Citation Nr: 21023740 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 10-36 301A DATE: April 21, 2021 REMANDED Service connection for degenerative arthritis of the cervical spine (cervical spine disorder) is remanded. Service connection for urinary tract infections (UTIs), to include urinary dysfunction, including as secondary to the service-connected hysterectomy and/or posttraumatic stress disorder (PTSD), is remanded. Service connection for an ear disorder, to include dermatitis or eczema, including as secondary to the service-connected PTSD, is remanded. REASONS FOR REMAND The Veteran, who is the appellant, served on active duty from February 1979 to May 1984. The issue of service connection for a cervical spine disorder and an ear disorder was most recently before the Board in August 2018, at which time the matters were remanded for further development. The issue of service connection for UTIs was most recently before the Board in March 2019, at which time the matter was also remanded for further development. For the reasons provided below, another remand is necessary in this case. 1. Service connection for degenerative arthritis of the cervical spine is remanded. During a May 2010 Decision Review Officer (DRO) hearing, the Veteran credibly testified to injuring her neck during service. The Veteran testified that she was negotiating an obstacle course when her helmet strap malfunctioned and the helmet hit her in the back of the neck as she fell approximately 30 feet to the ground. In a February 2009 lay statement, M.B. stated that she visited the Veteran near the end of March 1979, shortly after the neck injury, and witnessed the Veteran wearing a neck brace. The Board finds that the Veteran’s May 2010 DRO hearing testimony is credible, and that the neck injury she testified to did occur during service in 1979, and that the neck injury required a neck brace. In the Board’s August 2018 remand directives, the VA examiner was asked to specifically provide an opinion as to this injury, including discussing the February 2009 lay statement, and whether this neck injury might have caused the current degenerative arthritis in the cervical spine. The VA examiner was advised that the Veteran is competent to report such an injury and that her statements should not be disregarded solely due to the absence of contemporaneous medical records, especially given that service treatment records from 1979 cannot be located. See January 2018 correspondence. Following the Board’s August 2018 remand, the Veteran was provided with a VA examination for the claimed cervical spine disorder in August 2019. The August 2019 VA examination report contains the VA examiner’s negative nexus opinion, that is, that the current cervical spine disorder is not etiologically related to service; however, the VA examiner did not factually assume the neck injury sustained in 1979. Such factual assumption of injury having occurred is important foundation for any opinion rendered because portions of the Veteran’s service treatment records cannot be located, precluding reliance on absence of treatment in service as evidence of the nonoccurrence of injury or symptoms or treatment in service. Accordingly, another remand for a VA addendum opinion that is based on complete and accurate factual assumptions, including of a fall and neck injury in service that was treated with a cervical collar, is needed. 2. Service connection for UTIs is remanded. The Veteran generally contends that she experienced reoccurring UTIs, including urinary dysfunction, during service and has continued to experience frequent episodes of UTIs since service separation. Alternatively, the Veteran asserts that current chronic UTIs/urinary dysfunction are either caused or have been worsened beyond their normal progression by the service-connected hysterectomy and/or PTSD. The Veteran has cited two articles suggesting a link between UTIs/urinary dysfunction and PTSD. See March 2021 Informal Hearing Presentation (citing “Urinary Tract Dysfunction: Another Consequence of Interpersonal Trauma” and “PTSD Linked to Urinary Incontinence in Female Veterans”). As such, remand for a medical opinion to be obtained as to secondary service connection would be helpful in answering the question of whether chronic UTIs are caused or aggravated by the service-connected hysterectomy and/or PTSD. 3. Service connection for an ear disorder is remanded. The Veteran generally seeks service connection for an ear disorder, to include dermatitis or eczema, as having its onset during service. The Veteran alternatively asserts that the emotional symptoms associated with the service-connected PTSD have either caused or worsened an ear disorder beyond its normal progression. See March 2021 Informal Hearing Presentation. As the record does not contain a competent medical opinion on this theory of secondary service connection, remand to obtain a VA medical opinion is needed. The matters are REMANDED for the following actions: 1. Request that a VA medical professional review the electronic file and provide the VA addendum opinions requested below for the claimed cervical spine disorder. If the VA examiner determines that additional examination(s) of the Veteran is necessary to provide reliable opinions as to causation, such examination(s) should be scheduled; however, the Veteran should not be required to report for another examination as a matter of course, if it is not found to be necessary. The VA examiner should provide the following opinion: a) Is it at least as likely as not (i.e. probability of 50 percent or more) that the current cervical spine disorder is etiologically related to service? The examiner should assume as a fact that there was a neck injury in service in 1979 when the Veteran was negotiating an obstacle course, with the Veteran falling approximately 30 feet to the ground, and that the Veteran wore a neck brace following the incident, and had some residual neck symptoms during service. The examiner should not rely on an absence of contemporaneous service treatment record evidence of the neck injury as a basis for the opinion. 2. Request that a VA medical professional review the electronic file and provide the VA addendum opinions requested below for the claimed urinary tract infections, to include urinary dysfunction. If the VA examiner determines that additional examination(s) of the Veteran is necessary to provide reliable opinions as to causation, such examination(s) should be scheduled; however, the Veteran should not be required to report for another examination as a matter of course, if it is not found to be necessary. The VA examiner should provide the following opinions: a) Is it at least as likely as not (i.e., 50 percent probability or greater) that UTIs/urinary dysfunction was caused by the service-connected hysterectomy? b) Is it at least as likely as not (i.e., 50 percent probability or greater) that the UTIs/urinary dysfunction was worsened beyond its natural progression by the service-connected hysterectomy? c) Is it at least as likely as not (i.e., 50 percent probability or greater) that UTIs/urinary dysfunction was caused by the service-connected PTSD? d) Is it at least as likely as not (i.e., 50 percent probability or greater) that the UTIs/urinary dysfunction was worsened beyond its natural progression by the service-connected PTSD? In providing the reasons for the above opinion, the VA examiner should address the medical literature cited by the Veteran in the March 2021 Informal Hearing Presentation indicating a possible connection between UTIs/urinary dysfunction and PTSD. 3. Request that a VA medical professional review the electronic file and provide the VA addendum opinions requested below for the claimed ear disorder, including dermatitis and eczema. If the VA examiner determines that additional examination(s) of the Veteran is necessary to provide reliable opinions as to causation, such examination(s) should be scheduled; however, the Veteran should not be required to report for another examination as a matter of course, if it is not found to be necessary. The VA examiner should provide the following opinions: a) Is it at least as likely as not (i.e., 50 percent probability or greater) that an ear disorder, including dermatitis and eczema was caused by the service-connected PTSD? b) Is it at least as likely as not (i.e., 50 percent probability or greater) that an ear disorder, including dermatitis and eczema was worsened beyond its natural progression by the service-connected PTSD? J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Choi, 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.