Citation Nr: 21071543 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 17-37 305 DATE: November 30, 2021 REMANDED Service connection for bladder impairment is remanded. REASONS FOR REMAND The Veteran has active service from November 1969 to July 1987, including service in the Republic of Vietnam. This matter is on appeal from a June 2016 rating decision. In March 2021, the Veteran withdrew his prior request for a hearing. The appeal was previously remanded in June 2021 1. Service connection for bladder impairment is remanded. A remand is required for addendum opinions. The Veteran has been awarded service connection for diabetes, stroke associated with diabetes, lumbar spine degenerative disc disease, and cervical spine degenerative disc disease. He argues that his bladder disorder is the result of one or more of these service-connected disorders. In March 2014 and November 2014 VA medical records, the Veteran reports increased incontinence following private prostate surgery. In a December 2014 VA treatment record the Veteran describes incontinence that his urologist told him was secondary to his spine disability. In an October 2015 VA examination the Veteran notes "constant bladder leakage" in reporting functional impairment related to his spine disability. In April 2016, the Veteran filed a claim of service connection for "bladder leakage secondary to stroke." A July 2021 VA urinary tract examination indicates a current diagnosis of urinary incontinence. Corresponding medical opinions conclude that the Veteran's urinary incontinence is less likely than not related to his back and neck disorders. A June 2016 VA medical opinion concludes that the Veteran's bladder disorder is less likely than not related to his diabetes or stroke. For secondary service connection, a VA medical opinion should not combine causation and aggravation; separate findings and rationale should be provided. Atencio v. O'Rourke, 30 Vet. App. 74, 8991 (2018). As the June 2016 VA medical opinion does not provide separate bases causation and aggravation with respect to stroke, an addendum opinion is required. The RO should also obtain a medical opinion addressing direct service connection based on in-service genitourinary problems. The Veteran regularly complained of urethral discharge problems between January 1969 and October 1970 (service treatment records received 8/21/14, pages 1420 of 75 and 83 of 110). Also, a January 1975 service treatment record (received 8/21/14, page 37 of 76) describes cloudy, painful urine, and a March 1975 service treatment record (received 8/21/14, page 34 of 76) indicates "recurrent discharge." Additionally, on remand the RO should obtain all relevant VA treatment records dated from August 2021 to the present before the issues on appeal are decided on the merits. Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain all VA treatment records from August 2021 to the present. If no records are available, the claims folder must indicate this fact. Any additional records identified by the Veteran during the course of the remand should also be obtained, following the receipt of any necessary authorizations from the Veteran, and associated with the claims file. 2. After obtaining any additional records to the extent possible, an examiner should review the entire claims file and provide the following opinions: (a.) Whether the Veteran has any bladder impairment. (b.) Whether it is at least as likely as not that any bladder impairment was incurred in the Veteran's service. In rendering this opinion, the examiner should consider: 1) The Veteran complaints of urethral discharge problems between January 1969 and October 1970 (service treatment records received 8/21/14, pages 1420 of 75 and 83 of 110); 2) The January 1975 service treatment record (received 8/21/14, page 37 of 76) describing cloudy, painful urine; and 3) The March 1975 service treatment record (received 8/21/14, page 34 of 76) indicating "recurrent discharge." (c.) Whether the Veteran has any bladder impairment that is proximately due to diabetes, stroke associated with diabetes, lumbar spine degenerative disc disease, and/or cervical spine degenerative disc disease. Please address these disorders individually and in the aggregate. (d.) Whether the Veteran has any bladder impairment that was aggravated by diabetes, stroke associated with diabetes, lumbar spine degenerative disc disease, and/or cervical spine degenerative disc disease. This must be addressed in a separate opinion from the "proximately due to" opinion. Please address these disorders individually and in the aggregate. The examiner should provide a complete rationale for any opinions offered. If the examiner is unable to provide any requested opinion without resort to speculation, he or she should explain why this is so. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cannon, Brian 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.