Citation Nr: 21023767 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 15-26 953 DATE: April 21, 2021 ORDER Entitlement to service connection for urinary incontinence, including as secondary to service-connected disabilities is denied. FINDING OF FACT The Veteran’s urinary incontinence is not directly related to service, or secondary to any service-connected disability, including degenerative joint disease of the cervical spine, chronic lumbar strain, and fibromyalgia. CONCLUSION OF LAW The criteria for entitlement to service connection for urinary incontinence, including as secondary to service-connected disabilities have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from August 1979 to August 1982. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge in August 2018. A transcript of that hearing is associated with the claims file. The Board remanded this case for additional development in March 2019 and September 2020. With that development being completed, the case is once again before the Board. Under 38 U.S.C. § 7104, Board decisions must be based on the entire record, with consideration of all the evidence. The law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 128-29 (2000). The Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra. Entitlement to service connection for urinary incontinence, including as secondary to service-connected disabilities Direct Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131 (2018); 38 C.F.R. § 3.303 (2018). A Veteran seeking compensation under these provisions must establish three elements: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). The record establishes that the Veteran has been diagnosed with urinary retention. It was noted that the Veteran has a voiding dysfunction within the appellate period. See October 2019 VA examination. Thus, the current disability prong of a service connection claim has been satisfied After review of all the lay and medical evidence of record, the Board finds that the evidence weighs against a finding of a bladder condition during service. The Veteran’s active-duty STRs do not reflect complaints of, treatment for, or diagnosis of incontinence or an injury to the bladder. The November 2020 VA examiner opined that the claimed condition was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness. The rationale is that the Veteran was discharged in 1983 with no records of any urinary incontinence in the service medical records. Further, the Veteran’s claim of urinary incontinence began in 2004. As the nexus element is not demonstrated with respect to urinary incontinence, the claim for service connection must be denied on a direct basis. The Board has also considered whether service connection may be granted on a secondary basis. The Veteran contends that she is entitled to service connection for urinary incontinence as secondary to service-connected disabilities, including degenerative joint disease of the cervical spine, chronic lumbar strain, and/or fibromyalgia. Pursuant to the September 2020 Board remand directives, a medical opinion was obtained as to whether the Veteran’s bladder condition was proximately due to or aggravated by the Veteran’s service-connected disabilities. Secondary service connection Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). As noted above, the first element of service connection, a current disability, is met. Next, she is service connected for degenerative joint disease, chronic lumbar strain, and fibromyalgia. The second element of service connection on a secondary basis is also met. However, the third element, a medical nexus, must be resolved. As directed by the September 2020 Board remand, a VA examiner was asked to opine whether it is at least as likely as not (50 percent or greater probability), that the currently diagnosed bladder condition was caused or aggravated by the Veteran’s service-connected degenerative joint disease of the cervical spine, chronic lumbar strain, and fibromyalgia disorder. In a November 2020 medical opinion, the examiner opined that the condition claimed was less likely than not (less than 50% probability) caused by degenerative joint disease of the cervical spine, chronic lumbar strain, or fibromyalgia. The rationale for the negative nexus for degenerative joint disease of the cervical spine is that “no cervical spine arthritis can cause a urinary tract incontinence.” The rationale for the negative nexus for chronic lumbar strain and fibromyalgia is that neither condition causes urinary incontinence, unless severe damage is done to the lumbosacral spinal cord, which the doctor noted is not present. See November 2020 VA medical opinion. Regarding aggravation of the nonservice-connected condition by a service-connected condition, the examiner opined that the condition claimed was not at least as likely as not aggravated beyond its natural progression by the Veteran’s service-connected disabilities. The rationale is that the Veteran’s urinary incontinence began 21 years post discharge, and that neither the degenerative joint disease of the cervical spine, chronic lumbar strain, nor fibromyalgia can aggravate urinary incontinence, which is not related to the service-connected conditions. The examiner explained that Urinary incontinence in females is common, is multifactorial in etiology, with potential sources as a childbirth injury, or by an enlarged uterus pressing on the bladder, or the result of frequent UTIs which weaken the urethral sphincter. The examiner concluded that urinary incontinence is not related in any way to the diagnosis of fibromyalgia, C-spine DJD, or lumbar strain. See November 2020 VA medical opinion. The Board finds this medical opinion highly probative because it was based upon a thorough review of the claims file, current medical literature, and a well-reasoned rationale from the examiner about how the Veteran’s urinary incontinence cannot be related to service, caused by, or aggravated by a service-connected disability. The Board finds this opinion to be factually accurate, fully articulated, and containing sound reasoning. A medical opinion that is factually accurate, fully articulated, and based on sound reasoning carries significant weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board notes that the Veteran is indeed competent to testify as to such observable symptomatology, such as frequent urination and the associated feelings with that condition. Barr v. Nicholson, 21 Vet. App. 303 (2007). However, lay assertions do not constitute a competent clinical diagnosis of an existing disability nor are they adequate to establish a positive nexus with military service. See 38 C.F.R. § 3.159(a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). The issue is medically complex, as it requires specialized medical knowledge of the interpretation of signs and symptoms as well as diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Veteran has not been shown to possess such specialized medical knowledge, nor has she claimed to possess such knowledge. As a result, these lay assertions cannot constitute competent medical evidence in support of the claim, and the Board most heavily weighs the VA examiners’ opinions that there is no causal relationship between the Veteran’s urinary incontinence and active duty service, including degenerative joint disease of the cervical spine, chronic lumbar strain, and fibromyalgia. In light of the foregoing, the Board concludes that the preponderance of the evidence is against the Veteran’s claim of service connection for urinary incontinence. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Nelson, 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.