Citation Nr: 21003632 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 15-43 489 DATE: January 22, 2021 REMANDED Entitlement to an increased rating in excess of 40 percent for prostatitis is remanded. Entitlement to service connection for major depressive disorder, claimed as secondary to service-connected disabilities, is remanded. Entitlement to service connection for hypertension, claimed as secondary to diabetes, is remanded. Entitlement to service connection for peptic ulcer disease is remanded. REASONS FOR REMAND The Veteran had active service from August 1970 to March 1972. In January 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been reviewed. The Board previously remanded this case for additional development in July 2019. The remanded issues included entitlement to service connection for peripheral neuropathy of the upper and lower extremities. A September 2020 rating decision granted service connection for peripheral neuropathy of the upper and lower extremities. The grants of service connection for peripheral neuropathy of the upper and lower extremities are full grants of benefits sought with regards to the issues of service connection for peripheral neuropathy of the upper and lower extremities. 1. Entitlement to an increased rating for prostatitis is remanded. A 40 percent rating has been assigned for prostatitis based on urinary frequency with daytime voiding interval less than one hour. Under the rating criteria for urinary disabilities, a rating higher than 40 percent may be awarded if the evidence shows voiding dysfunction requiring the use of an appliance or the wearing of absorbent materials that must be changed more than four times per day or for renal dysfunction. The evidence during the appeal period has not shown that prostatitis results in renal dysfunction. VA examinations in February 2012 and August 2020 indicated that the Veteran has a voiding dysfunction that does not require the use of absorbent materials. At the Board hearing, the Veteran testified that he uses absorbent materials due to urine leakage, but the testimony did not indicate the frequency of changes of absorbent materials. An addendum opinion is necessary to clarify the conflicting information about his urinary disability. 2. Entitlement to service connection for major depressive disorder, claimed as secondary to service-connected prostatitis, is remanded. The Board previously remanded the case for a medical opinion. The examiner was asked to address whether the Veteran’s depressive disorder is caused or aggravated by his service-connected prostatitis. In August 2020, a VA examiner opined that depression is not related to prostatitis. The opinion did not address whether his depression is worsened by prostatitis. As such, the opinion did not comply with the remand directive. VA treatment records reflect that a VA psychologist opined that his depression was due to poor overall health. The case is being remanded for an addendum opinion to address the relationship of his depression to all of his service-connected disabilities. 3. Entitlement to service connection for hypertension, claimed as secondary to service-connected diabetes, is remanded. In July 2019, the hypertension claim was remanded for a medical opinion. The examiner was asked to opine as to whether hypertension is caused or aggravated by service-connected diabetes mellitus. The examiner opined in August 2020 that hypertension is less likely than not due to, or the result of, service-connected diabetes mellitus. The examiner noted that hypertension existed prior to diabetes mellitus. It was noted that hypertension was diagnosed in 2000, and diabetes mellitus was diagnosed in 2007. The examiner noted that there are other co-morbid conditions that increased the Veteran’s risk of developing hypertension. The August 2020 examination did not comply with the remand directives, as the examiner did not address whether diabetes mellitus aggravates hypertension. A remand is warranted to obtain a new medical opinion that complies with the remand directive. 4. Entitlement to service connection for peptic ulcer disease is remanded. The Veteran contends that his gastrointestinal disorder, which pre-existed service, was aggravated by service. In his October 2012 notice of disagreement, the Veteran asserted that his ulcer disease got worse due to the food and water in service. He alleged that his ulcer was worsened by Agent Orange exposure. The Veteran indicated that he was receiving medication for his ulcer when he was drafted but did not receive any medication for his ulcer while in service. The claim was previously remanded for a VA examination. The examiner was requested to opine as to whether it is clear and unmistakable that the Veteran’s peptic ulcer disease was not aggravated in service. The examiner was asked to determine whether there was no increase in his peptic ulcer disease during service or whether it is clear and unmistakable that any increase was due to the natural progress of the pre-existing condition. An August 2020 VA examination showed that there were multiple complaints during service in 1970 and 1971. The examination noted that the Veteran was hospitalized for peptic ulcer in 1969 and complained of stomach pain in 1970 and 1971. The examiner did not address the physical profile in 1971, which showed that due to his peptic ulcer disease, he was restricted to units not requiring combat rations. Further, his November 1970 upper GI examination noted that his ulcer, which was documented on x-ray, was now symptomatic. An addendum opinion is necessary to address the evidence about his physical profile and his contentions about his medical treatment and Agent Orange exposure. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for prostatitis (or telehealth interview, records request, etc. if an in-person examination is not feasible). The examiner must review the claims file. The examiner must clarify whether the Veteran uses absorbent materials and the frequency of changing absorbent materials during the period from November 2011 to the present. The examiner’s attention is directed to the Veteran’s January 2019 hearing testimony that he wears absorbent materials due to urinary dysfunction. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s claim for service connection for an acquired psychiatric disorder. The examiner must review the claims file. (a) The examiner must opine whether the Veteran’s depressive disorder is at least as likely as not due to his service-connected disabilities. His service-connected disabilities include prostatitis, peripheral neuropathy of the upper and lower extremities, diabetes mellitus, degenerative arthritis of the lumbar and cervical spine, and erectile dysfunction. (b) The examiner must opine whether the Veteran’s depressive disorder is aggravated beyond its natural progression by his service-connected disabilities. His service-connected disabilities include prostatitis, peripheral neuropathy of the upper and lower extremities, diabetes mellitus, degenerative arthritis of the lumbar and cervical spine, and erectile dysfunction. 3. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claim for service connection for hypertension. The examiner must review the claims file. The examiner must opine whether the Veteran’s hypertension is aggravated beyond its natural progression by his service-connected diabetes mellitus. 4. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claim for service connection for peptic ulcer disease. The examiner must review the claims file. The examiner must determine whether it is clear and unmistakable that peptic ulcer disease WAS NOT aggravated beyond the natural progression of the disorder by service. In other words, please determine whether it is clear and unmistakable that there was no increase in his ulcer disability in service or that it is clear and unmistakable that any increase in his disability was due to the natural progress of the pre-existing condition. (a) The examiner should address the service treatment records, which show complaints of symptomatic ulcer, gastrointestinal problems, and a physical profile restricting the use of military combat rations. (b) The examiner should address whether his exposure to Agent Orange worsened peptic ulcer disease. (c) The examiner should address whether his ulcer worsened due to a lack of treatment with medication during service. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Catherine Cykowski 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.