Citation Nr: 20048167 Decision Date: 07/20/20 Archive Date: 07/20/20 DOCKET NO. 16-11 407 DATE: July 20, 2020 ORDER Entitlement to service connection for a neurogenic bladder is granted. FINDING OF FACT The Veteran’s neurogenic bladder is causally or etiologically due to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a neurogenic bladder are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from April 1968 to April 1970. This matter comes before the Board of Veterans’ Appeals (BVA or Board) from a May 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing before the Board. The requested hearing was conducted in March 2019 by the undersigned Veterans Law Judge. A transcript is associated with the claims file. In July 2019, the Board remanded this claim in addition to a claim for entitlement to service connection for a lumbar spine disorder, for additional development. In April 2020, entitlement to service connection for a lumbar spine disorder was granted; as such, this issue is no longer before the Board. Entitlement to service connection for a neurogenic bladder. The Veteran seeks entitlement to service connection for a neurogenic bladder. Under the relevant laws and regulations, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). In general, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In some cases, lay evidence will also be competent and credible on the issues of diagnosis and etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not necessarily accorded to each piece of evidence contained in the record; not every item of evidence necessarily has the same probative value. Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant). First, the Veteran has a current diagnosis of neurogenic bladder. See, e.g., April 2008 VA examination; December 2019 Disability Benefits Questionnaire (DBQ). As such, Shedden element (1) is met. Next, the Veteran has asserted his neurogenic bladder is a result of an automobile accident that occurred during service. The Veteran asserts as a result of the accident, he also suffered a back injury. The Board notes the Veteran was recently granted service connection for his lumbar spine as a result of this in-service accident. He asserts his urinary problems began at that time, with symptoms such as frequency and urgency. Service treatment records document a motor vehicle accident with lumbar strain in May 1969. Service treatment records also document the Veteran complained of urinary frequency approximately two months later in July 1969. Thus, the Board finds that Shedden element (2) is met. As for Shedden element (3), nexus, there is unfavorable and favorable evidence. The Board notes the December 2019 VA examiner’s opinion that the Veteran’s current bladder disorder is less likely than not due to service or his service-connected lumbar spine disorder; however, the examiner failed to provide a sufficient rationale for this opinion. The claims file contains multiple opinions linking the Veteran’s neurogenic bladder to his motor vehicle accident during service. In January 2006, the Veteran’s treating VA physician, Dr. D., submitted a statement indicating that the Veteran was being treated for urinary frequency, urgency and occasional urinary accident, that at the least is considered an irritable bladder and more probably a neurologically deficit bladder, also called a neurogenic bladder. The physician noted that the Veteran apparently had an injury to his back many years ago with a truck causing blunt trauma to the lumbar area of the back and this type of injury could certainly be responsible for the current state of affairs in the Veteran. In July 2006, a VA physician, Dr. B., opined that after evaluating the Veteran, there was a causal relationship between the impact suffered while in Vietnam during a vehicle accident and his current symptoms of frequent incontinence and urgency. The physician stated he concurred with the opinion of Dr. D., who diagnosed a neurogenic bladder, and that it was more likely than not that the symptoms and signs related to the bladder and urinary tract are secondary to such a traumatic event that occurred in Vietnam (vehicle accident in service). The physician noted that the Veteran has clear documentation of these persistent problems. In January 2007, a private physician, Dr. G., stated that the Veteran has been followed for voiding difficulty and based on findings and findings of his evaluation at the VA Hospital, the Veteran’s difficulties are all consistent with injury to his spinal cord while in Vietnam. The Veteran was afforded a VA examination in April 2008, at which time the VA examiner opined that the Veteran had a neurogenic bladder leading to incontinence and urinary frequency and nocturia, more likely than not secondary to his injury while in service, because of the timing. (continued on next page) Given the evidence of record, the Board finds that the evidence supports the establishment of service connection for a neurogenic bladder. The Veteran has a current diagnosis, an in-service vehicle accident, and medical opinions that relate his current diagnosis to his accident during service. As such, the Veteran’s claim for service connection for a neurogenic bladder is granted. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Andersen, 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.