Citation Nr: 22012284 Decision Date: 03/03/22 Archive Date: 03/03/22 DOCKET NO. 13-23 061 DATE: March 3, 2022 REMANDED Entitlement to service connection for a bladder disability, to include as secondary to service-connected lumbar spine fusion with degenerative disc disease (DDD) of the L5- S1 and/or service-connected lumbar radiculopathy of the lower extremities, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1966 to November 1969. This matter comes on appeal before the Board of Veterans' Appeals (Board) from a July 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This appeal was last before the Board in March 2021, at which time it was remanded for an addendum medical opinion. This matter has now been returned to the Board for further appellate consideration. As stated previously in the prior Board remand, the Veteran testified at two hearings before two different Veterans Law Judges (VLJs) and declined another hearing before a third VLJ. Because more than one VLJ participated in the adjudication of this issue, a panel of three VLJs is required to adjudicate the claim. 38 U.S.C. § 7102(a). 1. Entitlement to service connection for a bladder disability, to include as secondary to his service-connected lower back and/or service-connected lumbar radiculopathy of the lower extremities, is remanded. Unfortunately, this service connection claim must again be remanded to obtain an adequate medical opinion. Once VA attempts to provide an opinion, it must provide an adequate opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Veteran was provided VA examinations in June 2016 and March 2020 with VA addendums in October 2020, April 2021, and May 2021. However, for the reasons discussed below, the Board finds the opinions inadequate to the extent discussed below. The June 2016 and March 2020 VA opinions are inadequate to the extent that they provided no opinion or failed to address aggravation. The June 2016 VA examiner diagnosed the Veteran with an overactive bladder, but then provided an opinion for open spina bifida even after acknowledging that there may have been some misunderstanding as there was no documentation of the Veteran ever having any type of spina bifida. The March 2020 VA examiner only opined that the Veteran's overactive bladder was less likely than not proximately due to or a result of the lower back disability; aggravation was not addressed. However, in an October 2020 addendum, the examiner stated that she could not provide an opinion regarding aggravation by the service-connected lower back disability as the Veteran's bladder disorder had "recovered" after stopping a medication. Therefore, no aggravation opinion was provided. Pursuant to the March 2021 Board remand instructions, the Agency of Original Jurisdiction obtained VA medical opinions in April and May 2021. At that time, the VA examiner explained that evidence demonstrated that the Veteran's bladder disability was related to his use of trazadone, since his symptoms resolved after cessation of the medication. Therefore, the examiner indicated that the Veteran's bladder disability was not caused or aggravated by the service-connected lower back disability. However, VA treatment records reflect that the Veteran was started on trazodone in February 2019 for insomnia/depression, while the Veteran first sought treatment for urge incontinence and urgency in September 2011 and was diagnosed with an overactive bladder in March 2014, over five years prior to being prescribed trazodone. As such, the VA examiner's opinions conflict with the history of the Veteran's bladder disability and associated symptoms and are therefore inadequate. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual predicate). Accordingly, a remand is required to obtain an adequate opinion. The matter is REMANDED for the following action: 1. Obtain an addendum by an appropriate VA examiner, such as a neurosurgeon or urologist, to address the nature and etiology of the Veteran's claimed BLADDER DISABILITY. If the designated examiner determines that an additional examination is necessary, one should be provided to the Veteran. After reviewing the claims file in its entirety, the examiner is asked to address the following with a complete rationale: (a) Address all relevant diagnoses rendered DURING the appeal period, to include an assessment of neurogenic bladder (see 12/29/15 VA treatment record) AND a VA physician's statement (see 7/13/16 VA treatment record) that his overactive bladder was likely due to his detrusor sphincter dyssynergia, which was due to the Veteran's chronic back problems vs. resulting pain. The Veteran asserts that his overactive bladder has not resolved, which is contrary to the most recent VA examination report (see October 2020 statement). (b) For each disability diagnosed during the pendency of the appeal (even if it has since resolved), provide an opinion as to whether there is at least an approximate balance of positive and negative evidence demonstrating that the disability was proximately caused by the service-connected lower back disability and/or lumbar radiculopathy of the lower extremities, and/or medications taken for such. *The examiner should consider that the Veteran first sought treatment for urge incontinence in September 2011 and was not started on trazodone for insomnia until around February 2019, as well as his report that his symptoms have not resolved.* (c) For each disability diagnosed during the pendency of the appeal (even if it has since resolved), provide an opinion as to whether there is at least an approximate balance of positive and negative evidence demonstrating that it is AGGRAVATED (underwent an incremental increase regardless of permanence) by the service-connected lower back disability and/or lumbar radiculopathy of the lower extremities, and/or medications taken for such. *In doing so, the examiner should consider that the Veteran first sought treatment for urge incontinence in September 2011 and was not started on trazodone for insomnia until around February 2019, as well as his report that his symptoms have not resolved.* The term 'incremental increase' in disability means additional impairment of earning capacity. Objective measurement or numerical quantification is not required to ascertain an increase in disability. A complete rationale should be provided for any opinions provided. 2. After ensuring that the requested opinions have been adequately addressed (THIS CASE HAS BEEN REMANDED MULTIPLE TIMES FOR ADEQUATE OPINIONS), readjudicate the remanded claim on appeal. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals M. HYLAND Veterans Law Judge Board of Veterans' Appeals TBD To Be Determined Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Lee, 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.