Citation Nr: 21064657 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 16-46 005A DATE: October 21, 2021 REMANDED Entitlement to service connection for a psychiatric disability, to include as secondary to residuals status post excision of bladder carcinoma, is remanded. Entitlement to service connection for multiple infections of the bladder as secondary to residuals status post excision of bladder carcinoma is remanded. REASONS FOR REMAND The Veteran had active duty service from September 1983 to April 1987. This appeal comes to the Board of Veterans' Appeals (Board) from a rating decision dated February 2014 issued by a Department of Veterans Affairs (VA) Regional Office. The Veteran timely appealed. The Veteran's appeal has previously been before the Board. In November 2018 and May 2021, the Board remanded the Veteran's claims to the Agency of Original Jurisdiction (AOJ) for additional development. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). 1. Entitlement to service connection for a psychiatric disability, to include as secondary to residuals status post excision of bladder carcinoma, is remanded. In its May 2021 remand, the Board directed that a VA medical opinion be obtained regarding the etiology of the Veteran's multiple infections of the bladder. On remand, the examiner was to specifically address four issues. The first issue the examiner was to address was whether the Veteran had a distinct diagnosed psychiatric disability apart from the service-connected insomnia. If the Veteran had a distinct diagnosed psychiatric disability apart from the service-connected insomnia, the examiner was also asked to specifically address if it was at least as likely as not caused by the service-connected bladder cancer residuals. If the Veteran had a distinct diagnosed psychiatric disability apart from the service-connected insomnia, the examiner was also asked to specifically address if it was at least as likely as not aggravated by (worsened in severity beyond a normal progression by) the service-connected bladder cancer residuals. Lastly, the examiner was asked to specifically address the August 2014 private examination report reflecting the private examiner diagnosed anxiety disorder, assessed that the anxiety disorder caused total occupational and social impairment, and related the anxiety disorder to the service-connected bladder cancer residuals. In June 2021, a VA examiner provided an opinion to answer the first question. As the VA examiner found that the Veteran did not have a distinct diagnosed psychiatric disability apart from the service-connected insomnia, he logically did not provide a nexus opinion for the theory of secondary service connection. The examiner did specifically address the August 2014 private examination report; however, his rationale is not adequate. The VA examiner wrote, "The evidence do[es] not support the private examination report of claimed anxiety disorder cause[d] total occupational and social impairment nor the relation of his claimed anxiety disorder to the service connected bladder cancer residual. The temporal relationship between the claimed neuropsychiatric disorder diagnose[d] in 2014, and the service connected physical condition of bladder carcinoma and treatment...is not established." The opinion does not explain how the evidence does not support the private diagnosis of generalized anxiety disorder, or the significance of a temporal relationship (or lack thereof). The Board finds that this rather conclusory statement lacks an adequate rationale and does not adequately address the August 2014 diagnosis of generalized anxiety disorder. Thus, the Board finds that remand is required to obtain an addendum opinion. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes the effort to provide an examination, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided). 2. Entitlement to service connection for multiple infections of the bladder as secondary to residuals status post excision of bladder carcinoma is remanded. The Veteran has also claimed entitlement to service connection for multiple infections of the bladder as secondary to his service-connected residuals status post excision of bladder carcinoma. The Veteran, his representative, and the record raise no other theory of service connection. As a result, the Board will limit its analysis to the theory advanced by the Veteran. Robinson v. Peake, 21 Vet. App. 545, 552-56 (2008). In its May 2021 remand, the Board directed that a VA medical opinion be obtained regarding the etiology of the Veteran's multiple infections of the bladder. On remand, the examiner was to specifically address four issues. The first issue the examiner was to address was whether the Veteran had a bladder infection and/or bladder infections at any time during the appeal period (from November 2012 to present). If the Veteran had a bladder infection and/or bladder infections at any time during the appeal period, the examiner was also asked to specifically address if it was at least as likely as not caused by the service-connected bladder cancer residuals. If the Veteran had a bladder infection and/or bladder infections at any time during the appeal period, the examiner was also asked to specifically address if it was at least as likely as not aggravated by (worsened in severity beyond a normal progression by) the service-connected bladder cancer residuals. Lastly, the examiner was asked to specifically address the Veteran's contention that he had had repeated bladder infections that had been treated with antibiotics. In June 2021, a VA examiner provided an opinion. When asked, "Does the Veteran now have or has he/she ever been diagnosed with a condition of the bladder or urethra of the urinary tract?" The examiner marked the box that said, "No." In the section following, the examiner was asked to describe the history of the Veteran's urinary tract condition. He wrote in relevant part, "There is no evidence of urinary tract since 2012." The claim for this disability was received in November 2012. Therefore, while the VA examiner found that the Veteran did not now have nor had ever been diagnosed with a condition of the bladder or urethra of the urinary tract, the Board notes that the urinary tract infection in 2012 is evidence of a diagnosed condition recent to the appeal period. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Therefore, the examiner's statement that the Veteran had not ever been diagnosed with a condition of the bladder or urethra of the urinary tract is incorrect. The Board finds that remand is necessary to obtain a nexus opinion addressing whether the bladder infections that the Veteran had in 2012 are at least as likely as not related to his service-connected bladder disability. Barr, 21 Vet. App. at 311 (once VA undertakes the effort to provide an examination, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided). Accordingly, the matters are REMANDED for the following action: 1. Request a medical opinion addressing the Veteran's claimed psychiatric disability. In-person examination is not required unless deemed necessary by the examiner. Based upon a review of the entirety of the claims file, the examiner is requested to provide an opinion as to the following questions: (a.) At any point from November 2012 to the present, has the Veteran had a distinct DSM-5 compliant psychiatric diagnosis apart from insomnia? In explaining the medical reasoning for this opinion, please address the August 2014 private examination report reflecting a diagnosis of generalized anxiety disorder. If the examiner reaches a different conclusion, please explain why. (b) For any psychiatric diagnoses identified in part (a), is it at least as likely as not that the diagnosis was caused by the service-connected bladder cancer residuals? Why or why not? (c) For any psychiatric diagnoses identified in part (a), is it at least as likely as not that the diagnosis was aggravated by (worsened in severity beyond a normal progression by) the service-connected bladder cancer residuals? Why or why not? Distinct and separate explanations for all opinions must be provided. In providing the requested rationale, the examiner is asked to cite to the pertinent evidence of record, including clinical records and the Veteran's statements regarding the onset of his symptoms. 2. Request a medical opinion addressing the Veteran's multiple bladder infections. In-person examination is not required unless deemed necessary by the examiner. Based upon a review of the entirety of the claims file, the examiner is requested to provide an opinion as to the following questions: (a.) Is it at least as likely as not the bladder infection(s) that the Veteran had in 2012 were caused by the service-connected bladder cancer residuals? Why or why not? (b.) Is it at least as likely as not the bladder infection(s) that the Veteran had in 2012 were aggravated by (worsened in severity beyond a normal progression by) the service-connected bladder cancer residuals? Why or why not? In explaining the medical reasoning for these opinions, please specifically address the Veteran's contention that he has had repeated bladder infections that have been treated with antibiotics. (Continued on the next page) Distinct and separate explanations for all opinions must be provided. In providing the requested rationale, the examiner is asked to cite to the pertinent evidence of record, including clinical records and the Veteran's statements regarding the onset of his symptoms. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Minock 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.