Citation Nr: 21066376 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 17-31 564 DATE: October 29, 2021 REMANDED Service connection for chronic urinary tract infection is remanded. Service connection for erectile dysfunction, to include as secondary to service-connected disability, is remanded. REASONS FOR REMAND The Veteran served in the Army National Guard from May 1967 to April 10, 1983. He also served on active duty in the United States Army from April 11, 1983 to June 1998. The Board thanks him for his service to our country. In February 2020, the Board remanded the claims on appeal for additional development. The Board finds that there has not been substantial compliance with the remand. Stegall v. West, 11 Vet. App. 268 (1998). 1. Service connection for chronic urinary tract infection is remanded. The Board remands this issue to obtain an adequate medical opinion that complies with the February 2020 remand. The February 2020 remand in part requested a VA medical opinion as to whether the Veteran's chronic urinary tract infection (even if resolved) is causally or etiologically related to any event, illness, or injury during active service. An August 2020 negative VA Medical Opinion which noted "there was no supporting evidence in the STRs" fails to acknowledge or address the significance of the fact that the Veteran's service treatment records reflect urinary tract infections in September and October 1991. The Medical Opinion also fails to acknowledge the Veteran's report that he has had recurrent urinary tract infections after separation to the present. See December 2015 VA Urinary Tract (Including Bladder and Urethra) Conditions examination report. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (holding that an examination must consider lay evidence of in-service incurrence or continuity of symptomatology since service). On remand, the agency of original jurisdiction (AOJ) must obtain an adequate VA medical opinion that addresses all relevant evidence. 2. Service connection for erectile dysfunction, to include as secondary to service-connected disability, is remanded. The Board remands this issue to obtain an adequate medical opinion that complies with the February 2020 remand. The February 2020 remand in part requested a VA medical opinion "as to whether it is at least as likely as not that any current erectile dysfunction has been aggravated (permanently worsened beyond normal progression) by the Veteran's service-connected obstructive sleep apnea." Remand at pages 4-5. This standard for aggravation by a service-connected disability is incorrect. The correct standard is "any increase" in disability. An August 2020 negative VA Medical Opinion uses this incorrect standard for aggravation. On remand, the AOJ must obtain an adequate VA medical opinion that uses the correct standard for secondary aggravation. The matters are REMANDED for the following action: 1. Please obtain any updated VA and non-VA treatment records pertaining to the disabilities on appeal. 2. Please obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's chronic urinary tract infection. The AOJ should make the e-folder available to the clinician, and the examination report must reflect that the clinician reviewed it. The Board asks the clinician to opine whether it is at least as likely as not (50 percent probability or more) that the Veteran's chronic urinary tract infection (even if resolved) is causally or etiologically related to any event, illness, or injury during active service with consideration of the fact that the Veteran's service treatment records reflect urinary tract infections in September and October 1991, and that the Veteran reported that he has had recurrent urinary tract infections after separation to the present. The Board advises the clinician that the Veteran is competent to report symptoms, treatment, events, and injuries in service, and that his reports must be taken into account, along with the other evidence of record, in formulating the requested opinion. The clinician must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If the clinician cannot provide an opinion without resort to speculation, he or she should provide an explanation as to why this is so and identify what, if any, additional evidence would permit such an opinion to be made. A new examination (or telehealth interview, etc., if an in-person examination is not feasible) should be scheduled only if deemed necessary by the clinician. 3. Please obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's erectile dysfunction. The AOJ should make the e-folder available to the clinician, and the examination report must reflect that the clinician reviewed it. The Board asks the clinician to opine whether it is at least as likely as not (50 percent probability or more) that any current erectile dysfunction is aggravated (defined as any increase in disability) by the Veteran's service-connected obstructive sleep apnea. If aggravation is shown, the clinician must specify what permanent, measurable increase in the severity of the erectile dysfunction is attributable to the service-connected obstructive sleep apnea. The clinician must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If the clinician cannot provide an opinion without resort to speculation, he or she should provide an explanation as to why this is so and identify what, if any, additional evidence would permit such an opinion to be made. A new examination (or telehealth interview, etc., if an in-person examination is not feasible) should be scheduled only if deemed necessary by the clinician. 4. Please confirm that the VA medical opinion addressing secondary aggravation comports with this remand, specifically that the medical opinion uses the correct standard for secondary aggravation of any increase in disability, not the incorrect standard of beyond the natural progression as noted on the examination form itself. If the secondary aggravation medical opinion does not comport with this remand, obtain another medical opinion. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Davitian, 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.