Citation Nr: 21015411 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 16-13 860 DATE: March 17, 2021 REMANDED Entitlement to service connection for a disability manifested by blood in urine is remanded. REASONS FOR REMAND The Veteran served on active duty for training in the Army from June 2004 to December 2004, and served on active duty from July 2005 to September 2006, and from May 2010 to May 2011 including service in Iraq. This matter comes before the Board of Veteran’s Appeals (Board) on appeal from a November 2013 rating decision by the Regional Office (RO). In December 2019, the Board remanded the Veteran’s claim for further development. The claim is now returned to the Board for further appellate review. Recently, an August 2020 rating decision granted service connection for a left inguinal hernia. Therefore, as the claim has been granted in full, there remains no issue or controversy for decision on that claim. See Holland v. Gober, 10 Vet. App. 433, 436 (1997). Entitlement to service connection for a disability manifested by blood in urine The Veteran contends she has a disability manifested by blood in her urine. During the Veteran’s last period of active service, a May 2011 urinalysis report showed a trace amount of blood was present, later noted as microhematuria. See Records, received December 2014 at p.13 of 13; Records, received December 2011 at p.7 of 13. Post-service, a June 2011 urinalysis at the VA medical center revealed a small amount of blood in the urine, and an April 2013 urinalysis revealed a trace of blood. See Records, received December 2014 at p.10-11. September 2012 private treatment records note blood of 2+ in urine, and that although dip testing was positive, microscopic analysis was negative, and pseudo hematuria was diagnosed. See Records, received February 2016 at p.1 and 4 of 5. A January 2015 VA examination report shows the Veteran reported she works as a “medic” and performs monthly dip stick tests on her urine, and that they are positive for blood. See CAPRI, received May 2017 at p.281-282. Chronic hematuria was diagnosed (per April 2013 VA treatment records), but no opinion was provided. See id. at p.282; see also CAPRI, received February 2017 at p.292 and 314 (April 2013 and December 2013 records). A June 2019 VA medical opinion was obtained, but in December 2019, the Board found the opinion to be inadequate. “Hematuria” is defined as “blood (erythrocytes) in urine; called also erythrocyturia.” See Dorland’s Medical Dictionary (30th Ed.) at p.827. “Microscopic hematuria” is defined as “blood in the urine visible only with a microscope, defined as at least two or three red blood cells per high power field. Called also microhematuria.” See id. There is no diagnostic code in the rating schedule that contemplates a compensable rating for blood in urine, or hematuria or microscopic hematuria. See 38 C.F.R. §§ 4.115A and 4.115B (2019). Most recently, in December 2019, the Board remanded the claim so that a new VA examination could be performed to clarify whether the Veteran has a current disability manifested by blood in urine, and if so, whether it had its onset in service or was otherwise caused by her active service. Subsequently, an August 2020 VA examination was performed. The VA examiner (A.M., N.P.) opined that the Veteran’s diagnosis of microscopic hematuria is at least as likely as not related to her active service in service. The examiner reasoned that microscopic hematuria was seen on urinalysis in service. However, the same VA examiner gave a separate August 2020 VA medical opinion (of the same date) that it is less likely than not that the claimed condition was caused by the Veteran’s active service. The examiner reasoned that microscopic hematuria is a common finding that can be incidental, and a September 2012 blood result was only 2+, with a positive dip test but a negative microscopic analysis. See Records, received February 2016 at p.1 and 4 of 5. The examiner opined that it is not clinically significant unless 3+ to 5+ red blood cells per high-power field are visible. Because the same VA examiner gave two conflicting medical opinions, the Board finds the claim should be remanded to obtain a new VA medical opinion by a different VA examiner to clarify whether the Veteran has a current disability manifested by blood in the urine, and if so, whether it had its onset during her active service or is otherwise caused by her active service. The matters are REMANDED for the following action: 1. Obtain a VA medical opinion from a physician qualified to assess kidney, bladder and urinary systems based on a review of the entire claims file, including this remand, to clarify whether it is at least as likely as not (50 percent or greater probability) that the Veteran has a disability manifested by blood in urine that onset in service or was caused by any aspect of service. An examination is necessary if required by the examiner to form an opinion of the nature of the disability and its impairment of daily and occupational activities. Explain to the VA examiner that service connection may be awarded for a disability shown at any time during the period on appeal – from January 2012 to present – if it had its onset in service or was otherwise caused by the Veteran’s active service. Also explain that for the diagnosed chronic hematuria shown in the April 2013 and December 2013 VA treatment records during the period on appeal, clarification is required as to whether such hematuria represented a benign or incidental finding, or whether it constituted manifestations of an underlying kidney disease or other underlying bladder or urinary disability, and if so, whether it had its onset in service or was otherwise caused by service. Please direct the VA examiner’s attention to VA urinalysis results dated in May 2011, June 2011, August 2011, April 2013, and December 2013 (showing trace or small amounts of blood in urine in May 2011, June 2011, and April 2013). Note that the Veteran’s last period of active service was from May 2010 to May 2011. Also direct the examiner’s attention to a September 2012 urology record from Scott and White showing that although dip testing was positive, microscopic analysis was negative for blood in urine, and “pseudo hematuria” was diagnosed. See Records, received February 2016 at p.1 and 4 of 5. Also, direct the examiner’s attention to records showing the Veteran was prescribed Plavix in May 2012 for her service-connected internal carotid artery ectasias, and showing that side effects may include blood in urine. See Records, received March 2014 at p.46 of 57, and received May 2017 at p.284; Medical Records, received February 2016 at p.6-8. Also, direct the VA examiner’s attention to records showing her drinking history, and to the January 2015 VA examination report showing the Veteran reported continued self-performed dip tests showing blood in urine. See CAPRI, received February 2017 at p.315 (excessive alcohol), and received October 2020 at p.12 (March 2020 – 8 glasses of wine per day); Any opinion must be accompanied by a complete rationale. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Juliano, 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.