Citation Nr: 21039891 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 16-11 125 DATE: July 1, 2021 REMANDED Entitlement to service connection for a prostate disability, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1964 to May 1968. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision issued by the Department of Veterans' Affairs (VA) Regional Office (RO) in Newnan, Georgia. By way of background, the Board previously decided this matter in a January 2017 decision denying service connection for a prostate disability. Thereafter, the Veteran timely appealed to the U.S. Court of Appeals for Veterans Claims (CAVC or "the Court"). In January 2018, the Court issued a Memorandum Decision wherein, of relevance, the Court remanded the Veteran's claim of service connection for a prostate disorder for additional considerations and development. The matter returned to the Board for development consistent with the Court's January 2018 Memorandum Decision prompting a September 2018 Board decision remanding for additional development. The matter was again remanded in November 2020. Unfortunately, as will be discussed in more detail below, remand is again necessary to ensure substantial compliance with the November 2020 remand directives has been met. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a prostate disability, to include as secondary to service-connected disabilities, is remanded. The Veteran contends his prostate disability was caused by or incurred during service, or in the alternative, is secondary to his service-connected disabilities. The Board finds the evidence of record is insufficient to resolve his claim. The Veteran's most recent April 2021 VA examiner opined that while coronary artery disease (CAD) and diabetes mellitus, type II, (DM) can worsen / exacerbate / aggravate benign prostate hypertrophy (BPH), it is less likely than not the Veteran's BPH was aggravated by his service-connected CAD and / or DM. The examiner reasoned that the record lacked "clear evidence" that the Veteran's CAD and / or DM aggravated BPH beyond its natural progression. The examiner, however, failed to address and reconcile the Veteran's reports of BPH symptom worsening in 2016, the same year in which records reference diagnosis of DM and approximately two years after diagnosis of CAD. The April 2021 examiner differentiated between evidence of "exacerbation" and "aggravation" for the purposes of secondary service connection. To this point, the Board notes under 38 C.F.R. § 3.310, service connection on the basis of aggravation is available when there is "Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease." 38 C.F.R. § 3.310. It is also noted that aggravation need not be permanent. See Ward v. Wilkie, 31 Vet. App. 233 (2019). Thus, remand is necessary for consideration of the Veteran's onset of symptom worsening in light of his diagnosis of DM in 2016 and CAD in 2014. Further, the examiner cited numerous studies discussing BPH symptom worsening in association with CAD and / or DM but relied upon the statistical frequency of men contracting BPH. The Board notes, just because it would be "very likely" that a 76 year-old man would have BPH and associated symptoms, it does not eliminate the possibility that CAD and / or DM aggravate the Veteran's BPH. Thus, clarification regarding whether the Veteran's specific BPH and symptoms associated therewith are aggravated by his service-connected CAD and / or DM is necessary. Accordingly, remand is necessary to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Return the entire claims file and this remand to the April 2021 VA examiner, if available, or to another appropriate examiner for review. The examiner shall render an addendum opinion, including rationale, addressing whether it is at least as likely as not the Veteran's BPH was aggravated by his service-connected diabetes mellitus and / or coronary artery disease. In so opining, the examiner is directed to address and reconcile the Veteran's statements and treatment records referencing worsening BPH symptoms in 2016 in connection with a diagnosis of coronary artery disease in 2014 and diabetes mellitus, type II in 2016. The VA examiner is cautioned that the term "aggravated," as used in 38 C.F.R. § 3.310(b), does not require that there be "permanent worsening" of the nonservice-connected disability. Instead, secondary service connection is warranted for "any incremental increase in disability and any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence." See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). The examiner must provide a complete rationale for any opinion expressed, based on the examiner's clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate. If any opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 2. After the above development, and any other development deemed necessary, readjudicate the claims. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.C. Allen, 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.