Citation Nr: 22012863 Decision Date: 03/07/22 Archive Date: 03/07/22 DOCKET NO. 18-50 300 DATE: March 7, 2022 REMANDED Entitlement to service connection for urinary incontinence, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran had active service in the United States Navy from March 1967 to March 1997. These matters come before the Board of Veterans' Appeals (Board) from a July 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The matter was previously remanded for further development in December 2020. The matters return for appellate consideration. The Board notes that in a January 2022 correspondence, the Veteran was notified that the Veterans Law Judge (VLJ) who presided over his September 2020 hearing no longer worked at the Board and the Veteran was given the option for another hearing before another VLJ. 38 C.F.R. § 19.3(b). The Veteran did not respond to this correspondence. As such, the Board will proceed to render a decision based on the evidence of record. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900 (c). 1. Entitlement to service connection for urinary incontinence, to include as secondary to service-connected disabilities, is remanded. 2. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disabilities, is remanded. The Veteran contends that his urinary incontinence and erectile dysfunction conditions are a result of service, or alternatively as secondary to service-connected disabilities. Pursuant to the December 2020 Board remand, a February 2021 VA examination was obtained. The examinations demonstrated diagnoses for erectile dysfunction and left varicocele. The examiner concluded it is less likely than not the Veteran's erectile dysfunction was caused or aggravated beyond normal progression by service-connected disabilities and is likely due to normal ageing. Additionally, the examiner concluded there is no evidence to support that the Veteran's urinary incontinence was caused or aggravated beyond normal progression by service-connected disabilities. The Board finds the February 2021 VA opinions are inadequate. The examiner failed to provide sufficient rationales for the causation and aggravation theories of the claimed conditions. The opinion was general in nature. Without an opinion that sufficiently provides a rationale for its conclusion, the Board cannot make a fully informed decision on the issues of entitlement to service connection for erectile dysfunction and urinary incontinence. See Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) ("a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to a doctor's opinion"). Moreover, the aggravation opinions were premised on an incorrect standard (i.e. "aggravated beyond a normal progression"). However, secondary service connection does not require "permanent" worsening of the condition being claimed by the service-connected disability and requires considering whether there has been any worsening, no matter how incremental, so even if not above and beyond the condition's natural progression. See Ward v. Wilkie, 31 Vet. App. 233 (2019). Therefore, an addendum opinion is warranted to determine the nature and etiology of the Veteran's urinary incontinence and erectile dysfunction conditions. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from the February 2021 VA or another qualified clinician to determine the nature and etiology of the Veteran's erectile dysfunction and urinary incontinence. The claims folder and a copy of this remand in its entirety must be provided to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and lay statements; the examiner must indicate on the report that such review was undertaken. The examiner is asked to determine the following: (a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's urinary incontinence is proximately due to or aggravated by his service-connected disabilities. (b) Whether it is at least as likely as not (50 percent probability or more) that the Veteran's urinary incontinence had its onset during service or is otherwise related to the Veteran's active service. (c) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's erectile dysfunction is proximately due to or aggravated by his service-connected disabilities. (d) Whether it is at least as likely as not (50 percent probability or more) that the Veteran's erectile dysfunction had its onset during service or is otherwise related to the Veteran's active service. The examiner is advised that secondary service connection does not require "permanent" worsening of the condition being claimed by the service-connected disability and requires considering whether there has been any worsening, no matter how incremental, so even if not above and beyond the condition's natural progression. See Ward v. Wilkie, 31 Vet. App. 233 (2019). The clinician must provide separate findings and rationales relating to causation and aggravation. Atencio v. O'Rourke, 30 Vet. App. 74 (2018). (Continued on the next page) The examiner must provide a rationale in support of all opinions provided. If any opinion cannot be provided without resorting to speculation, the examiner must explain why this is so. 2. Then, readjudicate the Veteran's claims on appeal. If the benefits sought on appeal remain denied, the Veteran and his representative should be provided a supplemental statement of the case. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Asfaw, 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.