07-12 042
07-12 042
| Board of Vet. App. | Feb 2, 2017Background
- Veteran served in Army (1970–1972) and Navy (1974–1977); claim arises from genitourinary symptoms treated in service (1971) and post-service diagnoses (prostatitis 2001, BPH 2006, cystitis 2015).
- STRs show dysuria, suprapubic pain, bacteriuria, referral to urology, and a service impression of chronic cystitis; multiple urinalyses in service records.
- Post-service VA and private records document recurrent urinary symptoms, diagnoses of prostatitis and benign prostatic hypertrophy (BPH), prescriptions (terazosin/tamsulosin), and a 2015 private record diagnosing cystitis.
- Multiple VA DBQ opinions (2012, 2015 addendum, 2016) concluded BPH/not related to service; examiners relied on absence of chronic cystitis in contemporaneous findings and age-related BPH pathology.
- Board discounted those opinions for failing to consider the 2015 private cystitis diagnosis and other medical evidence; Veteran’s credible lay testimony (and his training as a practical nurse) describing continuity of symptoms was given probative weight.
- Board granted service connection for a genitourinary disorder (chronic cystitis and chronic prostatitis). Claims about earlier effective date and higher evaluations for service-connected spine and radiculopathy were remanded to the RO for an SOC.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Service connection for genitourinary disorder (chronic cystitis/prostatitis) | Symptoms began in service; continuity of symptoms to present; service records show cystitis and bacteriuria | VA medical examiners: current condition is BPH or not shown to be chronic cystitis/prostatitis and is age-related, not service-connected | Granted: service connection for chronic cystitis and chronic prostatitis (reasonable doubt resolved for Veteran) |
| Whether VA medical opinions were dispositive | Veteran argues continuity and that diagnoses are related (cystitis/prostatitis) | VA relies on DBQs concluding no etiologic link to service and BPH as separate, age-related condition | Board found VA opinions weakened because they did not consider 2015 private cystitis diagnosis; gave greater weight to lay testimony and records |
| Competence of lay testimony to establish continuity/identity of symptoms | Veteran (practical nurse) asserts current bladder pain same as in service | VA questions medical linkage without contemporaneous medical nexus opinion | Board found Veteran competent to describe symptoms and credible; medical evidence and lay statements in equipoise, so claimant prevails |
| Effective date / higher evaluations for service‑connected spine and right leg radiculopathy | Veteran filed NOD contesting effective date and ratings | RO issued grant of service connection with specified effective dates and ratings; matter not yet SOC’d | Remanded to AOJ/RO for issuance of SOC; appellate steps to be followed if Veteran timely appeals |
Key Cases Cited
- Wensch v. Principi, 15 Vet. App. 362 (2001) (Board’s duty to assess credibility and weight of evidence)
- Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (lay evidence cannot be rejected solely because it lacks contemporaneous medical evidence)
- Caluza v. Brown, 7 Vet. App. 498 (1995) (factors VA may consider in weighing credibility)
- Reonal v. Brown, 5 Vet. App. 458 (1993) (limitations on probative value of medical opinions that do not consider pertinent evidence)
- Gabrielson v. Brown, 7 Vet. App. 36 (1994) (medical opinions must consider records to be probative)
- Gonzalez v. West, 218 F.3d 1378 (Fed. Cir. 2000) (Board must review entire record but need not discuss every piece of evidence)
- Manlincon v. West, 12 Vet. App. 238 (1999) (procedural rules for initiating appeals after RO decisions)
- Kutscherousky v. West, 12 Vet. App. 369 (1999) (claimant’s right to submit additional evidence on remand)