Citation Nr: 21077297 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 17-27 384 DATE: December 29, 2021 REMANDED Service connection for a urinary disability, to include as due to service-connected other specified trauma and stressor related disorder (psychiatric disorder) is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from January 1988 to November 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision, issued by a Department of Veterans Affairs (VA) Regional Office (RO) which denied entitlement to the benefits currently sought on appeal. By way of background, the Veteran was denied entitlement to service connection for a herniated stomach, a urinary disability, prostate cancer, and polyps on ileocecal vale (a gastrointestinal disability), in June 2015. The Veteran filed a timely Notice of Disagreement (NOD), in June 2016, and he was issued a statement of the case (SOC) in March 2017. The Veteran, through his Representative, filed a VA Form 9, appealing those issues to the Board. The claims were certified to the Board the following month. In March 2020, the Board remanded each claim, as the Veteran had specifically requested review of the additional evidence by the RO. See February 2020 Correspondence. In that same decision, the Board recharacterized the Veteran's urinary disability claim to include it being as due to prostate cancer and/or his service-connected specified trauma and stressor related disorder (psychiatric disorder) and ordered a VA examination so that etiological opinions may be rendered. In a statement from May 2021, the Veteran withdraw the issues for entitlement to service connection for prostate cancer, and for the gastrointestinal disability. The Veteran's claims returned to the Board, and in a Board Decision from September 2021 it was noted that the prostate cancer and gastrointestinal disability issues were no longer before the Board. The Board then denied entitlement to service connection for a stomach disability but remanded the urinary disability for further development and adjudication. Entitlement to service connection for a urinary disability, to include as due to service-connected other specified trauma and stressor related disorder (psychiatric disorder) is remanded. The Veteran has claimed that he has a urinary condition due to his service-connected psychiatric disorder. To establish an entitlement to service connection, the Veteran must establish (1) the existence of a present disability, (2) an in-service occurrence or aggravation of a disease or injury, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § § 3.303(a). Service connection may also be granted as secondary to a currently service-connected disability. To meet the criteria for secondary service connection, a Veteran must prove that there is (1) a current disability that is not already service-connected; and (2) at least one service-connected disability; and (3) evidence that the non-service-connected disability is either proximately due to or the result of a service-connected disability, or aggravated (increased in severity) beyond its natural progress by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran had previously claimed that his urinary condition was secondary to his prostate cancer disability. See February 2015 Fully Developed Claim. In March 2020, the Veteran's claim was remanded for a VA examination to also consider whether or not the Veteran's urinary disability, diagnosed as minor urinary incontinence, was proximately due to, or aggravated by, his service-connected psychiatric/anxiety disorder. In September 2021, the Board noted that an August 2020 VA medical examiner opined that the urinary disability was directly related to the prostatectomy that was performed for prostate cancer. The Board further noted that the VA examiner did not address the possibility that the urinary disability was proximately due to or aggravated by the service-connected psychiatric/anxiety disorder. Therefore, the claim was remanded again for an addendum opinion. That VA addendum opinion was given in October 2021. The VA examiner indicted that the Veteran's claims file was reviewed. The examiner opined that there is no anatomical or pathophysiologic mechanism by which psychological conditions, including 'other specified trauma and stressor related disorder (previously rated as unspecified anxiety)' can impact, cause, or aggravate prostate cancer. Furthermore, there is no indication or evidence of aggravation of the Veteran's prostate condition beyond its natural course due to any cause ... therefore, it is less likely than not that the Veteran's prostate cancer/condition has been aggravated beyond its natural course due to any cause, including prostate conditions/cancer. Essentially, the examiner provided a negative etiological opinion between the psychiatric disorder and the prostate cancer. The Veteran's urinary disability was not discussed, and as such, the question at hand was not addressed. As this was the reason for the prior remand, there was not substantial compliance with the Board's prior directives. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: Obtain an opinion from an appropriate clinician to address the nature and etiology of the Veteran's urinary condition. The need for an in-person clinical evaluation of the Veteran should be determined by the appointed examiner. The examiner should provide responses to the following questions: (a.) Was the Veteran's urinary condition at least as likely as not caused by (i.e., proximately due to) a different medical condition? (b.) Was the condition at least as likely as not aggravated (i.e., worsened beyond its natural progression) by a different medical condition, especially the service-connected psychiatric disability (other specified trauma and stressor related disorder (previously rated as unspecified anxiety disorder))? If it is determined that the condition was either caused or aggravated by a different medical condition, the examiner is asked to identify the primary medical condition. The examiner should not rely on silence in the medical records unless it can be explained: (a) why the silence in the available records can be taken as proof that the symptom(s) did not occur, including why the fact would have normally been recorded if present, or (b) why the absence of medical records is medically significant. Corey Bosely Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Mulrain, Associate 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.