Citation Nr: 22043390 Decision Date: 07/29/22 Archive Date: 07/29/22 DOCKET NO. 15-00 489 DATE: July 29, 2022 ORDER Entitlement to service connection for mood disorder, secondary to service-connected disabilities, on a causation basis, is granted. Entitlement to service connection for bilateral blepharitis, combined senile cataracts, and pinguecula, secondary to service-connected type II diabetes mellitus, on a causation basis, is granted. Entitlement to service connection for benign prostate hypertrophy, secondary to service-connected type II diabetes mellitus, on a causation basis, is granted. Entitlement to service connection for diabetic neurogenic bladder, secondary to service-connected type II diabetes mellitus, on a causation basis, is granted. FINDINGS OF FACT 1. The Veteran's mood disorder is caused by his service-connected disabilities. 2. The evidence is approximately evenly balanced as to whether the Veteran's bilateral blepharitis, combined senile cataracts, and pinguecula are caused by his service-connected type II diabetes mellitus. 3. The evidence is approximately evenly balanced as to whether the Veteran's benign prostate hypertrophy is caused by his service-connected type II diabetes mellitus. 4. The Veteran's diabetic neurogenic bladder is caused by his service-connected type II diabetes mellitus. CONCLUSIONS OF LAW 1. The criteria for service connection for mood disorder, as secondary to service-connected disabilities, on a causation basis, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for bilateral blepharitis, combined senile cataracts, and pinguecula, as secondary to service-connected type II diabetes mellitus, on a causation basis, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for benign prostate hypertrophy, as secondary to service-connected type II diabetes mellitus, on a causation basis, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for service connection for diabetic neurogenic bladder, as secondary to service-connected type II diabetes mellitus, on a causation basis, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1968 to March 1971, which includes service in the Republic of Vietnam. His awards include the Bronze Star Medal. These matters initially came before the Board of Veterans' Appeals (Board) from May 2012 and May 2013 rating decisions. In July 2018 and July 2021, the Board remanded these matters for further development. As a final preliminary matter, the Board notes that the Veteran had also perfected an appeal with regard to the issues of entitlement to service connection for hypertension and tension headaches, and the Board most recently remanded these issues in July 2021 for further development. The agency of original jurisdiction (AOJ) awarded service connection for hypertension and tension headaches in a May 2022 rating decision, and thereby resolved the appeal as to these issues. Service Connection Service connection is warranted for disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310. 1. Entitlement to service connection for mood disorder The Board finds, for the following reasons, that the Veteran has current mood disorder that is caused by his service-connected disabilities. A March 2012 VA psychiatric examination report indicates that the Veteran has been diagnosed as having mood disorder "due to medical conditions." Therefore, current psychiatric disability has been demonstrated. The psychiatrist who conducted the March 2012 examination explained that the Veteran had symptoms compatible with mood disorder due to general medical conditions, from his multiple medical problems as described in the March 2012 examination report. These medical problems include hypertension, type II diabetes mellitus, prostate hyperplasia (hypertrophy), and gastroesophageal reflux disease (GERD), among others. The Veteran is service-connected for hypertension, type II diabetes mellitus, and GERD, and the Board is awarding service connection for benign prostate hypertrophy. Although the March 2012 examiner did not provide any specific rationale for his opinion, the psychiatrist essentially provided an opinion, based upon an examination of the Veteran, a review of his claims file, and consideration of his reported history, that his mood disorder is caused, at least partially, by his service-connected hypertension, type II diabetes mellitus, and GERD and his now service-connected prostate disability. This opinion is therefore entitled to some probative weight. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). In sum, the March 2012 opinion supports the conclusion that the Veteran's current mood disorder is caused by his service-connected disabilities. There is no medical opinion contrary to this conclusion. Therefore, service connection for mood disorder, secondary to service-connected disabilities, on a causation basis, is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for bilateral blepharitis, combined senile cataracts, and pinguecula The Board finds, for the following reasons, that the Veteran has current bilateral blepharitis, combined senile cataracts, and pinguecula, and that the evidence is approximately evenly balanced as to whether these disabilities are caused by his service-connected type II diabetes mellitus. A May 2012 VA eye examination report indicates that the Veteran has been diagnosed as having bilateral blepharitis, combined senile cataracts, and pinguecula. Therefore, current bilateral eye disabilities have been demonstrated. As for whether the Veteran's eye disabilities are caused by his service-connected diabetes mellitus, there are conflicting medical opinions. The Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the Veteran. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The Board may favor one medical opinion over another, provided an adequate statement of reasons or bases is provided. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). In a January 2018 statement, A. Ali, M.D. noted that the Veteran's pertinent treatment records in his claims file were reviewed and the physician opined that it was "more likely than not that development of the Veteran's bilateral cataracts, blepharitis, and pinguecula [was] secondary to his service-connected diabetes." Dr. Ali cited medical literature which was attached to his statement and explained that the literature revealed that having diabetes increases the risk of developing cataracts, blepharitis, and pinguecula. While these conditions can develop without a diagnosis of diabetes, individuals with diabetes are more likely to develop these conditions. In January 2021, a VA optometrist reviewed the Veteran's claims file and opined that his claimed eye disabilities were not likely ("less likely than not"/"less than 50 percent probability") proximately due to or the result of his service-connected diabetes mellitus. He reasoned that although Dr. Ali opined that the Veteran's eye disabilities could be due to diabetes mellitus, his blepharitis was caused by meibomian gland secretions that may become dry on eyelashes, his cataracts were an age-related condition, and his pinguecula was produced by exposure to ultraviolet light from the sun. All of these disabilities could be there without diabetes mellitus and diabetes could or could not interfere with the Veteran's eyes, but not in this case because there were no medical records that related his diabetes to his diagnosed eye disabilities. The January 2018 and January 2021 opinions are based upon a review of medical literature and/or the Veteran's treatment records, and consideration of his reported history, and they are accompanied by specific rationales that are consistent with the evidence of record. Therefore, these opinions are entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). In light of the above opinions, the Board finds that the evidence is approximately evenly balanced as to whether the Veteran's bilateral blepharitis, combined senile cataracts, and pinguecula are caused by his service-connected type II diabetes mellitus. As the reasonable doubt created by the approximate balance in the evidence must be resolved in favor of the Veteran, service connection for bilateral blepharitis, combined senile cataracts, and pinguecula, secondary to service-connected type II diabetes mellitus, on a causation basis, is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 3. Entitlement to service connection for benign prostate hypertrophy and diabetic neurogenic bladder The Veteran contends that he has current prostate and urinary disabilities that are associated with his service-connected diabetes mellitus. The Board finds, for the following reasons, that the Veteran has current benign prostate hypertrophy and diabetic neurogenic bladder, that the evidence is approximately evenly balanced as to whether his benign prostate hypertrophy is caused by his service-connected diabetes mellitus, and that his diabetic neurogenic bladder is caused by his service-connected diabetes mellitus. The reports of VA male reproductive organ conditions and urinary tract examinations dated in December 2021 reveal that the Veteran has been diagnosed as having benign prostate hypertrophy and diabetic neurogenic bladder. Therefore, current prostate and urinary disabilities have been demonstrated. As for whether the Veteran's prostate disability is caused by his diabetes mellitus, there are conflicting medical opinions. In this regard, Dr. Ali opined in the January 2018 statement that the Veteran's "prostate hypertrophy and subsequent urinary incontinence [was] secondary to his service-connected diabetes." Dr. Ali explained that the medical literature included with the January 2018 statement revealed that diabetes is thought to increase the risk for prostatic hypertrophy and, therefore, its subsequent complication of urinary symptoms. The physician who conducted a November 2020 VA male reproductive system conditions examination opined that the Veteran's benign prostatic hyperplasia (hypertrophy) was not likely ("less likely as not") caused by or a result of his service-connected diabetes mellitus. The examiner reasoned that there was no pathophysiological relationship between the disabilities, as per a review of medical literature. The physician who conducted the December 2021 VA male reproductive organ conditions examination opined that the Veteran's claimed prostate disability was not likely ("less likely than not"/"less than 50 percent probability") proximately due to or the result of his service-connected diabetes mellitus. The examiner reasoned that there was no evidence in medical literature supporting a finding that benign prostate hypertrophy has a causative etiological nexus with diabetes mellitus. The Veteran's medications for diabetes were reviewed and were found not to be causative of benign prostate hypertrophy. The November 2020 and December 2021 opinions are of limited probative value because although the examiners reasoned that there was no evidence in medical literature to support a causative relationship between benign prostate hypertrophy and diabetes, the examiner did not acknowledge or discuss the medical literature that was cited by Dr. Ali. This medical literature reveals that diabetes may substantially influence the risk of benign prostatic hypertrophy and that diabetes is a risk factor for prostate gland enlargement. Dr. Ali's January 2018 opinion, by contrast, is based upon a review of medical literature and the Veteran's treatment records, and consideration of his reported history, and it is accompanied by a specific rationale that is consistent with the evidence of record. Therefore, this opinion is entitled to substantial probative weight. See Nieves-Rodriguez, 22 Vet. App. at 304. In light of the above medical opinions, the Board finds at the very least that the evidence is approximately evenly balanced as to whether the Veteran's benign prostate hypertrophy is caused by his service-connected diabetes mellitus. As the reasonable doubt created by the approximate balance in the evidence must be resolved in favor of the Veteran, service connection for benign prostate hypertrophy, secondary to service-connected type II diabetes mellitus, on a causation basis, is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As for the Veteran's diabetic neurogenic bladder, the examiner who conducted the December 2021 VA urinary tract examination opined that the Veteran's neurogenic bladder was likely ("at least as likely as not"/"50 percent or greater probability") caused by his service-connected diabetes. The examiner reasoned that it was well recognized in medical literature that diabetes damages the nerves that control bladder contractions, which leads to diabetic neurogenic bladder. The December 2021 opinion is based upon an examination of the Veteran, a review of medical literature and the Veteran's treatment records, and consideration of his reported history, and it is accompanied by a specific rationale that is consistent with the evidence of record. Therefore, this opinion is entitled to substantial probative weight. See Nieves-Rodriguez, 22 Vet. App. at 304. Overall, the December 2021 opinion supports the conclusion that the Veteran's diabetic neurogenic bladder is caused by his service-connected diabetes mellitus. There is no medical opinion that is contrary to this conclusion. Therefore, service connection for diabetic neurogenic bladder, as secondary to service-connected type II diabetes mellitus, on a causation basis, is also warranted. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Elwood, 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.