Citation Nr: 21070018 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 18-08 290A DATE: November 22, 2021 ORDER Entitlement to service connection for epididymitis and epididymo-orchitis is granted. REMANDED Entitlement to service connection for prostatitis is remanded. FINDING OF FACT Resolving reasonable doubt in his favor, the Veteran's epididymitis and epididymo-orchitis were incurred during active service. CONCLUSION OF LAW The criteria for service connection for epididymitis and epididymo-orchitis are met. 38 U.S.C. §§ 1110, 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from February 1967 to October 1970, and from September 1971 to March 1984. This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). In October 2021, the Veteran withdrew his request for a Board hearing. The Board has expanded the issues on appeal to include entitlement to service connection for prostatitis based on an April 2019 VA examination report, which noted a diagnosis of prostatitis related to service. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). For the reasons explained below, however, the Board finds that additional development is necessary before that issue can be decided. Service Connection Epididymitis and Epididymo-Orchitis The Veteran maintains that his testicular problems began during active service and that he has had testicular pain and swelling on and off since service. The Veteran's service treatment records indicated that he began experiencing testicular pain after heavy lifting in April 1973. He was diagnosed with epididymitis and was admitted for treatment and observation. In May 1973, it was noted that he had been hospitalized for 10 days and his left testicular pain resolved with bedrest, elevation, and antibiotics; however, it returned when he went back to duty. The impression was probable chronic epididymitis. In June 1973, it was noted that he continued to experience testicular pain and swelling. The impression was epidermal cyst and epididymitis. In December 1973, it was noted that he had a history of epididymitis and was now complaining of slight pain in his left scrotum. The examination revealed early epididymitis. In March 1974, he complained of swollen testicles and it was noted that he had a history of recurrent epididymitis. In July 1974, it was noted that he had recurrent epididymitis for one year and was in and out of the hospital several times for it. The impression was chronic epididymitis. The Veteran's February 1984 separation examination report indicated that his genitourinary system was normal. Post service, an August 2017 VA treatment record indicated that the Veteran complained of chronic left testicular pain. He stated that he had left testicular pain since 1970 and was hospitalized during service. He stated that the pain continued for a while and then went away. He reported that the pain reoccurred five years ago. Possible epididymitis was noted. An August 2017 ultrasound of the scrotum showed bilateral epididymal cysts and/or spermatoceles and small bilateral hydroceles. During a January 2018 VA examination, the Veteran reported that he had recurring testicular pain. On examination, he had diffuse tenderness of both testes. The examiner indicated that the source for the diffuse pain could not be determined without resorting to speculation but that it was unlikely epididymitis. The examiner did not provide any rationale for his opinion that it was unlikely epididymitis. Furthermore, somewhat contrary to that opinion, the examiner indicated a diagnosis of epididymitis with an onset date of January 2018 but noted that it had resolved despite evidence of diffuse tenderness on physical examination. Because of the internal inconsistencies, the Board finds that the VA examination report lacks probative value. A February 2018 VA ultrasound of the Veteran's scrotum indicated that both testes were normal. There were cysts found bilaterally in the epididymis and small bilateral hydroceles seen more on the left side. There was no evidence of neoplasm or inflammatory process. In March 2018, it was noted that he had probable epididymo-orchitis and prostatitis. The report of an April 2019 VA examination noted diagnoses of chronic epididymitis, chronic epididymo-orchitis, and prostatitis. The Veteran stated that he was treated for epididymitis during service. He stated that symptoms were reoccurring and that he had to wear special underwear. On examination, it was noted the left testicle was double the size of the right testicle. The examiner opined that it was at least as likely as not that the claimed condition was incurred in or caused by service. She noted that chronic pain, according to the National Institute of Health, was pain lasting more than 12 weeks, and that chronic pain persisted for months or even longer. She noted that the Veteran's testicular pain during service lasted for over a year and that he was diagnosed with chronic epididymitis. She also noted, according to a cited medical article, that acute epididymitis can lead to a range of complications, including chronic epididymitis, epididymo-orchitis, and infertility. She also noted, according to another medical article, that prostatitis can migrate to the epididymis causing complications such as epididymitis and vice versa. The examiner considered and addressed the relevant evidence of record, the Veteran's contentions, and provided rationale for her opinion. For those reasons, the Board finds the VA examiner's opinion significantly probative. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In this case, the Board finds that the evidence is at least in equipoise as to whether the Veteran's epididymitis and epididymo-orchitis were incurred in or are related to active service. Therefore, resolving reasonable doubt in his favor, the claim for service connection for epididymitis and epididymo-orchitis is granted. 38 U.S.C. § 5107(b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND The Board finds that additional development is necessary before the remaining claim on appeal is decided. As noted above, the April 2019 VA examiner indicated that the Veteran had prostatitis related to his service-connected epididymitis. However, the examiner did not examine the Veteran's prostate. VA treatment records note an impression of probable prostatitis, but the evidence of record does not indicate whether that diagnosis has been confirmed. Therefore, the Board finds that a remand is necessary for an additional VA examination. Additionally, the Board finds that any current treatment records should be identified and associated with the claims file. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination by an examiner with appropriate expertise to determine the nature and etiology of any prostatitis that may be present. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or better) that any currently present prostatitis was incurred in or is otherwise related to the Veteran's active service. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent probability or better) that any currently present prostatitis was caused or aggravated by his service-connected epididymitis and epididymo-orchitis. A rationale for all opinions expressed must be provided. 3. Confirm that the VA examination report and all opinions provided comport with this remand and undertake any other development found to be warranted. 4. Then, readjudicate the issue remaining on appeal. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Mishalanie, 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.