Citation Nr: 21025054 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 16-47 762 DATE: April 27, 2021 ORDER Entitlement to a rating in excess of zero percent, for hematuria is denied. FINDING OF FACT The Veteran’s hematuria is less likely than not the proximal cause of the Veteran’s nighttime awakening to void and associated urinary issues. CONCLUSION OF LAW The criteria for an increased rating in excess of zero percent for hematuria have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 3.102, 3.321, 4.20, 4.27, 4.3, 4.31, 4.7, 4.115a, 4.115b, Diagnostic Code 7599-7516. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from June 1964 to June 1990. In a September 1990 rating decision, the Regional Office (RO) granted the Veteran's claim for service connection for hematuria and assigned a noncompensable rating, effective from July 1, 1990, the day after the Veteran separated from service. In November 2018, the Board remanded the appeal for additional development. Following completion of the requested development, the RO issued a supplemental statement of the case (SSOC) in June 2020, continuing the Veteran's rating of zero percent, effective from July 1, 1990. In August 2020, the Board remanded the appeal for additional development. Following completion of the requested development, the RO issued an SSOC in December 2020, continuing the Veteran's rating of zero percent, effective from July 1, 1990. INCREASED RATING The Veteran is seeking an increased rating for hematuria. In his notice of disagreement (NOD), the Veteran asserted that he has a slow weak stream, awakens on average three times per night to void, day time voiding averages every two hours, and has worn depends during the day when he is out and there may not be facilities because he will leak if voiding becomes necessary. See November 2015 NOD; November 2015 VA Form 21-4138 Statement in Support of Claim. The Veteran further contends, that he awakens on average four or five times during the night to void, intermittent burning sensation when urinating, and wears depends during the day if he travels somewhere where there may not be restrooms. See June 2020 Veteran Correspondence; September 2020 VA Form 21-4138 Statement in Support of Claim. The Veteran’s representative contends the Veteran is entitled to an increased rating due to a marked obstructive symptomatology (weak stream) and awakening to void two times per night. See April 2018 Appellant Brief; July 2020 Appellant Brief. Applicable Laws and Regulations Disability ratings are assigned under a schedule for rating disabilities and based on a comparison of the veteran's symptoms to the criteria in the rating schedule. 38 U.S.C. § 1155 (2012); 38 C.F.R. Part 4 (2018). Disability evaluations are determined by assessing the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the ratings schedule. Individual disabilities are assigned separate Diagnostic Codes, and ratings are based on the average impairment of earning capacity. See 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2 (2018). If there is a question as to which evaluation should be applied to the veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2018). Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3 (2018). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. Where a veteran has been diagnosed as having a specific condition and the diagnosed condition is not listed in the Schedule or Rating Disabilities, the diagnosed condition will be evaluated by analogy to closely-related diseases or injuries in which not only the functions affected, but the anatomical localizations and symptomatology, are closely analogous. 38 C.F.R. § 4.20. In this case, the Veteran’s diagnosis of hematuria is not specified in the Rating Schedule. Thus, the Veteran has been rated by analogy under Diagnostic Codes 7599-7516. Diagnostic Code 7599 is a general reference to the rating criteria for disabilities of the genitourinary system. Diagnostic Code 7516 provides the rating criteria for a fistula of the bladder. These are the appropriate Diagnostic Codes for rating by analogy because they reference both the anatomical localization of the Veteran’s hematuria (the genitourinary system, specifically the bladder) and the symptoms (including renal or voiding dysfunctions). As these diagnostic codes reference both the location and symptoms of the Veteran’s hematuria, rating by analogy is appropriate. Under Diagnostic Code 7516, the criteria for voiding dysfunction assigns a maximum 60 percent rating if there is continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence which requires the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day. Id. A 40 percent disability rating is assigned for incontinence requiring the wearing of absorbent materials which must be changed 2 to 4 times per day. A 20 percent disability rating is assigned where the incontinence requires wearing of absorbent materials which must be changed less than 2 times per day. Id. Under the criteria for urinary frequency, a 10 percent disability rating is assigned where there is daytime voiding at intervals between two and three hours or awakening to void two times per night. A 20 percent disability rating is assigned where there is daytime voiding at intervals between one and two hours or awakening to void three to four times per night. A 40 percent disability rating is assigned where there is daytime voiding at intervals of less than one hour or awakening to void five or more times per night. 38 C.F.R. § 4.115a. Factual Analysis The Veteran presented to a VA report of medical examination for disability evaluation in August 1990 where the examiner noted the Veteran was found to have had hematuria during service in 1985 or 1986 and again during his separation examination. See August 1990 VA Report of Medical Examination for Disability Evaluation at 3. In October 2015, the Veteran presented to a VA urinary tract conditions disability benefits questionnaire (DBQ) where the examiner diagnosed him with microscopic hematuria. See October 2015 VA Urinary Tract Conditions DBQ. The examiner noted the Veteran did not have a voiding disfunction, urinary leakage, require the use of absorbent material, or use of a voiding appliance. Id. at 3. In February 2020, the Veteran presented to a VA urinary tract conditions DBQ where the examiner diagnosed him with hematuria. See February 2020 VA Urinary Tract Conditions DBQ. The examiner noted the Veteran has a voiding dysfunction and opined the etiology was associated with lower urinary tract symptoms (LUTS). The examiner noted the Veteran’s voiding dysfunction causes urine leakage but does not require the wearing of absorbent material. The examiner also noted the Veteran does not require the use of a voiding appliance. However, the examiner noted the Veteran wakes twice per night to void. Id. at 2. In November 2020, the Veteran presented to a VA kidney conditions (nephrology) DBQ (via a telephone interview) where the examiner diagnosed him with hematuria. See November 2020 VA Kidney Conditions (Nephrology) DBQ. The examiner opined that “[t]here are no specific symptoms attributed to the diagnosed condition. The symptoms of urinary urgency, leakage, frequency, nocturia, and burning are less likely than not related to the diagnosed condition.” Id. at 3. In late November 2020, the examiner provided an addendum opinion where he opined “it is less likely than not that the claimant's symptoms of frequency, urgency, nocturia, leakage, and dysuria are proximately due to his service connected hematuria condition, and are at least as likely as not proximately due to prostatic hypertrophy.” See November 2020 Addendum Opinion. The examiner further opined the Veteran’s symptoms of voiding urgency, leakage, frequency, and nocturia are most likely LUTS associated with “prostate enlargement.” Id. The examiner further opined the “lack of any significant microscopic hematuria on urinalysis performed [in November 2020] it is my opinion that it is less likely than not that the claimant's symptoms of frequency, urgency, nocturia, leakage, and dysuria are proximately due to his service connected hematuria condition, and are at least as likely as not proximately due to prostatic hypertrophy.” Id. Legal Analysis The Board finds that a rating in excess of zero percent for hematuria is not warranted. A rating in excess of zero percent under diagnostic codes (DC) 7599-7516 is not warranted, as there is no evidence to support the Veteran’s service-connected hematuria is the proximate cause of his symptoms, of urinary voiding frequency, urgency, nocturia, leakage, and dysuria. See November 2020 Addendum Opinion. Specifically, the November examiner opined the Veteran’s symptoms of urinary voiding frequency, urgency, nocturia, leakage, and dysuria are proximal due to his prostatic hypertrophy. Id. As discussed above the veteran is currently rated at zero percent for hematuria. As such to warrant an increased rating, the evidence must show that the Veteran’s symptoms more nearly approximate a rating of 10 percent at some point during the appeal period. See 28 C.F.R. § 4.7. A 10 percent rating is assigned where there is daytime voiding at intervals between two and three hours or awakening to void two times per night. To date, at no point has the Veteran’s hematuria been found to cause voiding at intervals between two and three hours or awakening to void two times per night. Specifically, the October 2015 VA examiner noted the Veteran did not have a voiding dysfunction, urinary leakage, require the use of absorbent material, or use of a voiding appliance. See October 2015 VA Urinary Tract Conditions DBQ at 3. Additionally, the February 2020 VA examiner noted the Veteran has a voiding dysfunction and opined the etiology was associated with LUTS. See February 2020 VA Urinary Tract Conditions DBQ. The only evidence in support of the claim for the Veteran’s increased rating are the Veteran’s own statements that he “feels” that it is related to his service-connected disability. See November 2015 NOD; November 2015 VA Form 21-4138 Statement in Support of Claim; See June 2020 Veteran Correspondence; September 2020 VA Form 21-4138 Statement in Support of Claim. While the Veteran believes that the symptoms are related to his service-connected disability, he is not competent to provide an opinion as the issue of causation in this case, as it requires knowledge and interpretation of complicated diagnostic medical testing, such as laboratory findings. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Given the aforementioned, the preponderance of the evidence is against the Veteran’s claim. The Board has considered the benefit-of-the-doubt doctrine, but it is not for application where the preponderance of the evidence is against the claim. The Board is grateful to the Veteran for his service, and regrets that it cannot render a favorable decision in this matter. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David B. Scheirich, 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.