Citation Nr: 21011151 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 14-42 204 DATE: March 1, 2021 REMANDED Entitlement to service connection for sudden death syndrome, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for congestive heart failure, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for right upper extremity myopathy, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for diabetes mellitus, type II, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for cystitis or residuals thereof is remanded. Entitlement to service connection for prostatitis or residuals thereof is remanded. Entitlement to service connection for tuberculosis or residuals thereof is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1973 to August 1973. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2019 and April 2020, the Board remanded the Veteran’s appeal for additional development. It is again before the Board for further appellate review. The Veteran’s claims for entitlement to service connection for cystitis, prostatitis, tuberculosis, and/or the residuals of each, to include any disability/chronic side effects resulting from INH therapy are on a direct basis. His claims for entitlement to service connection for sudden death syndrome, congestive heart failure, hypertension, right upper extremity myopathy, and diabetes mellitus, type II, are on both direct and secondary bases. The Board’s remand instructions included providing the Veteran with VA examinations to determine whether he experienced impairment due to his in-service cystitis, prostatitis, and possible tuberculosis with INH therapy, taking into consideration his in-service hospitalization and history of urinary tract infections. These examinations were provided; however, the AOJ did not readjudicate the claims following the development required by the remand instructions. As such, these issues must be returned to the agency of original jurisdiction (AOJ) for readjudication and issuance of a supplemental statement of the case. As the remaining issues are claimed on a secondary basis to the Veteran’s cystitis, prostatitis, and possible tuberculosis, these issues are intertwined and must be remanded, as well. In addition, with regard to the secondary claims, the Board finds that the opinions provided in September 2020 as to whether the Veteran’s hypertension, diabetes mellitus type 2, sudden death syndrome, congestive heart failure, and right upper extremity myopathy have been aggravated by his cystitis, prostatitis, and possible tuberculosis are inadequate, as the examiner did not provide an adequate rationale. For hypertension and diabetes mellitus, the examiner based her opinion on the length of time between the time the Veteran was discharged from service and the onset of the disability to find that hypertension and diabetes mellitus were not aggravated by cystitis, prostatitis, and possible tuberculosis. However, the remand directives were related to any current disability associated with cystitis, prostatitis, and possible tuberculosis. With regard to the claims for sudden death syndrome and congestive heart failure, the examiner based her opinion with regard to aggravation on the fact that these disabilities are not related to cystitis, prostatitis, and possible tuberculosis; however, the Board finds that this does not fully explain why the disabilities could not be aggravated by cystitis, prostatitis, and possible tuberculosis. With regard to right upper extremity myopathy, the examiner provided a rationale that explained why the disability was not caused by cystitis, prostatitis, and possible tuberculosis, but did not provide a rationale for aggravation. For these reasons, on remand, opinions should be provided as to whether the Veteran’s whether the Veteran’s hypertension, diabetes mellitus type 2, sudden death syndrome, congestive heart failure, and right upper extremity myopathy have been aggravated by his cystitis, prostatitis, tuberculosis, and/or the residuals of each with appropriate rationales provided for each opinion. The matters are REMANDED for the following action: 1. Obtain an opinion with regard to sudden death syndrome, congestive heart failure, hypertension, right upper extremity myopathy, and diabetes mellitus. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide an opinion as to whether it is at least as likely as not that each of these disabilities has been aggravated, i.e., worsened beyond its natural progression, by cystitis, prostatitis, tuberculosis, and/or the residuals of each. If the Veteran’s current sudden death syndrome, congestive heart failure, hypertension, right upper extremity myopathy, and diabetes mellitus have been aggravated by his cystitis, prostatitis, tuberculosis, and/or the residuals of each, the examiner should also indicate the extent of such aggravation by identifying the baseline level of disability. This may be ascertained by the medical evidence of record and also by the Veteran's statements as to the nature, severity, and frequency of his observable symptoms over time. Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran’s description of his/her in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his/her current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? (Continued on the next page)   2. Readjudicate all issues, including the issues of entitlement to service connection for cystitis, prostatitis, tuberculosis, and/or the residuals of each, and provide a copy of the supplemental statement of the case to the Veteran. J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Harrigan Smith 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.