Citation Nr: 21040443 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 10-38 666 DATE: July 3, 2021 ORDER Entitlement to service connection for neurological impairment, to include bladder dysfunction, secondary to a service-connected lumbar spine disability is denied. FINDING OF FACT The Veteran has not been shown to have neurological impairment in the form of bladder dysfunction secondary to his service-connected lumbar spine disability. CONCLUSION OF LAW The criteria for service connection for neurological impairment, to include bladder dysfunction, secondary to a service-connected lumbar spine disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.310, 4.71A (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the United States Air Force from July 2000 to July 2004. In May 2018, the Veteran testified before the undersigned at a Board of Veterans' Appeals (Board) videoconference hearing. A transcript of the hearing is of record. The appeal was remanded by the Board in November 2018. In October 2020, the Board denied entitlement to increased disability ratings for the Veteran's service-connected lumbar spine disability and associated left lower extremity radiculopathy; the Board also remanded the issue listed above for additional evidentiary development. Entitlement to service connection for neurological impairment, to include bladder dysfunction, secondary to a service-connected lumbar spine disability In general, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a); see also Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Service connection may be granted on a secondary basis for disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310. The Veteran is service-connected for a lumbar spine disability which is rated under the General Rating Formula for Disease and Injuries of the Spine. 38 C.F.R. § 4.71A. Note (1) to the General Rating Formula directs VA to evaluate any objective neurologic abnormalities associated with spine disabilities separately, under an appropriate Diagnostic Code. See 38 C.F.R. § 4.71A. In its October 2020 remand instructions, the Board observed that there was evidence of record suggesting that the Veteran had neurological impairment, to include bladder dysfunction, associated with his lumbar spine disability. Specifically, the Board noted that a Disability Benefits Questionnaire (DBQ) completed by a private physician in May 2018 noted that the Veteran had urinary incontinence secondary to thecal sac compression. In addition, private medical evidence demonstrated intermittent urinary incontinence since 2007 correlated with back pain; a May 2019 clinical note reflects the Veteran's report that he noticed "a change in his ability to urinate when [his] back pain is reduced." Consequently, the Board requested a VA medical opinion to evaluate the possibility of neurological impairment associated with the Veteran's lumbar spine disability. (The Veteran's service treatment records do not reflect, and he does not contend, that his current urinary symptoms were incurred in active service or are otherwise directly related to his period of active service.) Post-service VA and private medical records reflect that the Veteran has been treated for intermittent urinary symptoms since late 2006. In addition, a VA examiner diagnosed the Veteran with benign prostatic hyperplasia (BPH) with urinary obstruction in 2019. Accordingly, the Board finds that the "current disability" element has been met. See 38 C.F.R. § 3.303(a). As to the question of a causal nexus to his service-connected lumbar spine disability, the Board notes initially that the Veteran has been afforded many VA examinations for his lumbar spine disability throughout the pendency of his appeal. None of these reports indicate any positive evidence of neurological impairment (apart from radiculopathy), to include bladder or bowel dysfunction. In January 2021, another VA examination was performed in response to the Board's request for a more detailed opinion. The examiner provided a negative opinion with respect to the Veteran's bladder dysfunction. In so finding, the examiner acknowledged the Veteran's history of urinary symptoms, to include the positive findings noted in the May 2018 DBQ; the examiner characterized these symptoms as predominantly urinary hesitancy without evidence of loss of bowel or bladder control or sensation. Moreover, the Veteran had denied neurological impairment, to include urinary incontinence, on the day of the examination. Rather, the examiner concluded, the Veteran's symptoms were more likely attributable to his non-service-connected BPH with voiding obstruction, a condition which was "separate and unrelated" to neurological impairment due to spinal pathology. The examiner explained that BPH with voiding obstruction was consistent with symptoms of increased urinary frequency, hesitancy, and urgencysymptoms which the Veteran reported on the day of the examination. In this case, the positive evidence of record consists primarily of the Veteran's private physician's reports of urinary incontinence and other symptoms, which the examiner deemed associated with the Veteran's lumbar spine disability. However, the physician did not provide a detailed explanation in support of these findings; rather, the examiner essentially noted a correlation between the Veteran's back pain and his urinary symptoms. As to the Veteran's lay statements, the Board accepts his descriptions of urinary symptoms in the context of increased back pain as competent and credible evidence; there is no reason to doubt that he experienced urinary symptoms in conjunction with increased back pain. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Veteran is not competent to offer opinions on complex medical questions requiring specialized knowledge, such as the specific physiological cause of his urinary symptoms. Moreover, the Board does not find the private physician's positive findings in this case to be highly probative, as they were not accompanied by a detailed rationale (and did not address the possibility that the urinary symptoms were related to a prostate disorder). Conversely, a VA medical professional has reviewed the record and opined that the Veteran's current urinary symptoms are less likely than not causally related to neurological impairment due to his service-connected lumbar spine disability. The examiner thoroughly addressed the Veteran's medical history, the most likely causes of his current symptoms, and his lay contentions regarding the onset of his symptoms, finding that his urinary symptoms were most likely attributable to BPH. The Board likewise notes the many VA spine examination reports of record in which no urinary or bowel impairment was identified. In light of these findings as well as the detailed, fact-specific, and logical nature of the January 2021 VA medical opinion discussed above, the Board finds that the most probative evidence of record weighs against the claim. See, e.g., Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). For the reasons discussed above, the Board concludes that the preponderance of the evidence is against a finding that the Veteran has neurological impairment in the form of bladder dysfunction associated with his service-connected lumbar spine disability. In so finding, the Board notes that the January 2021 VA examiner's opinion substantially complied with the matters raised in the Board's October 2020 remand, to include discussing the specifics of the Veteran's medical history and the findings of his private physician as noted in the May 2018 DBQ. The examiner also addressed the Veteran's current symptomatology, finding such was most likely attributable to a non-service-connected prostate disorder. In contrast, the positive opinions from the Veteran's private physician do not include detailed reasoning but rather state in a conclusory fashion that the Veteran's urinary problems are related to spinal pathology. The Board finds that the January 2021 VA examiner's opinion outweighs the positive evidence of record. Accordingly, the claim for a separate rating for neurological impairment in the form of bladder dysfunction must be denied. The Board is grateful for the Veteran's honorable service, and this decision in no way is meant to detract from that service. The Board is constrained by law, however, and unfortunately there is no basis on which to award the benefits sought. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Minot, 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.