Citation Nr: 21068059 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 15-38 307 DATE: November 9, 2021 REMANDED Service connection for pelvic floor dysfunction. REASONS FOR REMAND In March 2019, the Veteran testified before the undersigned Veterans Law Judge. A copy of the transcript has been associated with the claims file. In June 2019, the Board denied the appeal. He appealed the findings to the Veterans Claims Court. In August 2020, the Court Clerk granted a joint motion for partial remand (JMPR). In February 2021, the Board remanded the appeal to obtain a medical opinion in accordance with the JMPR. However, additional development is required. Specifically, in accordance with the JMPR, the Board's February 2021 decision directed the AOJ to obtain a new VA examination or opinion assessing the etiology of the Veteran's pelvic floor dysfunction. In this regard, the Board directed that the examiner separately addresses causation, aggravation and permanent worsening, address March 2019 articles and a March 2019 private opinion, both of which suggested that stress was possibly interrelated to the development of pelvic floor dysfunction, and to base a rationale specifically upon the Veteran's history, and not rely solely on medical literature listing commonly accepted risk factors. Instead, the examiner copied and pasted prior history, failed to address any submitted articles, failed to address the March 2019 opinion, did not separately address causation, aggravation, or worsening, and once again relied solely on known risk factors for pelvic floor dysfunction without relating them to the Veteran's specific medical history. Thus, remand is necessary to ensure compliance with the previous directives. Stegall v. West, 11 Vet. App. 268, 271. The matter is REMANDED for the following actions: 1. Identify and obtain any outstanding, pertinent, VA and private treatment records and associate them with the claims file. 2. Obtain an addendum opinion regarding the etiology of the Veteran's pelvic floor dysfunction from a clinician who has not previously examined the Veteran or provided an opinion. The entire claims file should be made available to, and reviewed by the, clinician. An additional examination should not be scheduled unless deemed necessary by the clinician. The clinician is asked to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that a pelvic floor dysfunction was proximately caused by, aggravated by, or permanently worsened beyond its natural progression by the Veteran's service-connected other specified trauma and stressor-related disorder with major depressive disorder. The clinician is asked to separately address i) causation, ii) aggravation, and iii) permanent worsening. The clinician is also asked to specifically consider and address the medical articles submitted in March 2019 by the Veteran, as well as the March 2019 opinion describing a relationship between stress and the Veteran's pelvic floor dysfunction. In accordance with the JMPR's directives, if the clinician is basing his or her opinion on commonly accepted risk factors or medically accepted principles, he or she is asked to relate such risk factors to the Veteran's specific medical history, A thorough rationale is required for any opinions rendered. L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Yacoub, 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.