Citation Nr: 21013452 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 17-51 226 DATE: March 9, 2021 REMANDED Entitlement to service connection for urinary incontinence associated with intervertebral disc syndrome of the lumbar spine is remanded. REASONS FOR REMAND The Veteran served in the United States Marine Corps from June 1972 to August1979 . This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2016 rating decision issued by a Department of Veterans Affairs (VA) regional office. See February 2016 Rating Decision. The Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing in January 2021. See January 2021 Board Videoconference Hearing. Entitlement to service connection for urinary incontinence associated with intervertebral disc syndrome of the lumbar spine is remanded. The Veteran contends that he is entitled to service connection for urinary incontinence associated with intervertebral disc syndrome of the lumbar spine. Specifically, the Veteran contends his incontinence is caused by his service connected back conditions as well as medication (Wellbutrin) he is prescribed for his service-connected depressive disorder. See September 2017 VA Form 9. At the January 2021 Board videoconference hearing, the Veteran testified that he was informed by his VA treating physician at the VA pain clinic in Manchester, New Hampshire during the summer of 2020 that his incontinence was secondary to his service-connected intervertebral disc syndrome (IVDS). During the hearing the Veteran also informed the Board of pertinent medical records that are not associated with his claims file. See January 2021 Board Videoconference Hearing. First, a remand is warranted as the evidence indicates that there may be pertinent medical records, of which VA is aware, that are not associated with the electronic claims file. Specifically, the Veteran’s claims file only contains treatment records dated through December 2017. During the Board Videoconference in January 2021 the Veteran informed the Veterans’ Law Judge (VLJ) that there were VA treatment records not associated with his file from the VA pain clinic in Manchester, New Hampshire. As such, a remand is warranted to allow the AOJ to obtain pertinent medical records. See U.S.C. § 5103(a)(1), (b)(1); Ivey v. Derwinski, 2 Vet. App. 320, 323 (1992). Second, a remand is necessary to obtain an adequate opinion regarding the nature and etiology of the Veteran's claimed condition. With respect to the July 2017 Disability Benefits Questionnaire (DBQ), the examiner did not address aggravation, and therefore the opinion cannot be considered adequate to the extent it does not address aggravation. Specifically, the examiner opined the Veteran’s diagnosed urinary incontinence was less likely than not proximately due to or the result of the Veterans service-connected condition. See July 2017 DBQ. The examiner did not address whether the Veteran’s diagnosed urinary incontinence was aggravated by the Veteran’s service-connected disabilities. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-141 (2013). Accordingly, the matter is REMANDED for the following action: 1. With the Veteran's assistance as appropriate, obtain and associate with the Veteran's electronic claims file any outstanding VA records from December 2017 to current; specifically, records from the VA Pain Clinic in Manchester, New Hampshire. Pursuant to 38 C.F.R. § 3.159(e), any efforts to secure these records MUST be documented in the electronic claims file, and the Veteran MUST be informed if any of these records are unable to be secured. 2. The Board recognizes the potential practical difficulties in scheduling an examination in light of the COVID-19 epidemic and requests flexibility and understanding in affording the Veteran any warranted examination below. 3. After completing the above, and any additional development warranted by the record, schedule the Veteran for an examination with an appropriate clinician regarding the nature and etiology of his claimed urinary incontinence condition. The entire claims file must be provided to, and reviewed by, the examiner. Any indicated tests, studies, or evaluations should be performed. The examiner is asked to: (a.) Obtain the Veteran's lay in-service and post-service history, including onset of symptomatology of the Veteran’s diagnosed urinary incontinence condition. (b.) Opine as to whether it is at least as likely as not (i.e. a 50 percent or greater probability) that such condition had its onset during, or is otherwise related to, the Veteran's active duty service. (c.) Opine as to whether it is at least as likely as not (i.e. a 50 percent of greater probability) that such condition is: i. caused by a service-connected disability. Specifically, his service-connected IVDS. ii. caused by the side effects of prescribed medication for treatment of his service-connected depressive disorder. iii. underwent an incremental increase (aggravated), regardless of permanence, by a service-connected disability. Specifically, his service-connected IVDS. iv. underwent an incremental increase (aggravated), regardless of permanence, due to the side effects of prescribed medication for treatment of his service-connected depressive disorder. • The term incremental increase in disability means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any incremental increase in disability need not be permanent. • The term at least as likely as not does not mean within the realm of medical possibility. Rather, it means that the weight of the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. • Any opinion expressed by the examiner should be accompanied by a complete rationale. If medical literature is relied upon in rendering a determination, the examiner should identify and specifically cite each reference material utilized. If the examiner is unable to offer an opinion without resort to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. • The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. 4. The AOJ must review the claims file and ensure that the foregoing development action has been completed in full. If any development action is incomplete, the appropriate corrective action must be implemented. If any report or opinion does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David B. Scheirich, 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.