Citation Nr: 20081076 Decision Date: 12/28/20 Archive Date: 12/28/20 DOCKET NO. 15-31 172A DATE: December 28, 2020 ORDER Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for left carpal tunnel syndrome is denied. Entitlement to service connection for right carpal tunnel syndrome is denied. Entitlement to service connection for compensation under the provisions of 38 U.S.C. § 1151, for Hepatitis C at a VA Medical Center (VAMC) is denied. REMANDED Entitlement to a rating in excess of 10 percent for prostatitis is remanded. FINDINGS OF FACT 1. A left knee disability diagnosed as osteoarthritis was not manifest in service and is not otherwise attributable to service; arthritis did not manifest within one year of separation from active service. 2. A right knee disability diagnosed as osteoarthritis was not manifest in service and is not otherwise attributable to service; arthritis did not manifest within one year of separation from active service. 3. Left carpal tunnel syndrome was not manifest in service and is not otherwise attributable to service. 4. Right carpal tunnel syndrome was not manifest in service and is not otherwise attributable to service. 5. Hepatitis C was not caused by hospital care, medical or surgical treatment, or examination furnished to the Veteran under any law administered by the Secretary. CONCLUSIONS OF LAW 1. A left knee disability was not incurred or aggravated during service, nor may it be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 2. A right knee disability was not incurred or aggravated during service, nor may it be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 3. The criteria for establishing entitlement to service connection for left carpal tunnel syndrome have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019). 4. The criteria for establishing entitlement to service connection for right carpal tunnel syndrome have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019). 5. The criteria for compensation under 38 U.S.C. § 1151 for hepatitis C have not been met. 38 U.S.C. §§ 1151, 5107; 38 C.F.R. §§ 3.102, 3.361. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty as a U.S. Army paratrooper and parachute rigger from October 1971 to October 1974. In April 2019, the Board remanded these issues to the RO for additional development. There has been substantial compliance with the remand instructions. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141 (1999). The Veteran’s complete service treatment records (STRs) are not associated with the claims file although the file does contain an enlistment and discharge examinations and 66 pages of records. However, in December 2011, the RO made a finding of the unavailability of the Veteran’s complete STRs. The Veteran was notified that his STRs were incomplete in May 2012. In such situations, where STRs are missing, the Board has a heightened obligation to explain its findings and conclusions and carefully consider the benefit-of-the-doubt rule. O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). However, case law does not lower the legal standard for proving a service connection claim, but rather increases the Board’s obligation to evaluate and discuss in its decision all of the evidence that may be favorable to the veteran. Russo v. Brown, 9 Vet. App. 46 (1996). There is no presumption, either in favor of the claimant or against VA, arising from missing records. Cromer v. Nicholson, 19 Vet. App. 215 (2005). The Board also recognizes that there are outstanding private treatment records from the 1990’s. The Veteran has identified private treatment in New York, as well as treatment received while employed at the Post Office. The claims file reveals that multiple attempts were made to associate these records with the Veteran’s file and neither the private provider nor the Harbor Healthcare System provided a response. The Veteran was notified in May 2012. Claimants have an obligation to assist VA in the development of their claim. The duty to assist is not a one-way street or a blind alley. Wood v. Derwinski, 1 Vet. App. 190, 192 (1991). If a veteran wishes help, he cannot passively wait for it in circumstances where he has information that is essential in obtaining the putative evidence. Id. The AOJ made sufficient attempts to obtain the requested information. Additional followups would be futile. The Board finds VA satisfied its duty to assist despite not obtaining the requested private treatment records. Additional delay to attempt to obtain private medical records is not warranted. The Veteran’s claim will be adjudicated based on the current record. In January 2019 the Veteran was afforded a videoconference hearing before the undersigned Veterans Law Judge (VLJ). A copy of the hearing transcript has been associated with the claims file. In October 2020 correspondence, the Veteran’s representative requested another Board hearing. Neither the Veteran nor his attorney provided any rationale for the requested hearing. The representative contended that adequate consideration was not afforded to the Veteran’s history of parachute jumps which is additional argument that will be considered. He also noted that that opinions on orthopedic issues and Hep C may be necessary. No additional evidence has been received. The applicable regulation grants the Veteran the right to a hearing, which he has already been afforded. Accordingly, the Board concludes that another Board hearing is not warranted. See 38 C.F.R. § 20.700. Service Connection A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110, 1131. To establish a right to compensation for a present disability, a Veteran must show: “(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” - the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disease shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in-service. 38 C.F.R. § 3.303(d). Service connection for chronic disease may be granted if manifest to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. Under applicable criteria, VA shall consider all lay and medical evidence of record in a case with respect to benefits under laws administered by VA. 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. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for a right knee disability 2. Entitlement to service connection for a left knee disability The Veteran contends that he is entitled to service connection for right and left knee arthritis, caused by in-service parachuting accidents. Partial service treatment records (STRs) are associated with the claims file. As discussed above, the Veteran’s complete records are unavailable, but the Veteran’s separation examination is of record. The Veteran’s lower extremities were determined to be normal at his August 1974 separation examination, and the Veteran explicitly denied arthritis during October 1974 dental treatment questionnaire. There are no records of treatment for injuries sustained in a parachute jump during rigger school early in the Veteran’s service. The Veteran reported bilateral knee pain during April 1989 VA treatment. The Veteran was in a motor vehicle accident in 1992, which required an emergency room visit. See January 2002 VA treatment records. The Veteran sought VA treatment following an assault in which he injured both of his legs in May 1999. July 2000 VA treatment records reveal that the Veteran denied any muscular discomfort and a musculoskeletal examination was within normal limits. The Veteran requested a new knee brace during VA treatment in December 2007. The Veteran sought treatment for knee pain in June 2009. He reported an onset of pain three days prior. See June 2009 VA treatment records. Treatment records reflect continued treatment for knee pain from this point forward. March 2010 private diagnostic testing reflects that the Veteran had “minimal osteoarthritis” of the knees. In June 2010 correspondence, the Veteran reported that he hurt his right leg during a jump while in rigger school in 1972, and then hurt his left leg in 1973 while parachute jumping. On an October 2011 application for compensation, the Veteran reported that his right and left knee disabilities began in 1995. In June 2012 correspondence, the Veteran reported that a 1972 parachute accident forced him to use crutches for a month. He also reported that he was out of work for four months in 2008 due to pain in his knees. The Veteran attended a VA examination for his knees in August 2014. He told the examiner that he injured his right knee during a parachuting jump in 1972, while in jump school. He said that he was treated in the field and placed on a short-term profile. The Veteran reported that he first experienced left knee pain while working for the Post Office following his separation, but that he believed the left knee pain was also due to his service. The examiner noted that the Veteran was diagnosed with bilateral degenerative joint disease of the knee in 2010, she also noted that she reviewed records which revealed negative x-rays of the bilateral knees in July 1998. Following an examination and review of the claims file, the examiner concluded that the Veteran’s knee disabilities were not due to his service, to include the parachuting injury. She explained that had the Veteran’s current bilateral knee arthritis been caused by his service, the Veteran would have had chronic knee pain in service or shortly thereafter. The 1998 negative knee x-rays and the lack of continuous knee treatment instead suggested that the Veteran’s service was unrelated to his current knee disabilities. The examiner determined that the Veteran’s current knee disabilities were instead likely caused by his age. The examiner found it probative that the Veteran’s bilateral knee arthritis was equal in the right and left knee, which she concluded supported age-related arthritis. On his October 2015 VA Form-9, the Veteran stated that he strongly believed his current knee arthritis was due to his service. He stated that he complained of knee pain for years prior to his 2010 arthritis diagnosis. The Veteran attended a Board hearing in January 2019. He testified that in 1971, during rigger’s school in Virginia, he had a malfunction during his sixth jump and hit the ground on his right leg. He reported being unable to walk and needing an ambulance. The Veteran testified that following the incident, he was on restricted duty for a week and issued crutches. The Veteran also testified that once he went back to his unit, he did “not really” continue to have problems with his right leg because he “kept jumping and everything.” He “really started feeling it” around 1989 when he worked as a custodian for the Post Office and was required to walk about on his legs all day. The Board has carefully evaluated the evidence and finds that a preponderance of the evidence of record is against a finding that the Veteran’s current right and left knee disabilities are related to his service on a direct or presumptive basis. The Board finds the August 2014 VA examiner’s opinion to be highly probative. The examiner accepted the Veteran’s reports of an in-service knee injury after a parachuting accident but explained why that accident would be unrelated to the Veteran’s current knee disorders. The VA medical opinion was based on a thorough review of the record and analysis of the Veteran’s entire history, including his reported in-service injuries. Additionally, the VA examiner’s opinion is consistent with the Veteran’s documented medical history, which does not reflect any mention of knee pain or treatment until 1989, 15 years following his separation. Furthermore, arthritis was definitively not present in 1998, nearly 25 years following separation. The Veteran has not submitted a medical opinion to contradict the VA examiner’s opinion that his current right and left knee disabilities are not related to service. The Veteran has been accorded ample opportunity to present competent medical evidence in support of his claims. He has not done so. See 38 U.S.C. § 5107(a) (2012) [it is the claimant’s responsibility to support a claim for VA benefits]. To the extent the Veteran asserts his current right and left knee disabilities are related to his service, the Veteran is competent to report that he has a current diagnosis (as that is documented in the record). He is also competent to report the onset of symptoms, which according to the Board hearing testimony began in 1989. He is competent to report that he sustained some hard parachute landings on his knees and was authorized light duty on one occasion in jump school. However, he continued his service as a paratrooper with multiple subsequent jumps and his discharge examination showed no knee abnormalities. However, he does not have characteristic manifestations sufficient to identify the chronic disease entity, arthritis, during service or within one year of separation from active service. 38 C.F.R. § 3.303(b). The Board must find that the Veteran’s statements with regard to a nexus between his right and left knee disabilities and service to be of minimal probative value and outweighed by the VA opinion, prepared by a skilled neutral professional. For the reasons and bases expressed above, the Board finds that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for right and left knee disabilities. The benefits sought on appeal are accordingly denied. 3. Entitlement to service connection for left carpal tunnel syndrome 4. Entitlement to service connection for right carpal tunnel syndrome The Veteran contends that he is entitled to service connection for right and left knee arthritis, stemming from his responsibilities packing parachutes in the service. As discussed above, the Veteran’s complete service records are unavailable, but the Veteran’s August 1974 separation examination is of record, and his upper extremities were determined to be normal upon examination. The Veteran attended a VA examination in October 1976 and October 1979 for genito-urinary issues. He did not report any pain or issues with his wrists or hands. Medical records reveal that the Veteran appears to first report symptoms of carpal tunnel during VA treatment in February 1985, as right-hand numbness was noted. The Veteran had right carpal tunnel syndrome release surgery in 1993. See July 2000 VA treatment records. In Marcy 2004, he received VA treatment for the right hand after having it slammed in a vehicle door. In an April 2010 Social Security Administration examination, he reported sustaining a gunshot wound to the right hand in 1985. In June 2010 correspondence, the Veteran reported that around 1993 he had surgery on his right wrist to treat carpal tunnel syndrome. He reported that he had carpal tunnel syndrome in the left wrist as well but had not undergone surgery. The Veteran stated that he believed the carpal tunnel stemmed from his in-service responsibilities packing parachutes. The Veteran had carpal tunnel surgery for his left wrist in February 2011. On an October 2011 application for compensation, the Veteran reported that his right and left carpal tunnel syndrome began in 1989. The Veteran attended a VA examination in August 2014. He told the examiner while working for the Post Office he believed he filed a workman’s compensation claim for the 1993 carpal tunnel surgery. He stated that he believed the Post Office paid for his surgery since his union advised him to file the claim. The Veteran stated that he believed his carpal tunnel syndrome in both wrists was due to the repetitive movements from parachute packing. Following an examination and a review of the claims file, the examiner concluded that the Veteran’s bilateral carpal tunnel syndrome was not due to his service, to include the repetitive parachute packing. She explained that there was no evidence of carpal tunnel syndrome until about 10 years following the Veteran’s separation. She explained that his post-service occupation as a custodian for the Post Office was more likely the cause, because of the type of work he did in his post-service employment responsibilities and the start of symptoms. She further explained that had the Veteran’s carpal tunnel started in service, “it would have been expected to have him present with symptoms of pain and numbness in the median nerve during the service or shortly after discharge and not over a decade later.” On his October 2015 VA Form-9, the Veteran stated that he objected to the findings of the August 2014 examiner because he had only worked at the Post Office for four years prior to his right carpal tunnel surgery, and custodial work would not have caused carpal tunnel syndrome. The Veteran attended a Board hearing in January 2019. He testified that he believed he developed carpal tunnel syndrome as a result of his work as a parachute rigger. He explained that he was in the packing section, and the repetitive hand and wrist movements required to pack the parachutes caused nerve damage. The Veteran reported that he first had right wrist surgery in 1991, while working for the Post Office. The Board has carefully evaluated the evidence and finds that the weight of competent and credible evidence of record is against a finding that the Veteran’s current right and left carpal tunnel syndrome are related to his service. The Board finds the August 2014 VA examiner’s opinion to be highly probative. The examiner accepted the Veteran’s reports of an in-service repetitive wrist movement packing parachutes but explained why it was less likely than not the cause of his carpal tunnel syndrome. The VA medical opinion was based on a thorough review of the record and analysis of the Veteran’s entire history, including his in-service reports. Additionally, the VA examiner’s opinion is consistent with the Veteran’s documented medical history, which does not reflect any mention of wrist pain or treatment until 1985, more than 10 years following his separation. The Veteran has not submitted a medical opinion to contradict the VA examiner’s opinion that his current right and left carpal tunnel syndrome are not related to service. The Veteran has been accorded ample opportunity to present competent medical evidence in support of his claims and has not done so. See 38 U.S.C. § 5107(a) (2012). To the extent the Veteran himself asserts his current right and left carpal tunnel syndrome are related to his service, the Veteran is competent to report that he has a current diagnosis (as that is documented in the record). He is also competent to report the onset of symptoms. However, he does not have the requisite training or expertise to provide a competent opinion regarding the etiology of carpal tunnel syndrome. 38 C.F.R. § 3.303(b). The Board must find that the Veteran’s statements with regard to a nexus between his right and left carpal tunnel syndrome and service to be of minimal probative value and outweighed by the VA opinion, prepared by a skilled neutral professional. For the reasons and bases expressed above, the Board finds that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for right and left carpal tunnel syndrome. The benefits sought on appeal are accordingly denied. § 1151 Eligibility The Veteran contends that he contracted Hepatitis C during a test at a VA facility. In pertinent part, section 1151 provides for compensation for a qualifying additional disability in the same manner as if such additional disability were service- connected. A disability or death is a qualifying additional disability if the disability or death was not the result of the Veteran’s willful misconduct and (1) the disability or death was caused by hospital care, medical or surgical treatment, or examination furnished the Veteran under any law administered by the Secretary, and (2) the proximate cause of the disability or death was (A) carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the Department in furnishing the hospital care, medical or surgical treatment, or examination; or (B) an event not reasonably foreseeable. 38 U.S.C. § 1151. In determining whether additional disability exists, the physical condition immediately prior to the disease or injury upon which the claim for compensation is based will be compared with the subsequent physical condition resulting from the disease or injury. Compensation will not be payable for the continuance or natural progress of diseases or injuries for which the hospitalization or treatment was authorized. 38 C.F.R. § 3.361(b). To establish causation, evidence must show that the hospital care, medical or surgical treatment, or examination resulted in the Veteran’s additional disability or death. Merely showing that a veteran received care, treatment, or examination and that the Veteran has an additional disability or died does not establish cause. 38 C.F.R. § 3.361(c)(1). Hospital care, medical or surgical treatment, or examination cannot cause the continuance or natural progress of a disease or injury for which the care, treatment, or examination was furnished unless VA’s failure to timely diagnose and properly treat the disease or injury proximately caused the continuance or natural progress. 38 C.F.R. § 3.361(c)(2). Additional disability or death caused by a veteran’s failure to follow properly given medical instructions is not caused by hospital care, medical or surgical treatment, or examination. 38 C.F.R. § 3.361(c)(3). The proximate cause of disability or death is the action or event that directly caused the disability or death, as distinguished from a remote contributing cause. To establish that carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA’s part in furnishing hospital care, medical or surgical treatment, or examination proximately caused a veteran’s additional disability or death, it must be shown that the hospital care, medical or surgical treatment, or examination caused the Veteran’s additional disability or death (as explained in paragraph (c) of this section); and (i) VA failed to exercise the degree of care that would be expected of a reasonable health care provider; or (ii) VA furnished the hospital care, medical or surgical treatment, or examination without the Veteran’s or, in appropriate cases, the Veteran’s representative’s informed consent. To determine whether there was informed consent, VA will consider whether the health care providers substantially complied with the requirements of § 17.32 of this chapter. Minor deviations from the requirements of § 17.32 of this chapter that are immaterial under the circumstances of a case will not defeat a finding of informed consent. Consent may be express (i.e., given orally or in writing) or implied under the circumstances specified in § 17.32(b) of this chapter, as in emergency situations. Whether the proximate cause of a veteran’s additional disability or death was an event not reasonably foreseeable is in each claim to be determined based on what a reasonable health care provider would have foreseen. The event need not be completely unforeseeable or unimaginable, but must be one that a reasonable health care provider would not have considered to be an ordinary risk of the treatment provided. 38 C.F.R. § 3.361(d). In determining whether an event was reasonably foreseeable, VA will consider whether the risk of that event was the type of risk that a reasonable health care provider would have disclosed in connection with the informed consent procedures of § 17.32 of this chapter. 5. Entitlement to service connection for compensation under the provisions of 38 U.S.C. § 1151, for Hepatitis C at a VA Medical Center (VAMC) The Veteran contends that he is entitled to service connection for Hepatitis C because he believes he was exposed to the disease while receiving treatment at a VA hospital on some occasion from 1990 to 2008. In June 2010 correspondence the Veteran stated that he believed he contracted Hepatitis C, “in a test or something,” and that at one time 70 percent of the Veteran’s at the Bronx VA medical center had Hepatitis C. He also stated that he had high sexual activity and intranasal cocaine use. The Veteran was privately treated for a left arm gunshot wound in January 1985 at North Central Hospital in New York. The Veteran received VA in-patient treatment from July 1997 to October 1997. See December 1998 VA treatment records. August 1997 VA mental health treatment records reflect that the Veteran failed a trial of lithium secondary to severe side effects and possible allergic reaction. The Veteran requested a VA Hepatitis C test in September 1998 because his significant other discovered she had the disease and believed she contracted it from the Veteran. He was diagnosed with Hepatitis C at that time and reported a recent onset of myalgias. November 1998 VA gastroenterology records reflect that the Veteran had Hepatitis C and potentially had a transfusion to treat a 1985 gunshot wound. No other risk factors were listed. During his January 2019 Board hearing, the Veteran testified that he admitted himself to VA rehabilitation for alcohol abuse in the 1990’s, and during that stay he was offered $250 to test a medication. He accepted, and after taking the medication his blood was tested several times. He believes he contracted Hepatitis C at that time. He testified that there were several other Veteran’s at that VA center that also had Hepatitis C. There is no other evidence in the claims file regarding the etiology of the Veteran’s Hepatitis C. In short, there is no competent or probative medical evidence of record showing that Hepatitis C was caused by any VA treatment. Consequently, the Board need not reach the question of whether additional disability resulted from carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault as a result of VA hospital treatment, or the result of an event not reasonably foreseeable. Assuming the Veteran did take an experimental medication in the 1990’s for compensation through the VA, he still has not submitted any probative evidence that his participation in the experiment would have caused Hepatitis C. Furthermore, a risk factor noted in his treatment records is a possible transfusion at a private hospital in 1985. The Veteran has also reported high sexual activity and drug use as additional risk factors. The Board considered the lay evidence provided in support of establishing entitlement to VA compensation by way of Section 1151. The Board is not unqualifiedly rejecting lay evidence but, instead, finds that it is not sufficient to substantiate the claim. In general, whether considering the claim under the Section 1151 theory, a determination as to the nature and etiology of the current claimed disabilities is medically complex in nature. See Jandreau v. Nicholson, 492 F.3d 1372, 1977 (Fed. Cir. 2007). Thus, the Veteran, as a layperson, is not competent to offer a medical opinion as to the onset or cause of Hepatitis C because he has not demonstrated that he possesses the requisite specialized knowledge. Such an opinion requires medical expertise, and therefore, the Veteran is not competent to offer a medical opinion regarding such a complex medical question. Despite the contentions otherwise, the Veteran has not submitted persuasive evidence showing his Hepatitis C is related to VA treatment. A veteran bears the evidentiary burden to establish all material elements of a claim. See 38 U.S.C. § 5107 (a); Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009). As the preponderance of the evidence is against the claim, and there is no probative, credible evidence in support of his claim, the benefit-of the-doubt doctrine is not applicable here. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Therefore, compensation under 38 U.S.C. § 1151 for Hepatitis C is not warranted. REASONS FOR REMAND 6. Entitlement to a rating in excess of 10 percent for prostatitis The Veteran submitted correspondence in June 2010 stating that his prostatitis had increased in severity over the last six years because he had an increased urged to urinate both day and night. July 2011 VA treatment records reflect that the Veteran was advised to have a biopsy of his prostate. August 2011 VA treatment records reflect that the Veteran was seen for elevated prostate-specific antigen (PSA) and a “prior” history of prostatitis was noted. On his October 2015 VA Form-9, the Veteran stated that he believed he was entitled to a higher rating because he had an enlarged prostate, requiring surgical intervention. The Veteran attended a VA examination in December 2019. He reported receiving most of his urinary medical care through a private provider. Following the examination, the Veteran submitted four pages of private records indicating that in November 2017 he underwent a prostate biopsy and that he had an elevated PSA. The private records do not reflect any prostatitis diagnosis but do refer to a voiding dysfunction. The Board regrets further delay, but a remand is required to allow VA to obtain authorization and request these records. Furthermore, it is not clear from the record if the Veteran’s elevated PSA is in any way connected to his service-connected prostatitis, or if the urinary symptoms he has had in the last ten years is related to his prostatitis, or another nonservice-connected prostate condition. Accordingly, an opinion is necessary. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for Dr. Mahesh Patel, and any other private treatment providers the Veteran has seen for prostate conditions. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s prostate conditions. Only schedule the Veteran for an examination if deemed necessary. The examiner is asked to opine: (a.) Whether the Veteran currently has prostatitis. (b.) Whether the Veteran’s urinary symptoms at any time during the period on appeal are due to his prostatitis or due to another, nonservice-connected disorder. A rationale for all requested opinions shall be provided. 3. After completing the development requested above, and any other development deemed necessary, readjudicate the Veteran’s claim. If any of the benefits sought are not granted in full, the AOJ should furnish the Veteran and his representative with an SSOC and afford an opportunity to respond. The claims file should then be returned to the Board for further appellate review. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Fitzgerald, 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.