Citation Nr: 21071548 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 09-33 514 DATE: November 30, 2021 REMANDED Service connection for a genitourinary disorder, to include benign prostatic hyperplasia (BPH) is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1986 to January 1993, to include service in Southwest Asia. These matters come to the Board of Veterans' Appeals (Board) on appeal from a June 2008 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This appeal is being adjudicated under the legacy appellate process. The Veteran did not request a personal hearing before the Board. This matter was previously before the Board, and, in April 2014, August 2016, April 2019, and March 2021, the Board remanded this matter for further development. Unfortunately, further development is required before disposing of the Veteran's claim. Service connection for a genitourinary disorder, to include BPH is remanded. At issue is whether the Veteran is entitled to service connection for a genitourinary disorder, to include as secondary to his service-connected bilateral lower extremity pain, numbness, and tingling disabilities. This matter must be remanded for further development. In April 2019, the Board remanded this matter in order to provide the Veteran an expert opinion from a urologist. The Veteran was provided a VA examination by a family practitioner in November 2019 and an addendum opinion from a family nurse practitioner in September 2020. In March 2021, the Board found that the November 2019 and September 2020 opinions were inadequate, because the Board found that a family practitioner and a family nurse practitioner were not the equivalent of a urologist; and the Board remanded this matter in order to provide the Veteran with a medical opinion from a urologist or an equivalent medical expert. The Board provided the Veteran with a VA examination in July 2021. The July 2021 VA examination was competed by a physician of internal medicine (also known as an internist). Unfortunately, an internist is a generalist rather than a specialist. See "Types of Health Care Providers," MedlinePlus Medical Encyclopedia, https://medlineplus.gov/ency/article/001933.htm (July 15, 2021). A urologist, however, specializes in "disorders of the male reproductive system and urinary tract and the female urinary tract[.]" Id. An internist is clearly not a urologist, and an internist, as a generalist, is not a medical expert equivalent to a urologist (i.e. specializing in the male reproductive system or the urinary tracts of any sex) either. Although generally qualified medical personnel are not required to be specialists in order to offer a medical opinion; Cox v. Nicholson, 10 Vet. App. 279 (1997); in certain circumstances a relatively higher level of training in a particular bodily system may be necessary in order to render an adequate medical opinion. Black v. Brown, 10 Vet. App. 279 (1997). In this case, the Board has determined that an opinion from such an expert is necessary in order to fully develop this matter prior to disposition. Such an opinion has not been associated with the claims file, and, therefore, this matter must be remanded for a medical opinion from an appropriate expert in order to ensure substantial compliance with the Board's previous remand instructions. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: Arrange to provide the Veteran with a VA examination by a urologist or an equivalent medical provider specializing in urology in order to address the following. Is it at least as likely as not (50 percent or more) that the Veteran's chronic pelvic pain/bladder pain/prostate pain syndrome is caused or aggravated beyond their natural progression by the Veteran's service-connected bilateral lower extremity pain, numbness, and tingling disabilities? Why or why not? DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David R. Seaton, 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.