development has been completed, readjudicate the remanded claim, to include consideration as to whether the Veteran’s disability is more appropriately rated under DC 7523 or 7524. If any benefit sought on appeal remains denied, issue to the Veteran and his representative a supplemental statement of the case (SSOC). A reasonable period of time should be allowed for response before the case is returned to the Board. M. Donohue Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Tiffany N. Hanson, Associate Counsel