Citation Nr: 21001575 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 17-20 111 DATE: January 11, 2021 REMANDED Entitlement to service connection for benign prostatic hypertrophy (BPH), claimed as prostatitis, and prostatectomy residuals is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1973 to September 2003. This case comes to the Department of Veterans Affairs (VA) Board of Veterans’ Appeals (Board) on appeal from an Agency of Original Jurisdiction (AOJ) rating decision dated in October 2012. The Veteran testified at a Board hearing in May 2019. A copy of the transcript has been associated with the record. This case was previously remanded by the Board in October 2020. Unfortunately, the case is not ready for adjudication, and another remand is necessary. 1. Entitlement to service connection for benign prostatic hypertrophy, claimed as prostatitis, and prostatectomy residuals is remanded. The Board is obligated to ensure AOJ compliance with remand directives. Stegall v. West, 11 Vet. App. (1998). The October 2020 remand required the AOJ to obtain a medical opinion addressing certain evidence in the claims file, and included specific directives regarding evidence that needed to discussed in an opinion. It appears that the resulting November 2020 opinion only addressed the residuals of the Veteran’s prostatectomy, which was part 1(a) of the remand directives. However, no other directive or question was addressed, meaning the examiner did not address nexus, the Veteran’s contentions, or secondary service connection. Therefore, another remand is required to obtain the requested opinions. The matters are REMANDED for the following action: 1. Forward the record including a copy of this remand and the October 2020 remand to the examiner who provided an opinion in November 2020, or if the examiner is unavailable, another suitably qualified examiner, for completion of an addendum opinion. Following review of the record, to include the Veteran’s testimony, articles and websites in support of the claim, and the September 2019 and October 2020 Board remands, the examiner should respond to the inquiry below. The examiner should acknowledge having reviewed the reasons for remands. If the examiner determines that he or she cannot respond to the Board’s inquiry as set forth in detail below without examination of the Veteran, the Veteran should be afforded such an in-person examination, or by other means if an in-person examination is not feasible. If an examination is conducted, any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. The examiner should address the following: (a.) In providing a nexus opinion, the examiner must address the Veteran’s statements and contentions that: 1) he had elevated PSA levels during service for his age, and those levels combined with the in-service symptoms, including urinary frequency, continued until he was diagnosed with BPH, and those symptoms, including elevated PSA levels, and the BPH diagnosis subsequently led to development of adenocarcinoma, which required radical prostatectomy in 2011; 2) the in-service symptoms, including urinary frequency and urgency, were caused by prostatitis, which was chronic and led to BPH; 3) the in-service symptoms, including difficulty starting flow, frequency, weak flow, low back pain, pain in hips and upper thighs, and ED, continued and persisted through present day; 4) the in-service chronic prostatitis progressed into cancer; 5) the continuity of symptoms from service time to present day represented a progression of diagnoses and disease severity; 6) the present symptoms of soreness, tenderness, incontinence, and ED are symptoms of prostatitis, BPH, and cancer; 7) chronic prostatitis is a risk factor for developing prostate cancer; 8) and while the Veteran was over 50 when diagnosed with cancer, he experienced the symptoms of cancer in his 20s, 30s, and 40s. (b.) The examiner must address Dr. M. P.’s April 2013 opinion that the Veteran’s BPH like had its onset in service because of his symptoms, and Dr. C. R.’s April 2013 opinion that the Veteran’s PSA was elevated for his age. (c.) The examiner must also address the website cited in the Veteran’s representative’s September 2020 brief: https://www.mayoclinic.org/diseases-conditions/benign-protastatic-hyperplasia/symptoms-causes/syc-20370087. (d.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran’s prostate disability, to include residuals of a prostatectomy, is etiologically related to, incurred in, or caused by the Veteran’s military active service, including prostatitis and dysuria noted in service. (e.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran’s prostate disability, to include residuals of a prostatectomy, is proximately caused, or aggravated by, the Veteran’s service-connected diabetes mellitus. (f.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran’s prostate disability, to include residuals of a prostatectomy, is proximately caused, or aggravated by, the Veteran’s service-connected CAD. (Continued on the next page)   A complete explanation for all opinions expressed must be provided. A clearly stated rationale must not be based solely on lack of documentation or records. The reasons for any opinion must include a discussion of the relevant evidence. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Smith, 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.