Citation Nr: 9819058 Decision Date: 06/22/98 Archive Date: 07/06/98 DOCKET NO. 98-06 158 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Fort Harrison, Montana THE ISSUES 1. Entitlement to service connection for proximal ureteral bladder neck smooth muscle dyssynergia. 2. Entitlement to service connection for an acquired psychiatric disorder, including depression, claimed as secondary to proximal ureteral bladder neck smooth muscle dyssynergia. REPRESENTATION Veteran represented by: Montana Veterans Affairs Division WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD K. Conner, Associate Counsel INTRODUCTION The veteran had active military service from September 1968 to September 1971. Service in Vietnam is indicated by the evidence of record. This matter comes to the Board of Veterans’ Appeals (Board) from an April 1997 rating decision of the Department of Veterans Affairs (VA) Fort Harrison Regional Office (RO) which denied the veteran’s claims of service connection for proximal ureteral bladder neck smooth muscle dyssynergia, and depression. In October 1997, the veteran testified at a hearing at the RO. CONTENTIONS OF VETERAN ON APPEAL The veteran contends that he has a genetic condition, proximal ureteral bladder neck smooth muscle dyssynergia, which was aggravated by military service. In the alternative, the veteran claims that he was exposed to Agent Orange in Vietnam and that such exposure may have caused his bladder condition. As such, he maintains that service connection is warranted for this disorder. The veteran further contends that as a result of his bladder disorder, he developed depression. As such, he claims that service connection for depression is warranted on a secondary basis. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1998), has reviewed and considered all of the evidence and material of record in the veteran’s claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the veteran has not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claims of service connection for proximal ureteral bladder neck smooth muscle dyssynergia and an acquired psychiatric disorder, to include depression, are well grounded. FINDINGS OF FACT 1. No competent medical evidence has been submitted to show that the veteran’s pre-service proximal ureteral bladder neck smooth muscle dyssynergia underwent an increase in disability beyond the natural progress of the disease during his active service. 2. A psychiatric disorder, including depression, was not shown in service or for many years thereafter and no competent medical evidence has been submitted linking this disorder to the veteran’s active service or any incident therein. CONCLUSION OF LAW The claims of service connection for proximal ureteral bladder neck smooth muscle dyssynergia and an acquired psychiatric disorder, to include depression, are not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual Background The veteran’s September 12, 1968 military enlistment medical examination report is negative for pertinent complaints or abnormalities. Psychiatric evaluation and his genitourinary system were normal. The veteran denied frequent or painful urination and depression or excessive worry. On September 21, 1968, shortly after he began active duty, the veteran sought treatment for kidney pain and stated that although he had urgency, he could not void. He reported that he had been having such problems for the previous year and that previously he had been diagnosed with albuminuria. He further indicated that a previous intravenous pyelogram had shown that he had three kidneys. The impression was possible kidney disease. The veteran was seen again the following week; he reported back pain and occasional dysuria, but no hematuria. He again stated that he had three kidneys, although the examiner indicated that there was “no documentation of this.” In October 1968, the veteran was evaluated in the urology clinic, reporting that he had been passing some whitish material in his urine following exercise. Physical examination was normal and urinalysis was microscopically clear. The examiner indicated that “I do not believe that there is any significant urinary tract pathology in this patient. The small amount of whitish material he describes with exercise is most probably a small amount of prostatic secretion which is not unusual in young people after exercise.” In November 1968, additional service medical records show that the veteran sought treatment for testicular pain. Examination revealed a left varicocele. He sought treatment on three occasions in August 1969, complaining of dysuria. He was treated for a urinary tract infection. In February 1971, he sought treatment for a sore on his penis; he indicated that he had no trouble urinating and felt no type of sensation while urinating. The impression was herpetic lesions. The veteran’s August 1971 military separation medical examination report is negative for pertinent complaints or abnormalities. His genitourinary system was normal and he denied frequent or painful urination. In-service medical records are negative for complaints or findings of a psychiatric disorder, including depression. The first post-service medical evidence of pertinent complaints is in May 1986, approximately 15 years after service, when the veteran sought treatment for frequency of urination. On examination, he reported that he had had such symptoms for the past fifteen years. He also indicated that he was unable to urinate in public, which was reportedly his primary problem since he worked on a road construction crew. Physical examination was entirely normal, including examination of the urethra, testicles, and prostate. The examiner indicated that “I think he certainly has a component of psychogenicity to his frequency of urination but also may have some sphincter dysergia.” Valium and Di- tropan were prescribed. In August 1989, the veteran again sought treatment, stating that he had had quit work because he had had to urinate every twenty to thirty minutes. He stated that these symptoms had been present ever since his tour of duty in Vietnam, but that they had gotten progressively worse in recent years. Urinalysis was negative and the examiner discussed with the veteran the psychological aspect as well as the physical aspect of questionable bladder spasm, irritable bladder, frequency, urgency and polyuria. The examiner indicated that he was going to treat the veteran’s condition as a bladder spasm or irritable bladder. In December 1992, the veteran sought treatment for marked urinary frequency, reporting that he had lost jobs because of his condition. He stated that he voided every half hour and two to three times nightly. The examiner wrote “sounds like he’s got a stricture.” It was further noted that the veteran had undergone a catheterization for postvoiding residuals two years prior which showed that “he empties his bladder just fine.” A cystoscopy was performed which showed no stricture; the diagnosis was prostatitis and Di-tropan was prescribed. The veteran was evaluated by a private examiner in November 1995 in connection with his complaints of urinary frequency. The examiner noted that the veteran had been evaluated previously in 1992, at which time cystourethroscopic examination was negative. It was noted that Di-tropan had been helpful, although the veteran indicated that he was unable continue taking the medication as it had caused dizziness. Genitourinary examination showed a normal male phallus with no sign of penile lesions or plaques; testes were descended, bilaterally, without sign of hernia or mass. Urine dip was negative. The impression was urinary frequency, no urologic symptoms and no history of urine infection. On examination in February 1996, the veteran reported that his bladder problems had begun at age eight with bedwetting that lasted until age twelve; his problems reportedly continued to age fifteen with a “bashful bladder.” He also indicated that he had been treated for gonorrhea and herpes in Vietnam. The examiner indicated that “none of these are probably related to his current symptoms.” On examination, the veteran was tense in his mannerisms. Genitourinary examination was normal. The assessment was daytime frequency with difficulty starting stream, probably related to his frequent voidings and low volume. The possibility of early interstitial cystitis was noted. The veteran underwent a private neurologic examination in June 1996. He reported that he had had difficulty with anuresis up to age 12 and that at age 15, he developed difficulty with voiding. He stated that he went to Vietnam after high school, where he was exposed to Agent Orange. He stated that he had had increasing problems with his bladder with difficulty urinating in increasing frequency over the years. He further reported that he had consulted numerous physicians, urologists, a naturopath and a homeopath, with no success. The impression was progressively worsening symptoms regarding urinary frequency with no signs of neurologic injury. In August 1996, the veteran was evaluated at the University of Utah School of Medicine, Division of Urology. He reported a lifelong history of frequency and obstructive voiding symptoms which had gradually worsened over the last several years. Physical examination showed nothing abnormal in the abdominal, genitourinary, or neurological systems. A cystometrogram showed an enhanced and early level of sensation with reduced capacity. The impression was that the veteran probably had a proximal ureteral bladder neck smooth muscle dyssynergia. It was noted that the etiology of this type of problem was unknown. A transurethral incision of the bladder neck and proximal prostate was recommended. Outpatient treatment records from the Vet Center for the period of July through August 1996 show that the veteran was seen for complaints of depression, which were attributed to his physical problems. In a September 1996 private examination, the veteran reported that his symptoms of urinary frequency had progressed to the point that he was completely unable to work. The veteran reported that he had been a bedwetter until age twelve and had had other problems in the Army, although he “got by.” He reported that he had been treated for sexually transmitted diseases (STDs) in the Army, although the examiner noted that his current problems were unrelated to this. The veteran indicated that since 1989, he had seen three urologists, a naturopath, a psychiatrist, and a neurologist, but his bladder problems still persisted. As such, the examiner noted that the veteran had been referred to the University of Utah where a cystometrogram had shown a proximal ureteral bladder neck smooth muscle dyssynergia, the etiology of which was unknown. A transurethral incision of the bladder neck and proximal prostate was again recommended, although it was noted that the operation would leave the veteran incontinent and impotent. The impression was urinary frequency, apparently due to a proximal ureteral bladder neck smooth muscle dyssynergia, etiology undetermined. In October 1997, the veteran was referred by his attorney for private psychological evaluation in connection with his application for disability benefits from the Social Security Administration for his bladder disorder. On examination, he reported that he had always suffered from urinary frequency, although he stated that his problems had increased with age. He also indicated that he had had nighttime enuresis until he was twelve years old. After administering a battery of tests, the examiner concluded that the veteran did not appear to have a severe emotional problem; rather, she concluded that the veteran had a long-standing personality disorder with schizoid and avoidant traits. She indicated that it was very possible that his condition had developed within his tense family circumstances. She also noted that because the veteran had indicated that the stresses of the military and the post-service work environment aggravated his urinary problems, there was a significant psychological contribution to his reported physical symptoms. The diagnoses included personality traits or coping style affecting medical condition and reported urinary problems. In October 1997, the veteran testified at a hearing at the RO. He stated that he had been told by physicians that his bladder disorder was a developmental problem which he had had since childhood. However, the veteran indicated that he noticed a definite increase in his problems in service, which he attributed to the stress of military service. He stated that he was treated for his bladder problem in service and was told that he could be medically discharged for his condition, although he opted to stay in. Post-service, the veteran indicated that he had not sought treatment for his bladder condition until approximately 1986, when his condition began getting worse due to stress and age. He stated that such treatment had been unsuccessful and that it was not until 1996 when he was diagnosed with his most recent condition, proximal ureteral bladder neck smooth muscle dyssynergia. The veteran underwent a VA contract psychiatric examination in November 1997. He reported that he had served in Vietnam as a helicopter mechanic and did not see a great deal of combat, although he was “harassed daily by incoming rockets and mortars” and felt very vulnerable most of the time. He denied past psychiatric treatment. The veteran described chronic bladder pain caused by a chronic urinary tract problem. He stated that he wet the bed until he was twelve and at age fifteen, he was found to have three kidneys. He reported that while in service, he had experienced an increase in his frequency of urination and had problems initiating his stream of urine. The veteran reported that at the end of his basic training, he was told by an Army physician that he would get a 4-F status, but “he scared me so I decided to stay in the Army.” The veteran reported that his urinary frequency problem got worse after his Vietnam tour of duty, but admitted that his medical records would not reflect this. With respect to his medical history, he reported that beginning in 1986, he saw several physicians, a homeopath, a naturopath, a neurologist and a psychiatrist in connection with his bladder problems. He stated that he received a variety of treatments, none of which was successful. About one year prior, however, he indicated that he was evaluated at the University of Utah and was told that he had some type of obstruction at the outlet of his bladder and that his bladder had shrunk to the point that frequent urination was required. The veteran stated that he was told to return for more testing, although he had not done so and was apprehensive about it. The veteran further stated that his bladder problem dominated his life and made it impossible for him to work or engage in any type of healthy activities or social life. The veteran reported a strong family history of bladder problems and indicated that his daughter had a similar bladder problem which had been surgically corrected. He stated that his problems were “really not the fault of the U.S. Army, but he knows that his symptoms worsened after his duty in Viet Nam,” although he did not know why. The diagnosis was adjustment disorder with mixed anxiety and depressed mood and urinary frequency and urgency, etiology undetermined. The examiner indicated that the veteran was “experiencing considerable, but understandable emotional distress in response to his very significant medical problem. The examiner, a medical doctor, also concluded that “I fail to see any connection between his urinary tract problem and his military service.” In April 1998, the veteran was again referred by his attorney for a private psychological evaluation in connection with his application for disability benefits from the SSA. On examination, he reported that he had a long history of genetic urinary problems. Specifically, he indicated that his problems included not being able to urinate without pain, as well as frequency. He stated that his bladder was the size of a lemon, causing him to have to urinate every 20 minutes to half hour. He also said that he had three kidneys. The veteran reported that his condition had caused him much embarrassment, dating back to his childhood when he had difficulty in bedwetting. The examiner noted that “[a]s a result of these physical problems, patient has also suffered depression as one may imagine.” The Axis I diagnosis was mood disorder due to generalized medical condition; the Axis II diagnosis was personality and developmental disorders; and the Axis III diagnosis was physical disorders – urinary problems. II. Laws and Regulations Service connection In general, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by wartime service. 38 U.S.C.A. § 1110. Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Disability which is proximately due to or the result of a service connected disease or injury shall also be service connected. 38 C.F.R. § 3.310 (a). A veteran will be considered to have been in sound condition when examined, accepted and enrolled for service except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that an injury or disease existed prior thereto. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C.A. § 1111 (West 1991); 38 C.F.R. § 3.304 (1997). A preexisting disease or injury will be considered to have been aggravated by active service where there is an increase in disability during service, unless there is a specific finding that the increase in disability was due to the natural progress of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a) (1997). See Green v. Derwinski, 1 Vet. App. 320, 322-23 (1991). Clear and unmistakable evidence is required to rebut the presumption of aggravation when it is shown that the pre- service disability underwent an increase in severity during service. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(b). However, temporary or intermittent flare-ups of a pre-existing injury or disease are not sufficient to be considered “aggravation in service” unless the underlying condition, as contrasted to symptoms, is worsened. Jensen v. Brown, 4 Vet. App. 304, 306-07 (1993); Hunt v. Derwinski, 1 Vet. App. 292 (1991). Well-groundedness In general, in any claim for benefits, the initial question before the Board is whether the veteran has met his burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claim is well-grounded. 38 U.S.C.A. § 5107(a). The U.S. Court of Appeals for the Federal Circuit (Federal Circuit) has set forth the parameters of what constitutes a well-grounded claim, i.e., a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of section 5107(a). See Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). More specifically, the Federal Circuit has held that in order for a claim to be well grounded, there must be (1) a medical diagnosis of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service disease or injury and the current disability. Id. at 1468. Although the claim need not be conclusive, it must be accompanied by evidence. The VA benefits system requires more than just an allegation; a claimant must submit supporting evidence. Furthermore, the evidence must “justify a belief by a fair and impartial individual” that the claim is plausible. 38 U.S.C.A. § 5107(a); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). Where an issue is factual in nature, e.g., whether an incident or injury occurred in service, competent lay testimony may constitute sufficient evidence to establish a well-grounded claim; however, if the determinative issue is one of medical etiology or a medical diagnosis, competent medical evidence must be submitted to make the claim well grounded. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). A lay person is not competent to make a medical diagnosis or to relate a medical disorder to a specific cause. See Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). However, where the issue does not require medical expertise, lay testimony may be sufficient. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). III. Analysis Service connection for proximal ureteral bladder neck, smooth muscle dyssynergia The veteran has advanced two theories of entitlement to service connection for proximal ureteral bladder neck, smooth muscle dyssynergia. His first theory is that his bladder condition developed secondary to his exposure to Agent Orange in Vietnam. His second theory is that he had a pre-existing disability which was aggravated by service, in particular his service in Vietnam. Agent Orange exposure Under applicable regulations, a veteran who had active service in the Republic of Vietnam during the Vietnam Era shall be presumed to have been exposed during such service to a herbicide agent containing dioxin, including Agent Orange, unless there is affirmative evidence to establish that the veteran was not so exposed during that service. 38 C.F.R. § 3.307(a)(6). In this case, the veteran’s DD Form 214 indicates that he served on active duty from September 1968 to September 1971, including over two years of foreign and/or sea service, and that he was awarded the Vietnam Service Medal and the Vietnam Campaign Medal. Based on the foregoing, the Board presumes that the veteran was exposed to Agent Orange while serving in Vietnam. Regulations provide a list of diseases that are considered to be associated with herbicide exposure for purposes of presumptive service connection. However, the veteran’s disability, proximal ureteral bladder neck smooth muscle dyssynergia, is not among those diseases specified in the regulations which may be presumptively service connected. 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Accordingly, service connection may not be presumptively granted. Notwithstanding the foregoing, the Federal Circuit has determined that a veteran is not precluded from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). However, the record in this case is devoid of medical evidence linking the veteran’s bladder disorder to his presumed exposure to Agent Orange in Vietnam. The veteran’s own opinion as to the relationship between his bladder disorder and Agent Orange exposure is not competent, as the record does not reflect that he possesses a recognized degree of medical knowledge. Therefore, the veteran’s assertions are not sufficient to establish a plausible claim for service connection based on Agent Orange exposure. Espiritu, 2 Vet. App. at 494. Aggravation of pre-existing disability As an alternative theory of entitlement, the veteran has asserted that his pre-existing proximal ureteral bladder neck smooth muscle dyssynergia was aggravated by his military service. In this case, because proximal ureteral bladder neck, smooth muscle dyssynergia (or any other genitourinary disorder), was not diagnosed at the veteran’s September 1968 military enlistment medical examination, a presumption of a sound condition at service entrance initially attaches in this case. 38 U.S.C.A. § 1111; Verdon v. Brown, 8 Vet. App. 529, 535 (1996); Crowe v. Brown, 7 Vet. App. 238, 245 (1994); Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991). However, the veteran has conceded that his condition preexisted service. Moreover, the Board refers to the veteran’s frequent reports in clinical settings of pre-service symptoms such as urgency, urinary frequency, a “shy bladder,” and dysuria. For example, in September 1968, within days after his entrance into service, the veteran reported symptoms of urgency and indicated that he had been having such problems for the past year. The record consistently reflects such reports. Accordingly, the Board finds that the statutory presumption of soundness has been rebutted. Thus, the Board will now consider the veteran’s contentions that his preexisting condition was aggravated in service. As noted, an injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a). However, where the disability underwent no increase in severity during service on the basis of all the evidence of record, aggravation may not be conceded. Id. In this case, the medical evidence of record does not show that the veteran’s proximal ureteral bladder neck smooth muscle dyssynergia (or any other genitourinary disorder), underwent any permanent increase in underlying pathology during his active service. First, the Board notes that although the veteran sought treatment on several occasions in service for symptoms such as urgency, his symptoms apparently resolved and the August 1971 military separation medical examination report shows no genitourinary complaints. Moreover, despite his assertions that his condition worsened as a result of his Vietnam tour of duty, the record shows that medical treatment was not required for many years thereafter until 1986 and the veteran has not contended otherwise. Thus, there is no medical evidence showing any increase in disability of the veteran’s preexisting proximal ureteral bladder neck smooth muscle dyssynergia during service. In this case, the veteran has testified that his bladder symptoms increased in service. While he did not specifically allege that this happened in combat, he asserted that his stressful military duties in Vietnam generally aggravated his condition. The veteran is competent to provide testimony as to his in-service symptomatology, or other matters within his personal observation. Layno, 6 Vet. App. at 470. Thus, the Board accepts his testimony that his proximal ureteral bladder neck smooth muscle dyssynergia was symptomatic during service in Vietnam. 38 U.S.C.A. § 1154(b); Collette v. Brown, 82 F. 3d 389 (1996). However, temporary or intermittent flare-ups of a preexisting injury or disease are not sufficient to be considered “aggravation in service” unless the underlying condition as contrasted to symptoms, is worsened. Jensen v. Brown, 4 Vet. App. 304, 306-07 (1993); Hunt v. Derwinski, 1 Vet. App. 292 (1991). As noted, the veteran is not a medical professional; he is not competent to state that the underlying pathology of his condition increased in severity due to his Vietnam service. Cf. Libertine v. Brown, 9 Vet. App. 521, 523 (1996). Moreover, even conceding combat duty and accepting as credible the veteran’s statements that his proximal ureteral bladder neck smooth muscle dyssynergia was symptomatic in Vietnam, the Board notes that the Court has emphasized that 38 U.S.C.A. § 1154(b) addresses the question of whether a particular disease or injury was incurred or aggravated in service, not the questions of whether there is a current disability or whether there is a nexus to service which both require competent medical evidence. Libertine v. Brown, 9 Vet. App. 521, 524 (1996). While the recent evidence shows that the veteran has been treated for proximal ureteral bladder neck smooth muscle dyssynergia, there is no medical evidence which suggests any link between any increase in severity of the veteran’s proximal ureteral bladder neck smooth muscle dyssynergia and his period of active service, including his service in Vietnam. Hunt, 1 Vet. App. at 296. On the contrary, the November 1997 examiner opined that there was no relationship between the veteran’s urinary tract problem and his military service. In view of the foregoing, the Board concludes that the veteran’s claim of service connection for proximal ureteral bladder neck smooth muscle dyssynergia is not well grounded. Simply put, there is no evidence of record to show that the veteran’s pre-existing condition (although symptomatic in service) was permanently aggravated in service or of a nexus between his current proximal ureteral bladder neck smooth muscle dyssynergia and his service. Therefore, the veteran’s claim of service connection for proximal ureteral bladder neck smooth muscle dyssynergia must be denied. 38 U.S.C.A. § 5107(a) . Service connection for an acquired psychiatric disorder, to include depression In this case, service medical records are completely negative for complaints or findings of a psychiatric disorder, including depression. The veteran’s August 1971 military separation medical examination report shows that psychiatric examination was normal at that time. Likewise, the post- service medical evidence of record is negative for complaints or findings of a psychiatric disorder for many years after service. Moreover, none of this recent medical evidence relates any psychiatric disorder to the veteran’s period of service or any incident therein. Rather, the veteran’s psychiatric disorder (variously diagnosed as mood disorder, adjustment disorder with mixed anxiety and depressed mood, personality disorder with schizoid and avoidant traits, and depression) was in some instances attributed to his bladder condition. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. 3.310(a) (1996); Jones v. Brown, 7 Vet. App. 134, 137 (1994). In this case, as discussed in detail above, the veteran’s bladder disorder is not service-connected. Therefore, service connection for depression or any other acquired psychiatric disorder pursuant to 38 C.F.R. § 3.310 is not warranted. As there is no evidence of a psychiatric disorder in service, for many years thereafter, or any medical evidence linking any current psychiatric disorder to service or any incident therein, the Board must conclude that the claim of service connection for a psychiatric disorder, including depression, is not well grounded. 38 U.S.C.A. § 5107(a); Epps, supra. The benefit sought on appeal is accordingly denied. IV. Additional Matters Since well grounded claims of service connection for proximal ureteral bladder neck smooth muscle dyssynergia and an acquired psychiatric disorder, to include depression, have not been submitted, the VA is not obligated by statute to assist the veteran in the development of facts pertinent to his claims. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78 (1990). In that regard, the Board notes that the veteran has indicated in clinical settings that he has applied for disability benefits from the SSA for his bladder condition. No SSA records or determinations are associated with the claims file. However, the Board concludes that such documents are not probative to the issue at hand as they would tend to establish only that the veteran suffers from a current disability, which is not disputed. The evidence of record already clearly confirms that fact. Therefore, no additional development is warranted in this regard. See Hayes v. Brown, 9 Vet. App. 67, 73-74 (1996). When the Board addresses in its decision a question that has not been addressed by the RO, it must consider whether the veteran has been given adequate notice to respond and, if not, whether he has been prejudiced thereby. Bernard v. Brown, 4 Vet. App. 384 (1993). In this case, the Board has concluded that the veteran has been given ample opportunity to present evidence and argument in support of his claim, including his hearing testimony in October 1997. To the extent that the RO did not address both issues on the basis of well-groundedness, this was, in the opinion of the Board, harmless. Although where claims are not well grounded the VA does not have a statutory duty to assist the claimant in developing facts pertinent to the claim, the VA may be obligated under 38 U.S.C.A. § 5103(a) to advise a claimant of evidence needed to complete the application. This obligation depends upon the particular facts of the case and the extent to which the Secretary of the VA has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. Robinette v. Brown, 8 Vet. App. 69 (1995). In this case, the Board concludes that the RO fulfilled the obligation under section 5103(a) in an April 1997 letter to the veteran and in the July 1997 and February 1998 Statements of the Case in which the veteran was informed of the reasons for the denial of the claims. Furthermore, by this decision, the Board is informing the veteran of the evidence which is lacking and that is necessary to make the claim well grounded. CONTINUED ON NEXT PAGE ORDER Well grounded claims not having been presented, service connection for proximal ureteral bladder neck smooth muscle dyssynergia and an acquired psychiatric disorder, to include depression, is denied. Barry F. Bohan Member, Board of Veterans' Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1998), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. The Board notes that there may be another potential reason for denying the veteran’s claim of entitlement to service connection for proximal ureteral bladder neck smooth muscle dyssynergia based on his claim of aggravation during service. In the adjudication of claims for service connection for conditions of congenital or developmental origin, careful attention must be paid to whether the condition is a “disease process” or is simply a “defect” or abnormality. The terms “disease” and “defect” are interpreted as being mutually exclusive. Service connection may not be granted for aggravation of defects of congenital, developmental, or familial origin, which seems to be the situation in this case, even if aggravation had in fact been identified. See VAOPGCPREC 82-90; see also Monroe v. Brown, 4 Vet. App. 513, 515 (1993). The Board, however, chooses to find that the veteran’s claim of entitlement to service connection is not well grounded for the reasons stated above. - 2 -