Citation Nr: 21028354 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 18-02 067 DATE: May 11, 2021 ORDER Entitlement to an initial compensable disability rating of 40 percent, and no higher, for bilateral hydrocele with left testicular echotexture, residuals of groin injury, is granted. REMANDED Entitlement to a separate rating for neurological residuals of bilateral hydrocele with left testicular echotexture, residuals of groin injury is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDING OF FACT The Veteran's bilateral hydrocele with left testicular echotexture, residuals of groin injury has been manifested by painful, frequent urination. CONCLUSION OF LAW The criteria for an initial rating of 40 percent, but no higher, for bilateral hydrocele with left testicular echotexture, residuals of groin injury, rated as voiding dysfunction by analogy, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.115a, 4.115b. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 2009 to June 2011. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran presented sworn testimony at a hearing before the undersigned in April 2021. The Board notes that at the April 2021 Board hearing, the Veteran testified that he is unable to work due to his groin disability. Thus, the Board takes jurisdiction of the issue of entitlement to a TDIU because it is part and parcel to the increased rating claim on appeal. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). 1. Entitlement to an initial compensable disability rating for bilateral hydrocele with left testicular echotexture, residuals of groin injury. The Veteran contends that his bilateral hydrocele with left testicular echotexture, residuals of groin injury, warrants a compensable initial disability rating. The Veteran's disability is rated by analogy under Diagnostic Code 7523, which contemplates a zero percent rating for complete atrophy of one testicle, and a 20 percent rating for complete atrophy of both testicles. A November 6, 2014 VA treatment record notes the Veteran reported groin pain from an injury while on active duty. He described the pain as intermittent and varying in severity depending upon activity. It was noted that sexual activity, physical activity, and sports make the pain worse. He further reported occasional groin swelling and stated that the pain and discomfort affect sexual activity and function. A November 10, 2014 VA treatment record notes a November 8, 2014 scrotum echogram revealed small, bilateral hydrocele, small right varicocele and small left epididymal head cysts. The Veteran was afforded a VA male reproductive system conditions examination in May 2015. A diagnosis of bilateral hydrocele with left testicular echotexture status post trauma was noted. The Veteran reported continuing, intermittent tentacular pain and edema. In his June 2015 Notice of Disagreement (NOD), the Veteran reported having a daytime voiding interval between 2 and 3 hours and awakening to void 2 to 3 times per night. He then asserted that the examiner did not ask him about voiding. The Veteran was afforded a VA male reproductive system conditions examination in May 2016. Diagnoses of bilateral hydrocele with left testicle echotexture, status post trauma, as well as testicular trauma, were noted. The Veteran reported persistent scrotal pain, as well as scrotum swelling with certain activities, such as lifting or sexual intercourse. He further reported that sexual intercourse can be painful and that this has led to erectile dysfunction. He then reported that he can have painful urination, urge for frequent urination at times and difficulty in initiating urination. A voiding dysfunction was noted, though the etiology was characterized as unknown. A daytime voiding interval between 2 and 3 hours, as well as nighttime awakening to void 3 to 4 times, were noted. Hesitancy was noted, as was erectile dysfunction. It was noted that the Veteran works construction and that he has difficulty lifting squatting and carrying as these can lead to an increase in pain. It was then noted that if he aggravates the pain too much he has to stop working and rest. The Veteran reported that he had lost many days of work due to his scrotal pain, as well as knee pain. The examiner stated that "[i]t is possible that his symptoms of pain, erectile dysfunction, urinary symptoms and intermittent scrotal swelling are residuals from his initial injury." An addendum VA opinion was obtained in October 2017. The VA examiner stated that it is not clear from the medical records whether the Veteran's urinary dysfunction is from his testicular injury as he has had a renal calculus in the left ureter which may have contributed to his urinary symptoms, as might his prostatitis, neither of which are related to his testicular injury. The VA examiner then opined that it is unlikely that his urinary symptoms are from his testicular injury. Here, the VA examiner provided a negative nexus opinion after initially stating that it is unclear whether the Veteran's testicular injury is the cause of his urinary symptoms, or whether a former kidney stone or prostatitis are the culprit. As such, the Board finds this opinion is inadequate for rating purposes and is of no probative value. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Veteran testified at the April 2021 Board hearing that he has pain on voiding as well as urinary urgency every 30 to 60 minutes, day or night. He further stated that his pain starts in the groin and radiates throughout his pelvic region. The Board notes that the Veteran is competent to report his symptoms of urinary frequency, painful urination, and the location of that pain, and finds his testimony credible. See, Charles v. Principi, 16 Vet. App. 370, 374 (2002); see also, Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Here, the Board finds that the evidence shows that the Veteran's urinary symptoms are due to his bilateral hydrocele with left testicular echotexture, residuals of groin injury. As noted above, the Veteran's disability has been rated under Diagnostic Code 7523. However, as the evidence of record does not show that the Veteran's disability has been manifest by testicular atrophy, but rather by painful, frequent urination, the Board finds it is inappropriately rated under Diagnostic Code 7523, and instead should be rated by analogy as a voiding dysfunction. Voiding dysfunctions are rated under 38 C.F.R. § 4.115a, which indicates to rate the condition as either urine leakage, frequency, or obstructed voiding. The Board notes that the record does not reflect that the Veteran has urinary frequency, but not urinary leakage or obstructed voiding. As to urinary frequency, a daytime voiding interval between 1-2 hours or nighttime voiding interval of 3-4 times per night is rated at 20 percent. A daytime voiding interval less than one hour or nighttime voiding interval more than five times per night is rated at 40 percent, the maximum rating provided for urinary frequency. The above evidence is at least evenly balanced as to whether the Veteran has daytime voiding interval less than one hour or awakening to void five or more times per night. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to an initial rating of 40 percent for his bilateral hydrocele with left testicular echotexture, residuals of groin injury. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. REASONS FOR REMAND 1. Entitlement to a separate rating for neurological residuals of bilateral hydrocele with left testicular echotexture, residuals of groin injury is remanded. The Board notes that the Veteran and his representative asserted that he has a neurological component to his bilateral hydrocele with left testicular echotexture, residuals of groin injury. While the Board notes that the Veteran already has a separate rating for erectile dysfunction, no examiner has discussed whether the dysfunction is due to a deformity or is neurological in nature. The Court of Appeals for Veterans Claims (Court), recently defined "deformity" as a distortion of the penis, either internal or external. See Williams v. Wilkie, 30 Vet. App. 134 (2018). Here, the Board finds that the Veteran should be afforded a VA examination to determine the current level of severity of his erectile dysfunction and to determine if he is entitled to a separate disability rating for neurological impairment caused by his bilateral hydrocele with left testicular echotexture, residuals of groin injury. 2. Entitlement to a TDIU. As noted above, in light of the Veteran's testimony at the April 2021 Board hearing, the Board has found that TDIU has been raised by the record. As the RO has not adjudicated this matter, after giving the Veteran an opportunity to file a formal claim for a TDIU, the RO should address this matter, in the first instance. The matters are REMANDED for the following action: 1. Reach out to the Veteran and his representative and give the Veteran an opportunity to clarify his work history and submit a VA Form 21-8940 (Application for Increased Compensation Based on Unemployability) in addition to any additional evidence that is relevant with regard to his claim for a TDIU. 2. Schedule the Veteran for an examination to determine the current severity of his service-connected bilateral hydrocele with left testicular echotexture, residuals of groin injury, to specifically determine if there are any neurological manifestations. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Brian P. Keeley 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.