Citation Nr: 21031013 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 07-06 457A DATE: May 20, 2021 REMANDED Entitlement to an initial compensable rating for epididymitis is remanded. Entitlement to an effective date earlier than October 5, 2004 for entitlement to TDIU is remanded. REASONS FOR REMAND The Veteran had active service from January 1968 to February 1970. These matters come before the Board of Veterans' Appeals (Board) on appeal from April 2006 and June 2009 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a travel Board hearing before a Veterans Law Judge in August 2010 and at an October 2015 videoconference hearing before a different judge. The judges are no longer with the Board. At the October 2015 hearing, the Veteran waived his right to a third hearing before a Veterans Law Judge. See Arneson v. Shinseki, 24 Vet. App. 379 (2011). These matters were remanded for additional development in March 2011, June 2016, June 2017, and May 2020. 1. Entitlement to an initial compensable rating for epididymitis is remanded. In May 2020, the appeal was remanded to afford the Veteran a VA examination. The Veteran was afforded a VA examination in October 2020. The examination noted a history of epididymitis. The examination indicated that notes show that he had hematuria and low back pain over the past 16 years. He had recurrent swelling of the left testes when he was in Germany and Vietnam. The rating criteria provide that epididymitis is rated according to the criteria for urinary tract infection. While the examination showed a 16-year history of hematuria and back pain, the examiner did not indicate whether those symptoms are manifestations of urinary tract infections. An April 2007 VA examination reflects that the Veteran had a history of two intravenous pyelograms (IVP's), evidence of a urinary tract infection, and voiding 7 to 8 times a day. A December 2017 VA examination noted a history of Tamsulosin for benign prostatic hypertrophy. The October 2020 examiner did not address the Veteran's treatment with Tamsulosin and two IVP's. A private opinion dated in March 2021 reflects a medical opinion that the Veteran's urinary frequency is a manifestation of service-connected epididymitis. The October 2020 VA examination noted urinary frequency but did not address whether urinary frequency is a symptom of epididymitis. An addendum opinion is necessary to ascertain whether the Veteran had urinary tract infection requiring drug therapy or intermittent intensive management for his symptoms. The opinion must also address whether urinary frequency is a symptom of epididymitis. At the October 2020 VA examination, the Veteran reported that he was going to see a private urologist in November 2020. The treatment records from that private urologist should be obtained. 2. Entitlement to an effective date earlier than October 5, 2004 for entitlement to TDIU is remanded. The issue of an earlier effective date for the award of a TDIU is inextricably intertwined with the issue of an increased rating for epididymitis being remanded and therefore must also be remanded. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for the private urologist who treated him in November 2020. Make two requests for the authorized records from his private physician, unless it is clear after the first request that a second request would be futile. 2. Obtain an addendum opinion from the October 2020 VA examiner or another appropriate examiner. The examiner should address the severity of epididymitis from February 1970 to the present. The examiner should specifically address whether the Veteran's chronic epididymitis resulted in the following: (a) urinary tract infections, that required long-term drug therapy, 1-2 hospitalizations per year and/or requiring intermittent intensive management; or (b) recurrent symptomatic infection requiring drainage/frequent hospitalization (greater than two times/year), and/or requiring continuous intensive management; or poor renal function. 3. In providing the requested opinion, the examiner should address the following: (a) whether the 16-year history of hematuria and back pain noted on the October 2020 VA examination is indicative of urinary tract infections. (b) the April 2007 examination noting a history of two IVP's and urinary tract infection (c) the 2017 VA examination indicating that Tamsulosin was prescribed for BPH. The examiner should opine as to whether Tamsulosin is a long-term drug therapy for urinary tract infections. (d) The examiner should describe the medical treatment required for his hematuria and urinary symptoms and should indicate whether such treatment is considered intensive management. 4. The examiner must opine as to whether urinary frequency is a symptom of the Veteran's service-connected epididymitis. Provide a detailed rationale for the opinion. M. Mills Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Catherine Cykowski 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.