Citation Nr: 21062047 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 17-36 260 DATE: October 6, 2021 ORDER Entitlement to service connection for a bladder condition is denied. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDING OF FACT The evidence preponderates against a finding that the Veteran's voiding dysfunction was incurred in service or is otherwise related to an in-service injury, disease, or event. CONCLUSION OF LAW The criteria for entitlement to service connection for a bladder condition are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1997 to March 1999. This matter is on appeal from a June 2016 decision of a Department of Veterans Affairs (VA) Regional Office (RO). The case was previously before the Board in February 2019 when it was remanded for further development. Bladder Condition The Veteran contends that he is entitled to service connection for a bladder condition. Service connection will be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131. To establish service connection, the evidence must show: (1) the existence of a current disability; (2) an 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. 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may include statements conveying sound medical principles found in medical treatises. Competent medical evidence may also include statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. For example, lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing observable symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). 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. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. In this case, the Veteran was provided with a VA examination in October 2019 in which the examiner noted the presence of voiding dysfunction. Thus, the first element of Shedden is satisfied. In the June 2016 notice of disagreement (NOD), the Veteran stated that "on the ship I would urinate at least 4-5 days at night during sleeping hours and [the] problem still occurs to this day." The Veteran is competent to report an increase in urinary frequency, as such is a readily observable symptom. See, e.g., Washington v. Nicholson, 21 Vet. App. 191, 195 (2007) (stating that "as a layperson, the appellant is competent to provide information regarding the visible, or otherwise observable, symptoms of disability"). However, in this case, service treatment records reflect that the Veteran affirmatively stated that he did not experience frequent urination when examined during active duty in August 1997 and September 1998. Further, March 2017 VA treatment records note that the Veteran reported an increase in urinary frequency. To be clear, the Board is not questioning the Veteran's honesty or moral character. The Veteran is attempting to recollect events that transpired a long time ago and the passage of time, along with the inconsistencies noted above, compels the conclusion that the Veteran is not an accurate historian as to these particular statements. The Board therefore affords them no probative weight and finds that the record does not credibly establish the incurrence of voiding dysfunction during service. During the October 2019 VA examination, the examiner opined that the Veteran's voiding dysfunction is likely related to his diabetes mellitus type II. She noted that although the Veteran reported symptoms of frequent urination, the C-files lack evidence of a bladder or urethra condition. She stated that the Veteran's reported symptoms are more likely associated with his diabetes. This statement, when viewed in isolation, appears conclusory, as the examiner did not expressly discuss why these symptoms are likely related to the Veteran's diabetes. However, the report must be read as a whole, and a medical examiner is not required to provide a detailed review of medical history or comment on every piece of favorable evidence in the record. Monzingo v. Shinseki, 26 Vet. App. 97, 105-7 (2012); see Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (noting that VA examiners do not have a reasons or bases requirement). Where the opinion is lacking in detail, the Board is permitted to draw inferences based on the overall report so long as the inference does not result in a medical determination. Acevedo, 25 Vet. App. at 294. Review of the record as a whole makes clear that the examiner reasoned that increased urinary frequency is a symptom of diabetes, and the record establishes that the Veteran has a current diagnosis of diabetes. Specifically, November 2019 VA treatment records note that increased urination is a symptom of hyperglycemia. As the examination report reflects thorough consideration of the Veteran's pertinent medical history, the Board assigns a high degree of probative value to this opinion. The Board has considered whether service connection is warranted secondary to the Veteran's diabetes mellitus type II. See DeLisio v. Shinseki, 25 Vet. App. 45, 54 (2011). Service connection may be granted on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that it was either caused or aggravated by a service-connected disability. See 38 C.F.R. § 3.310(a), (b). However, the record does not reflect, and the Veteran does not contend, that his diabetes is, or should be, service connected. There is no indication that the Veteran's diabetes was present during service, manifest within one year of service, was productive of symptoms continuously since service, or is related to any in-service event, injury, or disease. The Veteran's VA treatment records indicate an initial diagnosis in December 2015. See February 24, 2017, Diabetology Risk Assessment Screening Consult. Thus, the record does not indicate that the Veteran's voiding dysfunction was either caused or aggravated by a service-connected disability. As such, the Board finds that the preponderance of the evidence is against the Veteran's claim. The Board has considered the benefit-of-the-doubt rule; however, since a preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt rule is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends that he is entitled to service connection for bilateral hearing loss. However, upon review of the record, the Board finds that further development is necessary to obtain an opinion that adequately addresses whether the Veteran meets the regulatory definition of hearing impairment. As explained in the prior remand, the Veteran was provided with a VA examination in June 2016 in which the examiner stated that the test results were not valid for rating purposes because the Veteran's responses were too inconsistent to record. In October 2019, the Veteran was provided with an additional VA examination in which this examiner also noted that the puretone test results were not valid for rating purposes because the results were too inconsistent to record. However, in one of the examination reports, the examiner noted diagnoses of bilateral sensorineural hearing loss in the frequency range of 500-4000 Hz, despite having previously stated that she was unable to obtain accurate readings. Once VA undertakes the effort to provide an examination for a service-connection claim, it must provide an adequate one or, at minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). An opinion is considered adequate when it is based on consideration of the Veteran's prior medical history and examinations and describes the disability in sufficient detail so that the Board's evaluation of the claimed disability is a fully informed one. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). As the VA examiner provided conflicting and inconsistent responses as to whether the Veteran currently experiences hearing loss, an addendum opinion is necessary to clarify the nature of the Veteran's condition so that the Board can make a fully informed decision in this case. The Board acknowledges that the examiners have also provided negative opinions regarding the etiology of the Veteran's condition, which may render the issue of whether a current disability exists moot. However, this does not relieve VA from its obligation of ensuring that the Veteran has been provided with an examination which adequately addresses whether a current disability is present. The record also reflects the Veteran receives VA treatment; thus, updated VA treatment records should be associated with the claims file. The matter is REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from November 2019 to the present. 2. After completing the development requested in item 1, return the claims file to an appropriate clinician for review and an addendum medical opinion. An in-person (or telehealth) examination is only necessary if deemed so by the clinician. The reviewing clinician should be requested to provide an opinion (based on a review of the record) as to whether the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or, the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or, speech recognition scores using the Maryland CNC Test are less than 94 percent. If the examiner finds that the Veteran has hearing impairment as defined above, the examiner must provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's hearing impairment is related to an in-service injury, disease, or event. A complete rationale for all opinions must be provided. 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 an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. J. B. FREEMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. H. White, 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.