Entitlement to service connection for left scrotal varicocele, claimed as a groin injury, is remanded.
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Citation Nr: 21059259 Decision Date: 09/22/21 Archive Date: 09/22/21 DOCKET NO. 19-34 858 DATE: September 22, 2021 REMANDED Entitlement to service connection for left scrotal varicocele, claimed as a groin injury, is remanded. Entitlement to service connection for a back condition, to include as secondary to his left scrotal varicocele, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from June 1976 to July 1976. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision and an April 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama (Agency of Original Jurisdiction (AOJ)). The Veteran testified at a hearing before the undersigned in April 2021. A transcript of the proceeding is of record. Regrettably, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the issues on appeal, in order to afford the Veteran every possible consideration. As an initial matter, the Board observes that the Veteran appears to be in receipt of Social Security Administration (SSA) benefits. While there has been some documentation related to these benefits associated with the file, the full SSA record has not been received. To that end, the Board will remand to obtain the Veteran's complete SSA records. 1. Entitlement to service connection for left scrotal varicocele, claimed as a groin injury, is remanded. The Veteran filed his claim for a groin injury in January 2015. The Veteran testified during his April 2021 hearing that he injured his groin during an in-service accident whereby he was carrying heavy equipment with other men and when one of them fell down, they all fell, causing the log to fall on him. He stated that this was the first injury he experienced related to his groin. He also said that he believes he was medically discharged for his groin as well as his shoulder, which he also injured during the same event. Service treatment records (STRs) document that he was seen in service after experiencing tenderness in his left testicle with increased pain when running. During a May 2015 VA examination, the physician failed to diagnose the Veteran with any testicular condition. However, VA treatment records indicate he has diagnoses of (1) bilateral varicoceles and small left hydrocele, (2) simple left testicular cyst, and (3) hypoechoic, well-circumscribed left epididymal nodule "most suggestive for a sperm granuloma." Other records also document that he had left epididymitis. There are a number of inconsistencies throughout the record as it pertains to the Veteran's claim for left scrotal varicocele. It does not appear that the Veteran received a medical discharge related to a groin injury; a review of his personnel record reveals he was discharged for being "a substandard soldier" and because his "immaturity [was] reflected in a lack of concern for [himself] and a lack of respect for authority." Nowhere in his file is his groin injury referenced as a reason for his discharge, though he cited sore testicles as one of the reasons why he could not perform adequately in service. The in-service injury alluded to by the Veteran is also not part of the file. Additionally, though the Veteran states this was the first injury he sustained to his groin, his enlistment examination noted "small varicocele on left scrotal contents." Nonetheless, the Board finds that a remand is necessary. The May 2015 examiner failed to provide a diagnosis and thus reported a negative nexus, but other evidence of record suggests he does have diagnoses related to his groin. As such, a new etiology opinion must be sought. Furthermore, an opinion considering whether he had a preexisting groin injury and whether it was aggravated beyond its natural progression should also be provided, as a small varicocele on left scrotal contents was also noted at enlistment. 2. Entitlement to service connection for a back condition, to include as secondary to his left scrotal varicocele, is remanded. The Veteran contends his current back condition developed as a result of the same in-service injury that he cites as the cause of his groin condition, i.e. falling and having a log land on him. Alternatively, he says that his back condition is secondary to his left scrotal varicocele due to years of walking with an altered gait to avoid pain in his testicles. The record reflects that the Veteran has received treatment for back pain. Medical treatment records indicate he has a current diagnosis of degenerative disc disease of the lower back. In January 2018, a Dr. Bash provided an opinion that suggests the Veteran's back condition is etiologically related to his groin condition; however, the Board observes that Dr. Bash provided the incorrect dates of service for the Veteran. Moreover, he cites to the Veteran's alleged "pre-service scoliotic curve" as being aggravated by his service, but it is unclear what evidence this physician is relying upon when noting this purported pre-service condition. The Board does observe his entrance examination appears to list a condition of the G-U system, but cannot decipher what technical medical terminology the examiner appears to have noted; to the Board, it looks like it may reference scoliosis, but it may instead be referring to a condition of his scrotum. On remand, the Board will seek a new etiology opinion that considers the evidence of record to determine whether the alleged in-service injury or his testicular condition may have caused his back problems, as well as whether he had a preexisting back condition that was aggravated by his service. 3. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is remanded. The Veteran contends that he suffers from PTSD as a result of his active duty service. He has suggested a number of stressors as the cause of his condition throughout the period on appeal. These include witnessing people being killed while conducting simulated combat exercises, the screaming of drill sergeants, his heavy artillery training, witnessing a soldier accidentally shooting himself in the face while loading his weapon, and witnessing another solider being run over by a tractor. Of note, the Board observes that the Veteran served a considerably lengthy prison sentence shortly after his discharge from the military. He cited to two instances from prison also as stressors for his PTSD; one involved a prison riot in 1981, and the other from spending 52 days in underground solitary confinement. In March 2018, the Veteran received a VA examination for his acquired psychiatric disorder, where he was subsequently diagnosed with PTSD. The examiner opined it was at least as likely as not that the Veteran's PTSD was incurred in or caused by his training during service. She rationalized, "The Veteran had no mental health issues prior to service. [The Veteran] now has clear symptoms of PTSD, identified in the report, which are related to the claimed/identified in-service stressor(s)." Unfortunately, the Board must remand this matter for additional development. As an initial matter, the stressors cited by the Veteran have not been corroborated; as such, this must be conducted on remand. Moreover, the opinion provided by the March 2018 examiner's rationale is insufficient. She relies on the fact that he had no symptoms prior to service (but does now) as the basis for her opinion, but does not consider other causes for his PTSD, such as his incarceration. On remand, the Board requests a new VA examination and opinion be provided. The matters are REMANDED for the following action: 1. The AOJ shall associate the Veteran's most recent outstanding VA medical treatment records with his file, specifically those records from September 2019 to the present. 2. Ask the Veteran to complete a VA Form 21-4142 for any private treatment providers that have treated him for any groin condition, a back condition, or a psychiatric condition. Thereafter, obtain and associate with the claims folder any private treatment records identified. 3. The AOJ shall seek to associate the Veteran's complete SSA records with the file. 4. Then, the Veteran should be afforded an appropriate VA examination in order to determine the current nature and etiology of his groin condition, to include left scrotal varicocele, left hydrocele, left testicular cyst, and left epididymal nodule. The claims file must be made available to and be reviewed by the examiner. The examiner should accept as fact that the Veteran has been diagnosed with a groin condition, to include left hydrocele, left testicular cyst, and left epididymal nodule. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such groin/testicular condition occurred in or is otherwise etiologically related to the Veteran's military service, to include his testicular pain during service and/or the alleged in-service injury whereby a log fell on his back. The examiner should accept as true that the Veteran had a falling injury although not documented in the service treatment records. Additionally, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the small varicocele on left scrotal contents noted on entry was aggravated beyond its natural progression by his active duty service. The examiner should consider the following: the Veteran's STRs and military personnel record, documenting complaints of testicular pain; the Veteran's enlistment examination, noting an abnormal, asymptomatic left testicle; CAPRI VA treatment records, noting testicular conditions; the May 2015 VA examination; the January 2018 opinion provided by Dr. Bash; and the April 2021 hearing testimony. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 5. The Veteran should also be afforded an appropriate VA examination in order to determine the current nature and etiology of his back condition. The claims file must be made available to and be reviewed by the examiner. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such back condition occurred in or is otherwise etiologically related to the Veteran's military service, to include his alleged in-service injury whereby a log fell on his back. The examiner should accept as true that the Veteran had a falling injury although not documented in the service treatment records. Additionally, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such back condition was a preexisting condition that was aggravated beyond its natural progression by his active duty service. The Board specifically requests the examiner attempt to decipher the notations made on the Veteran's enlistment examination and determine if the examiner noted any preexisting scoliotic condition. The examiner is also asked to provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such back condition is proximately due to or caused by his testicular condition, to include altered gait to avoid testicular pain. The examiner should consider the following: the Veteran's STRs and military personnel record, silent for the alleged in-service event and any back complaints; the Veteran's enlistment examination; CAPRI VA treatment records, noting degenerative disc disease of the lower back; the January 2018 opinion provided by Dr. Bash; and the April 2021 hearing testimony. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 6. The AOJ shall make every attempt to corroborate the in-service stressors cited by the Veteran as the cause of his PTSD. 7. Then, the Veteran should be afforded an appropriate VA examination in order to determine the current nature and etiology of his PTSD. The claims file must be made available to and be reviewed by the examiner. The examiner should consider the prior diagnosis of PTSD and opine whether this was a correct diagnosis or a misdiagnosis. If the Veteran manifests PTSD, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's PTSD occurred in or is otherwise etiologically related to the Veteran's military service, to include the stressors referenced throughout the record (including witnessing people being killed while conducting simulated combat exercises, the screaming of drill sergeants, his heavy artillery training, witnessing a soldier accidentally shooting himself in the face while loading his weapon, and witnessing another solider being run over by a tractor). If the Veteran manifests any acquired psychiatric disorder other than PTSD, provide opinion as to whether it is at least as likely as not that such disorder began in service or is causally related to an event in service. The examiner should consider the following: the Veteran's STRs and military personnel record; the Veteran's longterm incarceration (35 years) beginning shortly after his active duty service and ending in 2014; the Veteran's February 2018 stressor statement; the March 2018 psychiatric VA examination and opinion; and the Veteran's April 2021 hearing testimony. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 8. Thereafter, readjudicate the claims. If any benefit sought on appeal remains denied, furnish the Veteran and his representative, if any, a supplemental statement of the case and an appropriate period of time to respond. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Victoria A. Banis, 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.