Citation Nr: 21013923 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 09-33 514 DATE: March 10, 2021 REMANDED Entitlement to 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 the Department of Veterans Affairs (VA) Regional Office (RO) Huntington, West Virginia. Jurisdiction of this appeal is currently with the RO in Nashville, Tennessee. This case was most recently before the Board in April 2019, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. Service Connection – Genitourinary Disorder The Veteran seeks service connection for a genitourinary disorder, to include as secondary to his service-connected bilateral lower extremity pain, numbness, and tingling disabilities. As noted above, the claim for entitlement to service connection for a genitourinary disorder was most recently before the Board in April 2019, when the matter was remanded to the AOJ for further development. Specifically, the April 2019 Board found that an expert medical addendum opinion was necessary to address whether the Veteran’s chronic pelvic pain/bladder pain/ prostate pain syndrome were at least as likely as not secondary to his service-connected bilateral lower extremity pain, numbness, and tingling disabilities; and directed the AOJ to obtain such addendum opinion from an appropriate medical expert. In response, the AOJ scheduled the Veteran for an additional VA examination in November 2019, with an addendum opinion obtained in September 2020. However, the November 2019 VA examiner is a family practitioner and the September 2020 VA addendum opinion was rendered by a Family Nurse Practitioner. Neither opinion addresses their expertise with genitourinary disorders nor does either opinion address whether an expert medical opinion is deemed not necessary. Additionally, at no time did the AOJ indicate that a urologist or any other medical expert was unavailable to render the requested medical expert opinion as to the nature and etiology of the Veteran’s genitourinary disorder, nor did the AOJ indicate that a medical expert opinion was deemed not necessary at any time. Rather, the record appears that the AOJ simply overlooked the Board’s remand directive for a medical expert addendum opinion, and scheduled the Veteran for a VA examination with the first available examiner. Given these deficiencies, the Board is unable to find that substantial compliance with the prior remand has been achieved. See D’Aries, 22 Vet. App. at 105; see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). As such, remand is again required to obtain a medical expert opinion that complies with the Board’s prior remand directives. See Stegall v. West, 11 Vet. App. at 268, 271 (1998). The matter is REMANDED for the following action: 1. The Veteran should be given an opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Obtain an addendum opinion from an appropriate medical expert, such as a urologist, regarding whether the Veteran’s chronic pelvic pain/bladder pain/prostate pain syndrome are at least as likely as not (50 percent or greater probability) caused or aggravated beyond their natural progression by the Veteran’s service-connected bilateral lower extremity pain, numbness, and tingling disabilities. If an appropriate medical expert is not available, or one is deemed not necessary, the AOJ and/or examiner must provide an explanation as to why the medical expert was no longer available nor required. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.