Citation Nr: 21023035 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 15-03 627A DATE: April 20, 2021 REMANDED Entitlement to service connection for benign prostatic hyperplasia (BPH) with lower urinary tract symptoms and history of recurrent acute non-specific/non-gonococcal urethritis is remanded. REASONS FOR REMAND The Veteran served in the United States Marine Corps from October 1970 to October 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. This matter was previously before the Board in July 2018, at which time the Board remanded the claim to the agency of original jurisdiction (AOJ) in order to obtain, and associate with the Veteran’s claims file, relevant outstanding private treatment records. The claim has now been returned to the Board for further appellate consideration. The Board finds that there has been substantial compliance with its prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998) (see also Donnellan v. Shinseki, 24 Vet. App. 167, 176, stating that substantial compliance, rather than strict compliance, is required). However, for the reasons discussed below, the Board finds that another remand is warranted. Entitlement to service connection for BPH with lower urinary tract symptoms and history of recurrent acute non-specific/non-gonococcal urethritis is remanded. Although it sincerely regrets the additional delay, the Board finds that another remand is warranted before the Veteran’s claim can be properly adjudicated on its merits. The Veteran contends that he incurred non-specific urethritis in 1971, while on active duty service, and that his current diagnosis of benign prostatic hyperplasia (BPH) is related to the in-service condition. See, e.g., VA Form 21-526, Veterans Application for Compensation, dated November 30, 2012. He further asserts that he has experienced a continuity of prostate and urinary symptomatology since service. Additionally, the Veteran has conveyed that he was exposed to herbicide agents when he was stationed aboard a ship that traveled “near Da Nang” and has suggested that his prostate and urinary conditions were caused by such exposure. See, e.g., VA Form 21-4138, Statement in Support of Claim, dated December 4, 2018. As a preliminary matter, the Board observes that VA has conceded the Veteran’s exposure to herbicide agents. See VA Memorandum dated February 24, 2021. A review of the evidentiary record demonstrates that the Veteran has been afforded two VA examinations for the claimed disability. In a May 2013 examination, a physician diagnosed the Veteran with BPH with lower urinary tract symptoms and opined that the condition was less likely than not incurred in or caused by the Veteran’s active duty military service. In so finding, she reasoned that “medical literature does not support that acute, episodic, transient, recurrent [non-specific urethritis]” causes BPH with lower urinary tract symptoms. However, the Board finds the nexus opinion inadequate for adjudicative purposes. As an initial matter, the examiner did not address the lay statements regarding the Veteran’s asserted continuity of symptomatology. The examiner also failed to address the in-service treatment records documenting complaints of “purulent discharge from urethra” and its significance, if any. The Veteran underwent another VA examination in August 2018, at which time the Veteran’s BPH was noted to have cause a voiding dysfunction characterized by urine leakage, increased urinary frequency, and signs and symptoms of obstructed voiding. See VA examination dated August 24, 2018. Notably, the clinician who conducted the examination did not provide a nexus opinion. In light of the foregoing, the Board finds that a remand is warranted. Before the Board can render a fully-informed decision on the merits of the Veteran’s claim, an adequate nexus opinion addressing all of the Veteran’s contentions must be procured. Accordingly, the matter is REMANDED for the following action: 1. Send the Veteran’s claims file to an appropriate clinician for review and for the opinions sought regarding the Veteran’s claim for service connection for benign prostatic hyperplasia with lower urinary tract symptoms. ONLY IF another examination is deemed necessary to answer the questions below, should one be scheduled. The clinician is asked to address the following: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s benign prostatic hyperplasia with lower urinary tract symptoms and history of recurrent acute non-specific urethritis was incurred in service? (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s benign prostatic hyperplasia with lower urinary tract symptoms and history of recurrent acute non-specific urethritis is otherwise etiologically related to his military service, to include his conceded exposure to herbicide agents (notwithstanding the fact that it may not be a presumed association)? In responding to the above questions, the examiner is asked to address, and discuss as necessary, (i) the Veteran’s lay statements that he has experienced a continuity of prostate and urinary symptoms since active duty service; and (ii) the service treatment records documenting symptomatology including “purulent discharge from [the] urethra,” dated April 19, 1972. The examiner should take into consideration that the Veteran is competent to report in service and post-service symptomology. The term “at least as likely as not” does not mean “within the realm of medical possibility,” but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a conclusion as it is the find against it. A clear rationale for all opinions expressed would be helpful; and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Tolbert, 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.