Citation Nr: 21042646 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 15-03 627A DATE: July 13, 2021 REMANDED Entitlement to service connection for benign prostatic hyperplasia (BPH) with lower urinary tract symptoms and history of recurrent acute non-specific/non-gonococcal urethritis is remanded. REASONS FOR REMAND The Veteran served in the United States Marine Corps from October 1970 to October 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in July 2018, at which time the Board remanded the claim to the agency of original jurisdiction (AOJ) to obtain, and associate with the Veteran's claims file, relevant outstanding private treatment records. In April 2021, the Board remanded the Veteran's claim for a VA medical opinion addressing the nature and etiology of his claimed benign prostatic hyperplasia. The Veteran's claim is now before the Board again. The Board finds that there has not been substantial compliance with the Board's April 2021 remand directives. See Stegall v. West, 11 Vet. App. 268 (1998) (see also Donnellan v. Shinseki, 24 Vet. App. 167, 176, stating that substantial compliance, rather than strict compliance, is required). The Board directed the examiner to address and discuss as necessary the Veteran's lay statements indicating continuity of prostate and urinary symptoms as well as his relevant service treatment records. The April 2021 VA examiner's rationale did not discuss the Veteran's lay statements or service treatment records. Accordingly, this claim must be remanded so that the RO can obtain a VA medical opinion that substantially complies with the Board's remand directives. The matters are REMANDED for the following action: Send the Veteran's claims file to an appropriate clinician for review and for the opinions sought regarding the Veteran's claim for service connection for benign prostatic hyperplasia with lower urinary tract symptoms. ONLY IF another examination is deemed necessary to answer the questions below, should one be scheduled. The clinician is asked to address the following: (a) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's benign prostatic hyperplasia with lower urinary tract symptoms and history of recurrent acute non-specific urethritis was incurred in service? (b) Is it at least as likely as not (50 percent probability or greater) that the Veteran's benign prostatic hyperplasia with lower urinary tract symptoms and history of recurrent acute non-specific urethritis is otherwise etiologically related to his military service, to include his conceded exposure to herbicide agents (notwithstanding the fact that it may not be a presumed association)? In responding to the above questions, the examiner must address (i) the Veteran's lay statements that he has experienced a continuity of prostate and urinary symptoms since active duty service; and (ii) the service treatment records documenting symptomatology including "purulent discharge from [the] urethra," dated April 19, 1972. The examiner should take into consideration that the Veteran is competent to report in-service and post-service symptomology. The term "at least as likely as not" does not mean "within the realm of medical possibility," but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a conclusion as it is the find against it. A clear rationale for all opinions expressed would be helpful. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Hicks, 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.