Citation Nr: 21028825 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 15-25 613 DATE: May 12, 2021 REMANDED Issue of entitlement to service connection for voiding dysfunction due to or as a result of an injury to the ureter during service is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1975 to February 1977. This appeal to the Board of Veterans' Appeals (Board) arose from an October 2014 rating decision issued by the Department of Veterans Affairs (VA). See January 2015 Notice of Disagreement (NOD); May 2015 Statement of the Case (SOC); June 2015 Substantive Appeal (VA Form 9). In September 2017, the Board remanded the claim to allow the Veteran an opportunity for a hearing. September 2017 Board decision. The Veteran testified before the undersigned Veterans Law Judge in a January 2018 hearing. See January 2018 Hearing transcript. In July 2018, the Board remanded the claim for further development. July 2018 Board decision. In August 2020, the Board remanded the claim again for further development. August 2020 Board decision. The Agency of Original Jurisdiction (AOJ) developed the evidence and continued the denial of the Veteran's claim. January 2021 Supplemental Statement of the Case (SSOC). The claim is now back before the Board. Issue of entitlement to service connection for voiding dysfunction due to or as a result of an injury to the ureter during service is remanded. Unfortunately, the Board finds that there has not been substantial compliance with its prior remand directives. The July 2018 Board decision remanded the Veteran's claim to clarify the October 2014 VA examiner's findings that the Veteran has both normal urine flow to the left ureter and voiding dysfunction symptoms. Board decision. A July 2019 VA examination was obtained on remand, but the examiner only opined that the Veteran's voiding dysfunction is not due to an in service injury, and did not explain how the Veteran has normal urine flow to the left ureter and voiding dysfunction as directed by the Board. The August 2020 Board decision remanded the claim again to explain the finding of normal urine flow to the left ureter and evidence of voiding dysfunction. The August 2020 Board decision also noted that the VA examiner's rationale for finding no medical nexus between the Veteran's service and current disability should be based on more than a notation that there is absence of symptoms or treatment, and a detailed discussion is needed. On remand, a September 2020 VA examination was obtained in which the examiner opined that the Veteran's current voiding dysfunction is less likely as not due to his in-service injury. The VA examiner, again, did not explain the how the Veteran was found to have normal urine flow to the left ureter while having exhibited signs of voiding dysfunction. Id. The examiner also cited the lack of symptoms and treatment without explaining its significance in finding no medical nexus to service. The Board, thus, finds that remand is warranted to afford the Veteran another VA examination to evaluate any ureter condition and voiding dysfunction. The matters are REMANDED for the following action: 1. Obtain any outstanding VA records from the Ann Arbor Hospital. If necessary, contact the Veteran to ensure that any relevant and outstanding treatment records from the Ann Arbor VA Medical Center have been obtained. 2. Schedule the Veteran for a VA examination to determine the nature and cause of any ureter condition and voiding dysfunction during the period on appeal. The medical professional should respond to the following: (a) Identify any evidence that the Veteran has or has had a ureter or voiding dysfunction disability recent to or since his December 2013 claim. The examiner should specifically consider and discuss the August 2016 and September 2016 VA treatment notes in which the Veteran was seen for complaints of being unable to pass his catheter into his bladder and diagnosis for recurrent urethra stricture. The examiner should also consider and discuss the October 2014 VA examiner's finding that the Veteran has symptoms of obstructed voiding, including slow and weak stream during the examination, but opining that the Veteran has normal urine flow in the left ureter. 3. For each identified ureter or voiding dysfunction condition, is it at least as likely as not (a 50 percent or greater probability) that the condition began in (or is otherwise related to) the Veteran's service? The examiner should consider and discuss the Veteran's lay testimony and assertions regarding any pertinent complaints and symptoms. This includes the Veteran's September 2014 statement that his urethral stricture or stenosis is due to the damage to his left ureter and acute renal failure during service from a gunshot wound. A rationale is requested. (b) For each identified ureter or voiding dysfunction condition that is deemed to be unrelated to service, the examiner should, if possible, identify the cause considered more likely and explained why that is so. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Lin 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.