Citation Nr: 18161338 Decision Date: 12/31/18 Archive Date: 12/31/18 DOCKET NO. 12-17 998 DATE: December 31, 2018 ORDER Entitlement to a 60 percent disability rating for urinary dysfunction, but no higher, due to service-connected priapism for the entire period on appeal is granted. FINDING OF FACT For the entire period on appeal, the Veteran’s voiding dysfunction has been productive of continual urine leakage and urinary incontinence requiring the wearing of absorbent materials, which must be changed more than four times a day. CONCLUSION OF LAW For the entire period on appeal, the criteria for a 60 percent disability rating, the maximum allowable rate, for urinary dysfunction due to service-connected priapism have been met. 38 C.F.R. § 4.115a, 4.115b, Diagnostic Code (DC) 7512. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from June 1983 to July 1986 and from November 2001 to November 2002. The Veteran and his spouse attended a videoconference hearing before the undersigned Veteran’s Law Judge (VLJ) in March 2017. A transcript of that proceeding has been prepared and is associated with the file. This appeal was last before the Board in May 2017 when it was remanded for a new VA examination. That examination was provided in April 2018, and the appeal is now ready for appellate review. The Board notes that two other appeals have been certified to the Board, however, in both appeals, the Veteran has elected to have a videoconference hearing. As these hearings have not yet been conducted, those appeals are not ready for appellate review at this time. 1. Entitlement to a 60 percent disability rating for urinary dysfunction due to service-connected priapism Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In both initial rating claims and normal increased rating claims, the Board must discuss whether “staged ratings” are warranted, and if not, why not. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s service-connected priapism is rated under DC 7512, which requires rating as voiding dysfunction under 38 C.F.R. § 4.115a. See 38 C.F.R. § 4.115b. Under 38 C.F.R. § 4.115a, voiding dysfunction is rated with regard to urine leakage, frequency, or obstructive voiding. Continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence requiring the wearing of absorbent materials which must be changed less than two times per day warrants a 20 percent rating. The need to wear absorbent materials which must be changed two to four times per day warrants a 40 percent rating. The use of an appliance or wearing of absorbent materials which must be changed more than four times per day warrants a 60 percent rating. Urinary frequency with a daytime voiding interval between two and three hours or awakening to void two times per night warrants a 10 percent rating. A daytime voiding interval between one and two hours or awakening to void three to four times per night warrants a 20 percent rating. A daytime voiding interval of less than one hour or awakening to void five or more times per night warrants a 40 percent rating. Obstructive voiding symptomatology with marked obstructive symptomatology with any one or combination of: post void residuals greater than 150 cc, a markedly diminished peak flow rate of less than 10 cc/sec, recurrent urinary tract infections secondary to obstruction, or stricture disease requiring periodic dilatation every two to three months, warrants a 10 percent rating. Urinary retention requiring intermittent or continuous catheterization warrants a 30 percent rating. Urinary tract infection where the evidence shows recurrent symptomatic infection requiring drainage and frequent hospitalization (greater than two times per year) and/or requiring continuous intensive management warrants a 30 percent rating. A 60 percent disability rating is the highest disability rating available for any form of voiding dysfunction. Higher disability ratings of 80 and 100 percent are, however, available in cases involving renal dysfunction. See 38 C.F.R. § 4.115a. As there is no evidence or allegation of renal dysfunction in this case, those rating criteria will not be discussed. By way of background, the Veteran filed for an increased evaluation for his idiopathic priapism, rated at 40 percent disabling, in June 2011. A July 2011 rating decision denied that claim for increase. The Veteran filed a timely appeal and his claim was before the Board in May 2017, when it was remanded for a new VA examination. As a result of the examination in March 2018, the Veteran’s disability rating was increased from 40 percent to 60 percent disabling, the maximum allowable rating under the diagnostic code. The Veteran credibly testified that his incontinence has become worse and that he has to change the absorbent materials, which he called leak guards, five to six times a day. He described his incontinence as continual leaking, and that he is unable to get to a bathroom in time. The Veteran attended a VA examination for his service-connected idiopathic priapism in May 2011. The examiner reported that the Veteran, “has intermittent urinary leakage/incontinence in which a pad/absorbent material is required to be changed 4 times per day." The Veteran attended a VA Male Reproductive Organ examination in October 2015. Under medical history, the examiner noted that the Veteran “had some brief urine leaking were [sic] he can’t hold his urine.” Under voiding dysfunction, the examiner checked no for urine leakage, and noted daytime voiding interval less than 1 hour. The examiner noted hesitancy, slow stream, weak stream, decreased force of stream, and probable stricture due to repeated surgeries and infection. The Veteran attended a VA Urinary Tract examination in March 2018. The diagnosis was given as stricture disease secondary to idiopathic priapism, multiple surgeries with residual voiding dysfunction and recurrent bladder infections. The examiner reported that the voiding dysfunction caused urine leakage, described as requiring absorbent material which must be changed more than 4 times per day, increased urinary frequency, noted as daytime voiding interval less than 1 hour and nighttime awakening to void 5 or more times. The examiner reported no renal dysfunction. The Board notes that the treatment records in the file show repeated entries for chronic incontinence. Under active outpatient medications, the Veteran was prescribed super absorbent protective briefs for daily use for his incontinence, with a notation of, “change three times a day or as needed for incontinence.” The Board notes that lay evidence from the Veteran’s spouse and daughter has been received. In March 2017, the Veteran’s spouse wrote that the Veteran has to use the bathroom every 15 to 30 minutes, and that he is embarrassed about his urine leaking. In the same month, his daughter wrote that her father does not like to go out because of his need to use a restroom, as often as every 10 minutes. The Board finds that the competent, credible, and probative lay and medical evidence of record, as described above, shows that the Veteran has had continual urine leakage and incontinence throughout the period on appeal. This leakage and incontinence has required the Veteran to use absorbent materials, which must be changed more than 4 times in a day. Accordingly, a 60 percent disability rating, the maximum rating allowable, is warranted for the entire appeal period. (Continued on the next page)   Upon review, the Board finds that a disability rating in excess of 60 percent for the Veteran’s disability is not warranted at any point during the period on appeal. 60 percent is the highest schedular rating available for disabilities manifested by voiding dysfunction. The Veteran’s disability has been rated based on urine leakage; the highest available ratings for voiding dysfunction under the criteria for urinary frequency and obstructed voiding are 40 percent and 30 percent, respectively. Higher disability ratings may be warranted in cases involving renal dysfunction; however, in this case the evidence does not demonstrate, nor does the Veteran allege, that his disability is manifested by any renal dysfunction. Therefore, a 60 percent disability rating, the maximum rating allowable, is warranted for the entire appeal period. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Nelson, Associate Counsel