Citation Nr: 21026166
Decision Date: 04/30/21	Archive Date: 04/30/21

DOCKET NO. 12-08 914
DATE: April 30, 2021

REMANDED

Entitlement to service connection for benign prostate hyperplasia (BPH), to include as secondary to diabetes, is remanded.

REASONS FOR REMAND

The Veteran served on active duty from March 1966 to December 1967, including service in the Republic of Vietnam.

This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2009 rating decision issued by the Department of Veterans Affairs (VA) regional office.  The matter was most recently remanded in November 2020 and has returned to the Board for further adjudication. Unfortunately, there has not been substantial compliance with the prior remand directives and another remand is required.  Stegall v. West, 11 Vet. App. 268, 271 (1998).  

The claim must be remanded again because the March 2021 VA medical opinion is inadequate. The examiner offered negative nexus opinions on direct and secondary service connection as to causation, but did not address aggravation. The examiner offered little to no rationale for the negative opinions.  

The opinion on remand must also address articles referred to in the April 2021 Informal Hearing Presentation: August 2009 article from Advances in Radiology that addresses the coexistence of BPH and type 2 diabetes and a December 2014 article from Current Urology Reports that discusses “ increasing epidemiologic evidence suggests that diabetes and associated hyperglycemia and insulin resistance significantly increase the risks of BPH and Lower Urinary Tract Symptoms (LUTS).

The matters are REMANDED for the following action:

1. Forward copies of all pertinent records to an appropriate examiner to determine the likely etiology of diagnosed BPH. Based on a review of the record, the examiner must answer the following:

Is it at least as likely as not that the BPH is (i) caused by or (ii) aggravated by (defined as any increase in disability) the Veteran’s service-connected diabetes mellitus?  Why or why not?  

The examiner must specifically discuss the following articles: (i) Advances in Urology, (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774535/); (ii) Current Urology Reports, December 2014: “Hyperglycemia and Insulin Resistance and the Risk of BPH/LUTS: and Update of Recent Literature, (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527683/). 

A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner’s own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made.

2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum.

 

M.E. Larkin

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	T. Jarman, 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.