Citation Nr: 21028304 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 16-30 630 DATE: May 10, 2021 REMANDED Entitlement to an increased initial rating for service-connected total reconstruction of urinary tract due to urethral stricture disease (USD), currently rated at: 10 percent prior to May 1, 2008; 20 percent from May 1, 2008, to February 28, 2013; noncompensable from March 1, 2013, to January 30, 2019; and 20 percent thereafter, is remanded. Entitlement to an initial compensable rating for erectile dysfunction (ED) is remanded. Entitlement to a 10 percent rating based upon multiple non-compensable service-connected disabilities is remanded. REASONS FOR REMAND Prior to discussing the appeal at hand, the Board would be remiss if it did not recognize the Veteran's outstanding service. The Veteran, who served on active duty from January 1972 to January 1974, was clearly a credit to the United States Army, and his service to our country is greatly appreciated. Unfortunately, the Veteran passed away in November 2019, during the pendency of this appeal. The appellant, his surviving spouse, has been found to be eligible as the substituted claimant in the Veteran's appeal. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision issued by a Department of Veterans Affairs (VA) regional office. These matters were previously remanded by the Board in December 2018. 1. Entitlement to an initial rating for service-connected USD, in excess of: 10 percent prior to May 1, 2008; 20 percent from May 1, 2008, to February 28, 2013; noncompensable from March 1, 2013, to January 30, 2019; and 20 percent thereafter, is remanded. The Board sincerely regrets the delay associated with this remand, particularly as this matter has been the subject of a prior remand. However, based on a review of the evidence of record, the Board finds that another remand is necessary to allow the Agency of Original Jurisdiction (AOJ) to conduct additional development. Specifically, a remand is warranted as the evidence indicates that there may be relevant private medical records, of which VA is aware, that are not associated with the electronic claims file. Specifically, the record indicates that the Veteran received treatment for his USD from Our Lady of the Lake Regional Medical Center (RMC) and Dr. R.T. Grissom. However, only excerpts of such records have been associated with the claims file, and no such records have been associated with the claims file since May 2008. See Our Lady of the Lake RMC records, received August 2007; Dr. R.T. Grissom records, received May 2008. Additionally, the Veteran's VA treatment records indicate that he received private treatment from Dr. G. Wilks. See New Orleans VA Medical Center (VAMC) records, received January 2019 in CAPRI. However, no such records have been associated with the claims file, nor is there any indication such records were requested. As such, a remand is necessary to allow the AOJ to obtain pertinent private medical records. See 38 U.S.C. § 4103(a)(1), (b)(1); Ivey v. Derwinski, 2 Vet. App. 320, 323 (1992). Additionally, the Board notes that the Veteran was afforded VA examinations regarding his USD in May 2008, August 2011, March 2013, April 2016, and January 2019. See May 2008 VA Genitourinary Examination; March 2013 VA Male Reproductive System Conditions Disability Benefits Questionnaire (DBQ); April 2016 VA Male Reproductive System Conditions DBQ; April 2016 VA Urinary Tract Conditions DBQ; January 2019 VA Urinary Tract Conditions DBQ; January 2019 VA Male Reproductive System Conditions DBQ. However, as noted above, potentially relevant medical records may not have been associated with the electronic claims file. As such, if additional medical records are associated with the claims file on remand, an addendum opinion should be obtained regarding the nature and severity of the Veteran's service-connected USD. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). 2. Entitlement to an initial compensable rating for ED is remanded. The Board sincerely regrets the delay associated with this remand, particularly as this matter has been the subject of a prior remand. However, based on a review of the evidence of record, the Board finds that another remand is necessary to allow the AOJ to conduct additional development. First, as discussed above, a remand is necessary to allow the AOJ to attempt to obtain potentially relevant private medical records. See 38 U.S.C. § 4103(a)(1), (b)(1); Ivey v. Derwinski, supra. Second, a remand is warranted to allow the AOJ to obtain an addendum opinion regarding the nature and severity of the Veteran's ED. In January 2019, the Veteran was afforded a VA examination regarding his service-connected ED. In this examination, the examiner noted that the Veteran's penis was normal upon examination and that he did not have any scars. See January 2019 VA Male Reproductive Conditions DBQ. However, the evidence indicates that the Veteran had a scar on the ventral surface of his penis from his stricture surgery. See March 2013 VA Male Reproductive System Conditions DBQ; April 2016 VA Male Reproductive System Conditions DBQ. Indeed, the Veteran is service connected for such scar. As such, the January 2019 examination appears to be based, in part, on an inaccurate factual premise and, therefore, is inadequate. See Reonal v. Brown, 5 Vet. App. 458 (1993). Additionally, the Board notes that, to warrant a compensable rating for ED, the condition must present with both loss of erectile power and a distortion of the penis, either internal or external. See 38 C.F.R. § 4.115b, Diagnostic Code 7522; Williams v. Wilkie, 30 Vet. App. 134 (2018). The Board also notes that the Veteran is service connected for a total reconstruction of the urinary tract due to urethral stricture disease, as well as for a resulting scar. However, the January 2019 examiner did not address whether such conditions constituted a distortion of the penis, either external or internal. As such, the January 2019 examination is inadequate to the extent it ignores such. For these reasons, the Board finds the January 2019 VA examination to be inadequate for adjudication purposes. Therefore, a remand is necessary to obtain an addendum opinion regarding the nature and severity of the Veteran's ED. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 3. Entitlement to a 10 percent rating based upon multiple non-compensable service-connected disabilities is remanded. With respect to the claim of entitlement to a 10 percent rating based upon multiple noncompensable service-connected disabilities, the Board notes that if either of the increased rating claims are granted, it would directly impact the adjudication of this claim. See 38 C.F.R. § 3.324. Therefore, a remand is necessary as this issue is inextricably intertwined with the claims remanded herein. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Accordingly, the matters are REMANDED for the following action: 1. With the appellant's assistance as appropriate, obtain and associate with the electronic claims file any outstanding pertinent medical records, including records relating to treatment from Our Lady of the Water Regional Medical Center, Dr. R.T. Grissom, and Dr. G. Wilks. Pursuant to 38 C.F.R. § 3.159(c), any efforts to secure these records MUST be documented in the electronic claims file, and the Appellant must be informed if any records are unavailable to be secured. 2. After completing the development above, and any additional development warranted by the record, return this matter to the January 2019 examiner and obtain an addendum opinion regarding the nature and severity of the Veteran's erectile dysfunction and total reconstruction of the urinary tract due to urethral stricture disease (USD). The entire claims file must be provided to, and reviewed by, the examiner. The examiner is asked to: (a.) Provide a full description of the Veteran's USD from January 2007 through November 2019, and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating system. (b.) With respect to urinary frequency, to the extent possible, determine the Veteran's voiding interval from January 2007 through November 2019. (c.) Determine whether the Veteran had any penile deformity, to include any internal deformity. The examiner is instructed to specifically address the Veteran's service-connected penile scar and USD. Any opinion expressed by the examiner should be accompanied by a complete rationale. If medical literature is relied upon in rendering a determination, the examiner should identify and specifically cite each reference material utilized. If the examiner is unable to offer an opinion without resort to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. The examiner is advised that the Veteran and Appellant are competent to report symptoms, treatment, and injuries, and that any such reports must be taken into account in formulating the requested opinions. (Continued on the next page) 3. The AOJ must review the claims file and ensure that the foregoing development action has been completed in full. If any development action is incomplete, the appropriate corrective action must be implemented. If any report or opinion does not include adequate responses to specific opinions requested, it must be returned to the providing examiner for corrective action. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. T. Martin III, 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.