Citation Nr: 22006366 Decision Date: 02/04/22 Archive Date: 02/03/22 DOCKET NO. 18-49 730 DATE: February 4, 2022 ORDER A rating in excess of 60 percent for residuals of prostate cancer is denied. FINDINGS OF FACT 1. The Veteran served on active duty from May 1968 to May 1971. 2. Prostate cancer residuals are manifested by a voiding dysfunction with symptoms at various times without use of absorbent materials, a daytime voiding interval of between 1-2 hours, and a nighttime voiding interval of 5 or more times. CONCLUSION OF LAW The criteria for a rating in excess of 60 percent for residuals of prostate cancer have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A (2012); 38 C.F.R. §§ 3.102, 3.321, 4.3, 4.7, 4.115a, 4.115b; Diagnostic Code (DC) 7528 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION In May 2020, the Board remanded the appeal. It is now before the Board for adjudication. Turning to the relevant laws and regulations, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The Veteran was originally awarded a 100 percent rating for prostate cancer until November 1, 2017, when it was reduced to 60 percent based on residuals. As the evidence does not show an active current malignancy, the Board will consider the severity of prostate cancer residuals from the date the 60 percent rating was originally assigned. Prostate cancer is evaluated under DC 7528, which covers malignant neoplasms of the genitourinary system and provides for an initial 100 percent rating for 6 months following the cessation of surgical, X-ray, antineoplastic chemotherapy, or other therapeutic procedure. If there is no local reoccurrence or metastasis, the disability is rated on residuals either voiding dysfunction or a renal dysfunction, whichever is predominant. Voiding dysfunction related to residuals of prostate cancer is evaluated under 38 C.F.R. § 4.115a, which provides that any voiding dysfunction shall be rated by the particular condition as urine leakage, urinary frequency, or obstructive voiding. A 60 percent evaluation is assigned for the use of an appliance or the wearing of absorbent materials which must be changed more than four times per day. This is the highest rating permitted for urine leakage, frequent, or obstructed voiding. To warrant a higher rating for renal dysfunction, the evidence must show persistent edema and albuminuria with BUN 40 to 80 mg; or, creatinine 4 to 8 mg; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion, which would warrant an 80 percent rating. Turning to the medical evidence, VA laboratory findings from 2017 revealed a BUN of 26 mg/dl and creatinine of 1/5 mg/dl. Private laboratory tests from February 2019 showed a BUN of 37 and creatinine of 1.42, and from August 2019 revealed a BUN of 24 and creatinine of 1.36. VA laboratory readings from November 2019 revealed a BUN of 21.0 mg/dl and creatinine of 1.4 mg/dl. In a July 2020 VA examination, the Veteran complained of chronic kidney disease with hospitalizations. He noted that he was diagnosed with prostate cancer in 2009 and underwent a radical prostatectomy, with his PSA's being negative since that time. He complained of erectile dysfunction and excessive urination which was worse at night. The examiner noted that the prostate cancer was in remission, with the last PSA in 2020 being 0.03. The examiner found that the Veteran had a voiding dysfunction, but that it did not require the wearing of any absorbent material, or the use of an appliance. However, there was an increase in urinary frequency, with daytime voiding intervals between 1 and 2 hours, and nighttime awakening to void more than five times. There was no obstructed voiding. The examiner also found no history of urinary tract or related kidney infections. No additional residuals were found. The examiner found that erectile dysfunction related to the Veteran's service-connected prostate cancer; however, he has already been independently awarded benefits for loss of use of a creative organ for such. Thus, there is no additional rating which is appropriate for erectile dysfunction. In this regard, voiding dysfunction is rated under the three subcategories of urine leakage, urinary frequency, and obstructed voiding. The Veteran's residuals of prostate cancer already are rated at 60 percent disabling. The highest rating for urinary frequency is 40 percent and the highest rating for obstructive voiding is 30 percent. Accordingly, there is no basis for a higher rating under either of those criteria. Additionally, the Veteran found no evidence of residuals pertaining to the kidneys or urinary tract. In this regard, the available private and VA treatment records have also been reviewed but have failed to show any indications for renal dysfunction which would warrant a higher rating under the appropriate diagnostic criteria. Thus, there is no basis for a higher rating under the criteria for renal dysfunction. As such, after reviewing the totality of the evidence, a rating in excess of 60 percent is not warranted. Specifically, a 60 percent rating is the highest available rating for residuals of prostate cancer based on voiding dysfunction. Further, the evidence does not support a higher rating based on renal dysfunction. As noted, the clinical records do not show persistent edema and albuminuria with BUN 40 to 80mg%, creatinine 4 to 8mg%, or generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion. As such, the medical evidence does not support a higher rating based on renal dysfunction. Next, the evidence does not show that the Veteran has an active neoplasm of the genitourinary system. As such, a 100 percent rating for malignant neoplasms under DC 7528 is not warranted. As a result, the medical evidence does not support a rating in excess of 60 percent. The Board has also considered the Veteran's lay statements that his disability is worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's prostate cancer and residuals has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which this disability is evaluated. Moreover, as the examiner has the requisite medical expertise to render a medical opinion regarding the degree of impairment caused by the disability and had sufficient facts and data on which to base the conclusion, the Board affords the medical opinion great probative value. As such, these records are more probative than the Veteran's subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable, and the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Yacoub, 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.