Citation Nr: 22011695 Decision Date: 03/01/22 Archive Date: 03/01/22 DOCKET NO. 08-24 558 DATE: March 1, 2022 REMANDED Entitlement to a rating in excess of 40 percent disabling for lumbar spine strain with degenerative disc disease is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from September 1959 to June 1963. The Board sincerely thanks the Veteran for his service. This claim comes before the Board of Veterans' Appeals (Board) from March 2007 and April 2008 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The issue was previously before the Board in April 2016, when it was remanded for additional development. The claim was again before the Board in January 2019, when a rating in excess of 40 percent disabling was denied. The Veteran appealed the Board's denial to the U.S. Court of Appeals for Veterans Claims (Court). In a September 2021 Order, granting a September 2021 Joint Motion for Partial Remand (Joint Motion), the Court vacated and remanded, in part, the January 2019 Board decision. The case has now returned to the Board for further appellate review and readjudication consistent with the terms of the Joint Motion. 1. Entitlement to a rating in excess of 40 percent disabling for lumbar spine strain with degenerative disc disease is remanded. The Joint Motion describes that the January 2019 Board found that the Veteran had not alleged, and the evidence does not show, that he has bladder or bowl impairment as a result of his service-connected lumbar back strain. The Joint Motion explains that the Board, in its decision, did not consider the notation of "urinary incontinence" in the April 2010 VA spine examination report. The Joint Motion states that "on remand, the Board must address the April 2010 notation of urinary incontinence in the first instance." At the April 2010 VA examination, the Veteran stated that he experiences dribbling after urination and reported voiding every 2 hours, about 4 times per day. The examiner noted "urinary incontinence" as an effect of the lumbar spine disability on occupational activities. September 2010 and January 2011 VA spine examination reports indicate that the Veteran did not have a history of urinary incontinence but did have a history of urinary urgency and frequency. Both examination reports state that the etiology of these symptoms is not unrelated to the Veteran's lumbar spine disability. A July 2014 VA reproductive examination report also describes a voiding dysfunction, which causes increased urinary frequency, but not leakage. The etiology of the voiding dysfunction was specified as "age". A March 2018 VA reproductive examination confirms a voiding dysfunction, but states that the etiology is unknown. As it is unclear from the medical evidence of record whether the Veteran's voiding dysfunction is a result of his lumbar spine disorder or another cause, the claim must be remanded for a medical opinion as to the etiology of the voiding dysfunction. The matters are REMANDED for the following action: 1. Please secure for the record copies of complete updated clinical records (any not already of record) of all VA and/or private treatment the Veteran has received for his disability on appeal. Please ask the Veteran to provide the releases necessary for VA to secure private treatment records, including records of any medications he may have been prescribed for his disabilities. 2. After the action requested in paragraph 1 above is complete, please obtain a medical opinion to determine the nature and etiology of the Veteran's voiding dysfunction. The Veteran's claims-file must be made available to and reviewed by the clinician. (a.) Based on review of the entire record, the clinician should opine as to whether the Veteran's voiding dysfunction (also described as urinary incontinence) is at least as likely as not a result of his lumbar spine disability with consideration of the April 2010, September 2010 and January 2011 VA spine examinations and the July 2014 and March 2018 VA reproductive examinations. Please explain the reasoning behind the opinion. The clinician is requested to consider and address, as appropriate: The April 2010 VA examination reporting that the Veteran experiences dribbling after urination and reported voiding every 2 hours, about 4 times per day. September 2010 and January 2011 VA spine examination reports indicating that the Veteran has a history of urinary urgency and frequency that is not unrelated to the Veteran's lumbar spine disability. The July 2014 VA reproductive examination report describing a voiding dysfunction, the etiology of which was determined to be "age". The March 2018 VA reproductive examination confirms a voiding dysfunction of unknown etiology. ONLY IF the clinician determines that an examination is necessary for the addendum opinion, the Veteran should be scheduled for an appropriate VA examination (or telehealth interview, etc., if an in-person examination is not feasible) to determine the nature and etiology of the disorder on appeal. The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. The clinician should take into consideration that the Veteran is competent to report inservice and post-service symptom experiences; other witnesses are competent to report observable symptoms. If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board O. Halpern 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.