Citation Nr: 20030102 Decision Date: 04/29/20 Archive Date: 04/29/20 DOCKET NO. 10-00 155 DATE: April 29, 2020 REMANDED Entitlement to service connection for urinary tract infections (UTIs), to include as secondary to service-connected atrophy of the right testicle with residual erectile dysfunction and epididymitis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1981 to March 1990. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is associated with the Veteran’s claims file. In May 2019, the Board last remanded the matter to the RO for further development. Entitlement to service connection for UTIs, to include as secondary to service-connected atrophy of the right testicle with residual erectile dysfunction and epididymitis Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the Veteran’s claim so that he is afforded every possible consideration. In this regard, unfortunately, the Board cannot make a fully informed decision on the Veteran’s claim because the last VA opinion of record, in December 2019, is again inadequate. The December 2019 VA examiner opined that the Veteran’s claimed condition was less likely than not related to service because “there is no documentation in the available medical records that the [V]eteran had UTI during the of time.” This opinion is inadequate because the examiner failed to consider the Veteran’s lay statements that he has experienced recurrent UTIs since service and also failed to consider the medical evidence of record documenting the Veteran’s reports of recurrent UTIs. See December 2010 VA examination. Additionally, this opinion is based on the lack of in-service documentation of a UTI. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (an examination is inadequate where the examiner relies on the absence of evidence in the STRs to provide a negative opinion). As such, this opinion does not comply with the May 2019 Board remand instructions, which specifically noted that the rationale for a negative opinion must not be based solely on the lack of a relevant in-service diagnosis or clinical finding. Stegall v. West, 11 Vet. App. 268 (1998). The Board also finds that the December 2019 VA examiner provided an inadequate opinion as to the Veteran’s secondary service connection contentions. In this regard, the VA examiner opined that the Veteran’s claimed condition was not a result of or aggravated by his service-connected atrophy of the right testicle with residual erectile dysfunction and epididymitis. As rationale, the examiner asserted that there is not enough evidence or literature to conclude that the Veteran’s UTI is connected to his service-connected disability or to establish a baseline level of severity. The examiner did not explain why one condition would not cause or aggravate the other nor explain how, in the Veteran’s particular case, his atrophy of the right testicle with residual erectile dysfunction and epididymitis would not cause or aggravate his UTI disability. The Board notes that a medical examination report must contain not only clear conclusions with supporting data, but also reasoned medical explanations connecting the two. Accordingly, a remand is warranted for an addendum VA opinion that considers the Veteran’s lay statements, all the evidence of record, and includes adequate rationale in compliance with the May 2019 Board remand. See Stegall, 11 Vet. App. at 268; Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following action: 1. Obtain additional VA treatment records from January 2020 to present and associate them with the Veteran’s claims file. The Veteran should also be afforded the opportunity to identify and submit any outstanding private treatment records that are related to his claim. 2. Then, arrange for an appropriate medical opinion to address the claim for service connection for UTIs, to include as secondary to service-connected atrophy of the right testicle with residual erectile dysfunction and epididymitis. The Veteran’s claims file, to include a copy of this remand, should be made available to and be reviewed by the examiner. The prior examination was inadequate for several reasons: the examiner relies on the absence of evidence in the STRs to provide a negative opinion; fails to consider the Veteran’s lay statements that he has experienced recurrent UTIs since service; fails to consider the medical evidence of record documenting the Veteran’s reports of recurrent UTIs; and why one condition would not cause or aggravate the other nor explain how, in the Veteran’s particular case, his atrophy of the right testicle with residual erectile dysfunction and epididymitis would not cause or aggravate his UTI disability. Opinions as follows are requested: (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s UTI disability had its onset in service or is otherwise related to his military service? The examiner must consider (1) the June 2009 VA treatment record reflecting that the Veteran was currently being treated for rectal dysfunction UTI and was taking medication for a UTI; (2) the December 2010 VA examination noting the Veteran has a UTI approximately once a year that he treats with antibiotics; and (3) the November 2017 VA treatment note reflecting antibiotics prescribed for recurrent UTI. The examiner must address the Veteran’s reports that he experienced a UTI in service at the time of his testicle atrophy and has continued to experience UTIs since service. See January 2017 Board Hearing Transcript, pp. 4-8. (b) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s UTI disability is (1) proximately due to OR (2) aggravated by his service-connected atrophy of the right testicle with residual erectile dysfunction and epididymitis? The examiner is advised that he/she must provide a rationale for both causation AND aggravation. Additionally, if aggravation is found, the examiner should quantify the degree of aggravation, if possible. State whether there was an increase in disability regardless of permanence, but medically ascertainable. Any increase in disability should be described in terms of diagnosis, severity, and duration. A clearly stated rationale should be provided for ALL opinions and must not be based solely on the lack of any evidence of a diagnosis in the Veteran’s service treatment records or immediately thereafter. In this regard, a discussion of the relevant facts and medical principles involved would be of considerable assistance to the Board. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Amanda Purcell, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.