Citation Nr: 21026229 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 17-36 284 DATE: April 30, 2021 ORDER Service connection for hematuria with voiding dysfunction is granted. FINDING OF FACT The probative evidence of record demonstrates that it is at least as likely as not that the Veteran’s hematuria with voiding dysfunction began during service. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for hematuria with voiding dysfunction have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. § 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1985 to October 1989. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Board denied the Veteran’s claim for service connection for hematuria and urine incontinence, and the Veteran appealed that decision to the Court of Appeals for Veterans Claims (Court). In a November 2020 Joint Motion for Partial Remand (Joint Motion), the parties agreed that the Board provided an inadequate statement of reasons or bases for its determination that the Veteran did not have a current disability manifested by hematuria and voiding dysfunction, particularly in light of the holdings in Saunders v. Wilkie, 886 F.3d 1359, 1363 (Fed. Cir.. 2018) and Wait v. Wilkie, 33 Vet. App. 8, 17 (2020). The parties moved the Court to vacate the portion of the Board’s January 2020 decision denying service connection for hematuria and urine incontinence. In a November 2020 order, the Court granted the Joint motion and remanded the claim to the Board for readjudication. The Court did not disturb the portion of the Board’s decision dismissing claims for earlier effective dates for the awards of 10 percent ratings for bilateral foot and knee disabilities. The Board notes that in the January 2020 decision, it also remanded claims for service connection for a psychiatric disorder, sleep apnea, and hearing loss, and claims for higher ratings for bilateral foot and knee disabilities. Service connection for a psychiatric disorder was subsequently granted in a November 2020 rating decision. In January 2021, the Veteran opted to have his remaining claims adjudicated under the Appeals Modernization Act (AMA), and those claims were addressed in an April 2021 Higher-Level Review decision. Accordingly, they are no longer before the Board. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). The term “disability” refers to the functional impairment of earning capacity, not the underlying cause of a disability. Saunders, 886 F.3d at 1363. Functional impairment in earning capacity can be demonstrated by “showing manifestations of a similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait, 33 Vet. App. at 17. 1. Entitlement to service connection for hematuria with voiding dysfunction Upon review of the record, the Board finds that it is at least as likely as not that the Veteran’s hematuria with voiding dysfunction began during service. Service treatment records show that the Veteran reported symptoms of dysuria in May 1986. A urinalysis revealed microscopic 0-2 white blood cell count (WBC) and 0-2 red blood cell count (RBC). In June 1986, the Veteran sought treatment for urethral discharge and a burning sensation while urinating. In July 1987 and August 1987, he reported urethral discharge and pain with urination and underwent urinalyses. In February 1989, the Veteran sought treatment for a burning sensation during urination and itching inside the urethra. A urinalysis revealed 0-2 WBCs, and the assessment was rule out gonorrhea. A urinalysis performed during the Veteran’s separation examination in September 1989 revealed trace blood in the urine, and a repeat urinalysis was recommended. A repeat urinalysis performed in October 1989 revealed 1.020 trace protein and 3-4 WBCs with occasional clumps. A urinalysis performed later in October 1989 revealed 5-7 WBCs. The Veteran was treated for non-gonococcal urethritis and advised to follow up with VA or another treatment provider. A March 1990 VA treatment record shows the Veteran was tested for chlamydia, and that test was negative. The next earliest treatment record associated with the claims file is dated October 1999 and shows that the Veteran requested a prostate examination, which was normal. In March 2001, the Veteran underwent an intravenous pyelogram with tomography for microhematuria and urinary frequency, which was negative. In April 2001, he reported continued symptoms of urinary frequency, and a urine culture was negative. In May 2001, the Veteran was evaluated for microhematuria. An examination was negative, and a urinalysis showed greater than 5 RBCs per high power field. In June 2001, it was noted that an intravenous pyelogram was unremarkable, and a cystoscopy was negative. The treatment provider recommended checking the Veteran’s urine for hematuria every two months. In September 2004, the Veteran sought treatment for frequent urination. A May 2006 letter from a private physician indicates the Veteran had blood in his urine when he treated him in November 2004, and the Veteran was referred to a urologist for further evaluation. The urinalysis performed by the specialist again showed blood in the urine; however, a CT scan was negative, and the Veteran’s urinary tract was structurally normal without any evidence of significant disease. The Veteran was advised to follow up with a urologist every five years for hematuria. In April 2006, the Veteran again sought treatment for frequent urination, and a urinalysis revealed blood in the urine. The Veteran was prescribed Detrol and advised to follow-up for repeat urinalysis. A urinalysis performed in September 2007 revealed a moderate amount of blood in the urine. In March 2010, the Veteran reported symptoms of overactive bladder for years, and it was noted that he tried Flomax and Uroxatral without any relief. The Veteran underwent a urine cytology in July 2010, which was benign. In August 2010, he again reported symptoms of urinary frequency. An August 2010 urology treatment record shows that the Veteran had a history of microhematuria and irritative bladder, and his symptoms included urinary urgency and frequency. The Veteran underwent a cystoscopy for lower urinary tract symptoms and microhematuria in October 2010, which revealed a small among of microhematuria, but no significant pathology was found. The Veteran underwent a VA examination in March 2013, and the examiner indicated that the Veteran “has been noted to have microscopic hematuria since 1987,” but cystoscopy and renal imaging have failed to yield a specific diagnosis. The examiner also indicated that the Veteran was diagnosed with bladder outlet obstruction in 1987, which was the cause of his current symptoms of voiding dysfunction in the form of urinary frequency and obstructed voiding. The examiner opined that it was at least as likely as not that the claimed condition was incurred in or caused by service. In support of this, the examiner explained that multiple studies were undertaken during the Veteran’s military service, which were intended to diagnose a possible etiology of the hematuria. Subsequent VA treatment records show that in May 2015, the Veteran reported symptoms of frequent, painful urination. He was given a trial of Flomax because his medication for spasm was not effective. A June 2015 VA treatment record notes that the Veteran had chronic overactive bladder, which remained unchanged. It was also noted that he had chronic hematuria without any clear etiology. In October 2015, the Veteran reported urinary frequency, urgency, and weak stream of flow and requested an appointment with a urologist. In July 2019, the Veteran reported that his urinary hesitancy improved somewhat, but there still appeared to be a weak stream. The Veteran was referred to a urologist for bladder symptoms and chronic hematuria. Subsequent VA treatment records dated through 2020 list microscopic hematuria and overactive bladder among the Veteran’s current problems. Based on the foregoing, the Board finds that it is at least as likely as not that the Veteran’s hematuria with voiding dysfunction began during service. Accordingly, service connection for hematuria with voiding dysfunction is granted. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Banister, 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.