Citation Nr: 21030379 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 18-25 067 DATE: May 18, 2021 REMANDED Entitlement to a compensable rating for a left varicocele is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from September 1980 to September 1984. This matter is before the Board of Veterans' Appeals (Board) on appeal from a February 2017 Department of Veterans Affairs (VA) rating decision. In April 2021, a virtual hearing in this matter was held before the undersigned. A transcript of the hearing has not yet been associated with the file. The hearing transcript will still be processed and associated with the claims file in the ordinary course of Board business. Entitlement to a compensable rating for a left varicocele. Further development of the record is necessary to comply with VA's duty to assist the Veteran in the development of facts and medical evidence to properly adjudicate this claim. On January 2017 Male Reproductive System Conditions Disability Benefits Questionnaire (DBQ), the examiner noted that the Veteran had a voiding dysfunction, which caused increased urinary frequency (daytime voiding interval between 1 and 2 hours), but the voiding dysfunction did not cause signs/symptoms of obstructed voiding. A May 2018 private medical treatment report notes the Veteran reported left scrotal pain and urinary incontinence. He took Flomax and ditropan without improvement in symptoms. He denied hematuria, dysuria, and stones. The examiner noted there was benign non-nodular hyperplasia with obstruction and/or lower urinary tract symptoms. At the April 2021 Board hearing, the Veteran testified he had ongoing groin pain and urinary frequency. He also raised additional matters with medical questions which require medical guidance. Specifically, he questioned the appropriateness of rating the disability by analogy to Codes (Codes) 7199-7120 and 7805 and argued that voiding dysfunction rating criteria should apply. Based on his testimony and the nature of the disability, his left varicocele disability appears to be a genitourinary condition (and not an artery/vein or similar to scar one, as is reflected by the current diagnostic code designation). Clarification of the appropriate diagnostic code to rate the disability picture presented by his left varicocele disability by a medical professional is needed. Accordingly, remand for an examination to determine the nature and severity of the Veteran's left varicocele disability and related functional impairment is necessary. Furthermore, the records of postservice treatment for the Veteran's left varicocele in the claims file are rather sparse and incomplete. Any such records that are outstanding and available may shed light on the nature of the disability and thus are pertinent evidence that must be sought. The matter is REMANDED for the following: 1. Secure for the record updated (to the present, any not already associated with the record) complete clinical records of all VA evaluations and treatment the Veteran has received for his left varicocele disability. Also ask the Veteran to identify all private providers of evaluations or treatment he has received for his left varicocele postservice, and to submit authorizations for VA to secure for the record complete clinical records from the providers identified. Obtain those records (all available). 2. When the development requested above is completed, arrange for the Veteran to be examined by an appropriate clinician (e.g., a urologist) to ascertain the nature and severity of his left varicocele disability. The examiner must have available for review 38 C.F.R. §§ 4.104, 4.115, and 4.118, Codes 7199-7120, 7805 (and the criteria for rating voiding dysfunction), and all pertinent notes in the rating schedule. On review of entire record (to include this remand, the January 2017 VA examination, May 2018 private medical record, and any records received pursuant to the development ordered above) and examination/interview of the Veteran, the urologist should: (a.) Elicit from the Veteran a description of all symptoms and impairment he alleges are due to his left varicocele disability. (b.) Opine on the nature of symptoms and impairment that could potentially be associated with his left varicocele disability. Describe all symptoms of and related functional impairment due to his left varicocele (considering his accounts, noted on examination). Identify any symptoms he reports that are capable of being objectively confirmed by examination, but were not found; and also identify any symptoms he reports that are incapable of being objectively confirmed. (c.) Review 38 C.F.R. §§ 4.20 (pertaining to rating by analogy); 4.104 (in particular the criteria for rating diseases of the arteries and veins), 4.115 (for genitourinary system disorders), 4.118 (for considering of rating by analogy to painful scars), Codes 7199-7120, 7805, and the criteria for rating voiding dysfunction, and opine (with explanation) whether the disability presented on examination is best reflected (or most best compared by analogy) by a diagnostic code under which the current rating is assigned, a diagnostic code in the criteria for rating genitourinary disorders (including voiding dysfunction), or some other diagnostic code deemed more appropriate. (d.) To the extent possible, distinguish symptoms (and related impairment) attributable to the Veteran's service-connected residuals of left varicocele disability from any attributable solely to a co-existing nonservice-connected disability. (e.) Describe in detail the impact that the left varicocele disability has on the Veteran's daily activity and occupational functioning. [If an opinion sought cannot be provided without resort to mere speculation, indicate whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner lacks the requisite knowledge or training.] All opinions must include rationale, with citation to supporting factual data and medical principles as deemed appropriate. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Chu, 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.