Citation Nr: 18113121 Decision Date: 06/21/18 Archive Date: 06/21/18 DOCKET NO. 14-41 506 DATE: June 21, 2018 ORDER Entitlement to a disability rating in excess of 10 percent for the period on appeal prior to August 6, 2015, for recurrent right orchitis and epididymitis is denied. REMANDED ISSUE Entitlement to a disability rating in excess of 10 percent from August 6, 2015 for recurrent right orchitis and epididymitis is remanded. FINDING OF FACT For the period on appeal prior to August 6, 2015, the Veteran’s recurrent right orchitis and epididymitis presented with symptomatology requiring long-term drug therapy. CONCLUSION OF LAW The criteria for entitlement to a disability rating in excess of 10 percent for the period on appeal prior to August 6, 2015, for recurrent right orchitis and epididymitis have not been met. §§ 1101, 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.1, 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.20, Diagnostic Code 7525 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1973 to November 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In March 2018, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge seated at the RO. A transcript is included in the claims file. Entitlement to a disability rating in excess of 10 percent prior to August 6, 2015 for recurrent right orchitis and epididymitis The Veteran contends his recurrent right orchitis and epididymitis are more severe than is currently contemplated by his 10 percent disability rating. Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects her ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The Veteran’s genitourinary disorder is rated as 10 percent disabling under Diagnostic Code 7599-7525. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27 (2017). When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be “built-up” as follows: the first two digits will be selected from that part of the schedule most closely identifying the part, or system of the body involved and the last two digits will be “99” for all unlisted conditions. Then, the disability is rated by analogy under a diagnostic code for a closely related disability that affects the same anatomical functions and has closely analogous symptomatology. 38 C.F.R. §§ 4.20, 4.27 (2015). Diagnostic Code 7525 provides that the disability is to be rated under the criteria for urinary tract infection (UTI). The rating criteria for UTI provides that a 10 percent rating is warranted if the condition requires long-term drug therapy, one to two hospitalizations per year, and/or intermittent intensive management. A 30 percent evaluation is warranted if the condition is manifested by recurrent symptomatic infection requiring drainage or frequent hospitalization (greater than two times per year), and/or requiring continuous intensive management. Higher ratings may be assigned for poor renal function under the criteria for renal dysfunction, or for tubercular infections. 38 C.F.R. § 4.115a. Any voiding dysfunction shall be rated by the particular condition as urine leakage, urinary frequency, or obstructive voiding. Under urine leakage conditions (continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence), a 60 percent disability rating is warranted for the use of an appliance or the wearing of absorbent materials which must be changed more than four times per day. A 40 percent disability rating is warranted for the wearing of absorbent materials which must be changed two to four times per day. A 20 percent disability rating is warranted for the wearing of absorbent materials which must be changed less than two times per day. Id. Under urinary frequency conditions, a 40 percent disability rating is warranted for a daytime voiding interval of less than one hour, or; awakening to void five or more times per night. A 20 percent disability rating is warranted for a daytime voiding interval between one and two hours, or; awakening to void three to four times per night. A 10 percent disability rating is warranted for a daytime voiding interval between two and three hours, or; awakening to void two times per night. Id. Under obstructed voiding conditions, a 30 percent disability rating is warranted for urinary retention requiring intermittent or continuous catheterization. A 10 percent disability rating is warranted for marked obstructive symptomatology (hesitancy, slow or weak stream, decreased force of stream) with any one or combination of the following: (1) post void residuals greater than 150 cc; (2) uroflowmetry demonstrating markedly diminished peak flow rate (less than 10 cc/sec); (3) recurrent urinary tract infections secondary to obstruction; or (4) stricture disease requiring periodic dilation every two to three months. A non-compensable disability rating is warranted for obstructive symptomatology with or without stricture disease requiring dilation one to two times per year. Id. An April 2013 VA treatment record noted the Veteran had a history of hematuria. In June 2013, after a VA physical examination, the impression was “hematospermia followed by gross and microscopic hematuria easily [] from prostatitis.” A February 2014 VA male reproductive system conditions examination report and opinion notes that an in-person examination was conducted and recounts the Veteran’s history and complaints. The Veteran did not have a voiding dysfunction, a history of recurrent symptomatic urinary tract or kidney infections, erectile dysfunction, or retrograde ejaculation. The examiner noted the Veteran had a history of chronic epididymitis, epididymo-orchitis, or prostatitis treated with long-term drug therapy. The Veteran used intermittent antibiotics for the prior six months. A March 2014 private treatment record notes the Veteran had no difficulty urinating, blood in urine, no urinary urgency, no frequent urination, no urinary incontinence, no voiding dysfunction, no vulvodynia, no dyspareunia, no recurrent UTI, no nocturia, no pain with urination, no incomplete urination. An April 2014 VA treatment record notes the Veteran had renal tuberculosis. After a review of the evidence, the Board finds that a rating in excess of 10 percent for recurrent right orchitis and epididymitis is not warranted for the period on appeal prior to August 6, 2015. The objective medical evidence does not demonstrate that the Veteran experiences recurrent symptoms of urinary tract infections requiring drainage or frequent hospitalization or requiring continuous intensive management. Further, the Veteran has not demonstrated voiding dysfunction requiring the wearing of absorbent materials which must be changed less than two times per day; daytime voiding between one and two hours or awakening to void three to four times per night; urinary retention requiring intermittent or continuous catheterization. There is also no objective medical evidence demonstrating that the Veteran has constant or recurring albumin with hyaline and granular casts or red blood cells, compensable hypertension or edema. In considering the appropriate ratings, the Board has also considered the Veteran’s statements that his disability is worse than the rating he currently receives. The Veteran has reported subjective symptoms of pain and discomfort as well as blood in his urine and semen. The Veteran has also reported that his symptoms do not require any intermittent intensive management, nor any long-term drug therapy. While the Veteran is competent to report his symptoms, as this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability for his disorder according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (“although interest may affect the credibility of testimony, it does not affect competency to testify”). Thus, the above evidence reflects the Veteran’s symptomatology caused by his service-connected genitourinary disability is best characterized by the 10 percent disability rating. Accordingly, entitlement to a disability rating in excess of 10 percent for the period on appeal prior to August 6, 2015, for recurrent right orchitis and epididymitis is denied. As a preponderance of the evidence is against the assignment of a higher rating, the benefit-of-the-doubt doctrine is not for application, and the appeal must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REMAND Entitlement to a disability rating in excess of 10 percent from August 6, 2015 for recurrent right orchitis and epididymitis is remanded. Evidence indicates that there may be outstanding relevant VA treatment records. During the March 2018 hearing, the Veteran reported that he has continued to receive VA treatment for the disability on appeal. However, the most recent VA treatment record in the Veteran’s claim file is dated August 6, 2015. Any VA treatment records are within VA’s constructive possession, and are considered potentially relevant to the issue on appeal. A remand is required to allow VA to obtain them. Further, the Veteran submitted private treatment records indicating that he underwent a renal function panel and urinalysis on May 2, 2018; however, the results of this testing was not included with the submission. A remand is necessary to attempt to retrieve the results of these tests. The matter is REMANDED for the following action: 1. Obtain any additional medical records pertaining to the Veteran’s genitourinary disorders, to include any VA treatment records after August 6, 2015, or private medical records, to include results of the May 2, 2018 renal function panel and urinalysis, that the Veteran may identify. 2. Should the RO deem it necessary in light of any new evidence obtained, schedule the Veteran for a VA examination to evaluate the current level of severity of his genitourinary disability. The claims file should be made available to the examiner. The examiner should report the extent of the Veteran’s disability in accordance with VA rating criteria, and determine whether the Veteran’s service- recurrent right orchitis and epididymitis have developed into any additional genitourinary disorders. All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Duthely, Associate Counsel