Citation Nr: 21004163 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 12-28 998 DATE: January 26, 2021 REMANDED Entitlement to service connection for incontinence and/or sexual dysfunction as secondary to service-connected lumbar spine degenerative disc disease is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from August 1991 to October 1995. This appeal comes to the Board of Veterans’ Appeals (Board) from a February 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2017, a videoconference hearing was held before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. In January 2018, the Board remanded the Veteran’s claim for an increased rating for his lumbar spine degenerative disc disease, in pertinent part, for an updated VA examination and specifically requested that the examiner opine as to whether the Veteran suffered from any incontinence or sexual issues as the result of his service-connected lumbar spine disability. In May 2020, the issues of entitlement to separate ratings for incontinence and sexual dysfunction were again remanded for additional development. The Board notes that the remand directive specifically requested that the Veteran be afforded a VA examination, and, that in the medical opinion, the VA examiner address the February 2018 VA treatment record in which the Veteran was noted to have new onset bladder/urinary dysfunction. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Also, a remand by the Board confers on the Veteran, as a matter of law, the right to substantial compliance with the remand directives. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141 (1999). In attempt to comply with the May 2020 remand directives, the RO obtained a July 2020 VA examination and medical opinion. The VA examiner opined that it was less likely than not that the Veteran’s erectile dysfunction and incontinence are proximately due to or the result of his lumbar spine degenerative disc disease. Unfortunately, the Board finds that remand is required as the VA medical opinion above does not comply with the Board’s remand directives. See Stegall, 11 Vet. App. at 271. The Board acknowledges that the standard in Stegall only requires substantial, not strict, compliance. However, the Board is careful not to make conclusions based on its own medical judgment. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). The Board is simply unable to ascertain whether the claim for erectile dysfunction and/or incontinence is etiologically related to the Veteran’s service-connected lumbar spine degenerative disc disease. The sole rationale for the July 2020 VA examiner’s opinion was that the Veteran had not reported his symptoms of erectile dysfunction or incontinence to his treatment providers nor had he had a basic medical work up for them. However, as documented in the February 2018 VA treatment record, the Veteran has reported having bladder/ urinary dysfunction. Moreover, it is not clear from the examiner’s report why an etiology opinion may not be rendered in the absence of medical workup/treatment. As such, remand is required to obtain a VA addendum opinion. The matters are REMANDED for the following action: Obtain a VA addendum opinion from an appropriate examiner to determine whether the Veteran has any incontinence and/or sexual dysfunction as a result of his lumbar spine degenerative disc disease. The examiner must opine as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s sexual dysfunction and/or incontinence are related to his service-connected lumbar spine degenerative disc disease. The examiner should specifically address the testimony provided by the Veteran and his spouse at the May 2017 Board hearing, in which he described waking up in pain from his back to find that he has wet himself, as well as the difficulties he and his spouse share regarding physical intimacy as a result of his back pain. The examiner should also address the February 2018 VA treatment record in which the Veteran was noted to have new onset bladder/urinary dysfunction. (Continued on the next page)   The examiner must provide a rationale for all opinions offered. If the examiner feels that the requested opinion cannot be rendered without resorting to speculation, he/she should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts), by a deficiency in the record (i.e. additional facts are required), or by the examiner himself/herself (because he/she does not have the needed knowledge or training). A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Talton, John H. 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.