Citation Nr: 21028541 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 06-32 712 DATE: May 11, 2021 REMANDED Entitlement to a separate compensable rating for urinary incontinence associated with right varicocele is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1967 to July 1969. The Veteran originally filed a claim for his right varicocele, which has a long procedural history that has been outlined in prior Board decisions. Most recently, in an August 2020 decision, the Board denied an initial rating in excess of 10 percent for right varicocele and remanded the issue of entitlement to a separate compensable rating for urinary incontinence associated with his right varicocele. The Veteran's urinary incontinence was linked to his diagnosis of benign prostatic hypertrophy (BPH), which was in turn, may have been linked to his varicocele. In August 2017, the Veteran submitted an article from a peer-reviewed medical journal which linked BPH and varicocele. He also submitted a Wikipedia article which notes BPH may be a symptom of varicoceles. In a May 2019 VA medical opinion, the VA examiner referenced a 2018 study from The National Center for Biotechnology Information, that out of 901 patients with BPH, all 901 were noted to have bilateral varicocele. Based on this and the Veteran's submitted medical articles, the examiner opined that the Veteran's BPH is most likely secondary to varicocele, and incontinence is due to the BPH. However, the examiner failed to discuss the conflicting medical opinion from a June 2014 VA examiner, who opined the Veteran's voiding dysfunction was due to dialysis, and his renal disease was not related to his varicocele. The Board remanded for clarification, and in December 2019, a VA examiner noted that the Veteran's varicocele was not related to BPH and his urinary incontinence was not a symptom of varicoceles. However, he did not address the conflicting medical literature discussed in the May 2019 opinion. Thus, the issue was remanded for another VA medical opinion. In February 2021, the examiner found that BPH was not attributable to varicocele etiology. He noted that although this conflicts with previous medical opinions, "there was no scientifically backed medical literature identified that supported this relationship." The Board notes, however, the record contains references to medical literature, to include articles submitted by the Veteran and referenced by the May 2019 VA examiner. The February 2021 examiner stated he based his opinion on current medical knowledge; however, he did not acknowledge or discuss these seemingly relevant articles. Another remand is required for a medical opinion that considers and reconciles the medical literature supporting the relationship of BPH and varicocele. The matters are REMANDED for the following action: 1. Obtain a VA medical opinion to determine the nature and etiology of the Veteran's urinary incontinence in relation to his service-connected right varicocele. The claims file should be made available and reviewed by the opinion provider. If deemed necessary, afford the Veteran a VA examination. The opinion should address the etiology of the Veteran's urinary incontinence by answering the following questions: It is at least as likely as not (50 percent or greater probability) that: (a.) the Veteran's incontinence is a symptom of, or attributable the Veteran's benign prostate hypertrophy/hyperplasia (BPH), (b.) the Veteran's BPH is a symptom of, or attributable to the varicocele. A fully articulated medical rationale for each opinion expressed must be set forth in the medical report. The medical professional should discuss the particulars of this Veteran's medical history to include:(i) the prior VA examinations (especially in June 2014, May 2019, and December 2019), (ii) lay evidence of record, and (iii) the medical articles submitted by the Veteran in August 2017, as well as, the relevant medical articles addressed in the May 2019 examination report. 2. After any further development as may be indicated has been accomplished, readjudicate the issue on appeal. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Jaigirdar, 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.