Citation Nr: 21004280 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 12-35 610 DATE: January 26, 2021 REMANDED Entitlement to a separate rating for urinary incontinence associated with service-connected degenerative disc disease with intervertebral disc syndrome (IVDS) and laminectomy is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1982 to May 1988. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in May 2009 by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2013, the Veteran testified before a Decision Review Officer at the RO and, in January 2016, at a Board hearing before the undersigned Veterans Law Judge. Transcripts of both hearings are associated with the record. In March 2016, the Board remanded the issue on appeal for additional development and, in July 2018, denied the claim. The Veteran subsequently appealed the denial to the U.S. Court of Appeals for Veterans Claims (Court). In June 2019, the Court granted the Veteran’s and the Secretary of VA’s (the parties’) Joint Motion for Remand (JMR), which vacated and remanded the Board’s July 2018 decision. In June 2019 and June 2020, the Board remanded the case for additional development and it now returns for further appellate review. Entitlement to a separate rating for urinary incontinence associated with service-connected degenerative disc disease with IVDS and laminectomy. Pursuant to the June 2020 Remand, the Veteran underwent VA examination via video telehealth in July 2020, the associated report of which indicates the Veteran did not have a diagnosis of voiding dysfunction. In this regard, he noted the Veteran’s subjective reports of such symptomatology, but found there was no objective findings to suggest a pathology and no organic etiology identifiable in the records. The VA physician also noted the records were conflicting in that most entries reflected reports of fecal incontinence rather than urinary problems. Further, the most recent entries did not indicate any urinary incontinence, to the extent that such was not mentioned on the Veteran’s VA problem list. Additionally, he noted a June 2019 magnetic resonance imaging scan (MRI) of the Veteran’s lumbar spine did not show any cauda equina syndrome, which is the lesion that causes bladder and bowel incontinence. According to the VA physician, the MRI showed no structural lesion that can cause incontinence, which was further supported by a nerve conduction study performed in July 2019. Specifically, such indicated that, from a signal/electrical viewpoint, there were no issues with the spinal nerves going to the bladder and anal area. Furthermore, the VA physician found pertinent that rectal examination in July 2019 showed the “external sphincter demonstrates good tone and reflex”, thereby indicating that the pudendal nerve, which mediates urination, defecation, and orgasm, was intact. Moreover, a June 2019 cystoscopy showed no bladder neck lesions and the urology visits and consults were “very quiet” regarding the issue of urinary incontinence. Thus, the VA physician found that the presence of urinary incontinence was unlikely from anatomic/structural, electrical, and functional aspects, and concluded it is less likely than not that the Veteran’s claimed urinary incontinence was proximately due to, the result of, or aggravated by his service-connected back disability. Conversely, an October 2020 VA treatment record indicates a nurse practitioner discussed with the Veteran his incontinence issues, post-void residual, and the medication Oxybutynin (prescribed for bladder spasms) to help control his incontinence issues, which she indicated were “presumably secondary to his lower back surgery.” Notably, the nurse practitioner did not provide a rationale for her statement. Nevertheless, given the indication of the favorable nature of such record in connection with the claim on appeal, and the July 2020 VA examiner’s inability to review and comment upon such future information, the Board finds a remand is warranted to obtain an addendum opinion considering the evidence of record in its entirety. The matter is REMANDED for the following action: Forward the record, to include a copy of this Remand, to the VA clinician who conducted the July 2020 examination, or an appropriate substitute if unavailable, to obtain an addendum opinion addressing the etiology of the Veteran’s claimed urinary incontinence. Following a review of the record, to include the newly received October 2020 VA treatment record reflecting a nurse practitioner’s notation of her discussion with the Veteran’s regarding his incontinence issues, post-void residual, and the medication Oxybutynin (prescribed for bladder spasms) to help control his incontinence issues, which she indicated were “presumably secondary to his lower back surgery,” the clinician should address the following inquiries: (A) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran currently has urinary incontinence, to include as a result of bladder spasms, associated with his service-connected degenerative disc disease with IVDS and laminectomy? (B) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran currently has urinary incontinence, to include as a result of bladder spasms, that is caused or aggravated by his service-connected degenerative disc disease with IVDS and laminectomy? For any aggravation found, the clinician should state, to the best of his/her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. (C) If urinary incontinence, to include as a result of bladder spasms, is found to be related to the Veteran’s service-connected degenerative disc disease with IVDS and laminectomy, please identify the date of onset as well as the nature and severity of such impairment. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. M. Celli, 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.