Citation Nr: 21010588 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 16-32 788 DATE: February 25, 2021 ORDER Entitlement to service connection for a urinary retention condition, to include as secondary to the service connected coronary artery disease (CAD) status post artery bypass graft with congestive heart failure (CHF), is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran’s diagnosed urinary retention condition is related to his active duty or was caused or aggravated by the service-connected CAD status post artery bypass graft with CHF. CONCLUSION OF LAW The criteria for service connection for a urinary retention condition, to include as secondary to the service-connected CAD status post artery bypass graft with CHF, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from March 1959 to February 1961 and from April 1961 to April 1979. This current matter returns to the Board of Veterans’ Appeals (Board) following completion of development ordered in Remands dated in August 2018 and August 2020. Those Remands are incorporated herein by reference. Service connection for a urinary retention condition, to include as secondary to the service connected CAD status post artery bypass graft with CHF Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence 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. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” Continuity of symptoms after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may be established for any disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. To prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Initially, the Board finds that service connection for a urinary retention condition did not onset in, and is not otherwise related to, the Veteran’s active duty. Significantly, the June 2019 VA examiner opined that it was less likely than not that the Veteran’s urinary retention was incurred in, or otherwise caused by service, as the onset of the condition was after service and “a nexus has not been established.” The examiner referenced the Veteran post-service treatment records. Indeed, the Veteran asserts that his urinary retention was caused by surgery for his service-connected heart condition. He notes that, following surgery for his service-connected heart condition in 2000, he was unable to urinate without a self-catheter, which continues to cause occasional hospitalizations and treatment for urinary infections. The Veteran has been service-connected for CAD status post artery bypass graft with CHF since 1996. Pursuant to the August 2018 Board remand, the Veteran was afforded a VA examination in June 2019, at which time the examiner opined that the Veteran’s progressive urinary condition can be attributed to his BPH. VA treatment records indicate that the Veteran has been diagnosed with benign prostatic hypertrophy (BPH), a condition for which service connection has not been granted. Further, the examiner explained that the Veteran’s urinary condition was at least as likely as not aggravated by his chronic kidney disease, also a condition for which service connection has not been granted. Importantly, the examiner did not find a link between the Veteran’s urinary condition and his service-connected CAD status post artery bypass graft with CHF. Pursuant to the August 2020 Board remand, the Veteran was afforded an additional VA examination in November 2020. The examiner opined that the Veteran’s urinary retention condition is less likely than not related to an in-service injury, event, or disease. The examiner explained that the conditions of an inability to urinate and the service-connected CAD status post artery bypass graft with CHF are not medically related. Rather, the examiner believed that the Veteran’s urinary condition is a separate entity entirely from his service-connected CAD status post artery bypass graft with CHF. A thorough review of medical literature failed to demonstrate a causal relationship. The examiner further explained that, although post-operative urinary retention can occur after surgery, it is most often transitory and due to the use of anesthetics during surgery and not the surgical procedure itself. According to the examiner, the Veteran’s diagnosis of BPH (which occurred in the same year as the diagnosis of CAD) is more likely the cause of his urinary retention condition. Based on the medical evidence of record, the Board finds that the preponderance of the evidence is against service connection for urinary retention. The examination reports of record indicate consideration of the Veteran’s contentions concerning a relationship between his urinary retention with his service-connected heart condition—or aggravation of his urinary retention by his service-connected disorders. The examiners offered well-reasoned opinions that the Veteran’s urinary retention is unrelated to his active service, or his service-connected conditions. For these reasons, service connection for a urinary retention condition—on a direct or secondary basis—must be denied. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.E. Lee 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.