BVA9502276 DOCKET NO. 92-05 756 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in New York, New York THE ISSUE Entitlement to service connection for a genitourinary disability, including kidney and prostate disorders. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. Lawson, Counsel INTRODUCTION The appellant, a veteran, served on active duty from November 1953 to November 1955 and from February 1958 to December 1960. The Board of Veterans' Appeals (Board) remanded the case to the RO in November 1992 on the issue of service connection for a kidney disorder to develop additional VA treatment records and a VA urological examination. REMAND The appellant seeks service connection for what he calls a kidney infection or pus in the kidney, but also refers to urinary incontinence. He has a history of benign prostatic hypertrophy and a transurethral prostate resection in 1979 followed by terminal dribbling. It may be that in fact what he really wants service connection for is a prostate disorder. The appellant referred to treatment for a kidney infection in 1955 when he applied for service connection in 1968, and a prostate disorder is the first and only urological disability that has been rendered treatment after service. The RO has not considered the issue of service connection for a prostate disability in its adjudication, and such issue is inextricably intertwined with the issue of service connection for a kidney disability, given these circumstances and those described below. The evidence shows that during the appellant's first period of service, he underwent a right orchiectomy for an undescended testicle in June 1954. Then, in October 1954, he was noted to have had extreme urgency with incontinence and nocturia for 10 to 12 days. Urinalysis was significant for 8 to 15 white blood cells per high power field. An intravenous pyelogram was negative. Cystoscopy revealed urethritis. Urine cultures were negative. Urinalysis revealed a few calcium oxalate crystals. The diagnosis was acute nonvenereal urethritis of undetermined organism. He was discharged from the hospital after about two weeks. Gantrisin was prescribed. Nothing remarkable was mentioned on service discharge examination in November 1955 or service enlistment examinations in February 1958. In January 1959, the appellant was seen for weakness, chills, fever, left back ache, and no frequency or dysuria. Urine was negative. Darvon was prescribed the next day. In June 1959, his urine was loaded with pus cells, and Pyridium was prescribed. Seven days later, it was reported that he "still had the drip this a.m." Terra (oxytetracycline -- an antibacterial) was prescribed, and his frenulum, which was short, was removed. In June 1959, urine showed 25 to 30 cells. Continued terra was prescribed. On service discharge examination in February 1960, no pertinent positive comments were made. The appellant testified recently that he received treatment shortly after service for similar symptoms from a physician who is now deceased, and that afterwards, he treated himself with sulfur, which he bought over the counter, until 1979 when he went to the VA hospital for surgery. In March 1979, the appellant presented to the VA with a four year history of urinary frequency, with urinary dribbling and occasional incontinence for about two years and nocturia two to three times per night for six months. He was diagnosed with benign prostatic hyperplasia, and a transurethral resection of the prostate was performed. A "kidney" disorder, per se, has never been diagnosed. The most recent RO rating action and supplemental statement of the case have denied the appellant's claim on the basis that a "kidney" disability has not been shown. That does not dispose of the question of whether or not the appellant's prostate disability is the result of disease or injury which was incurred or aggravated in service. The question of whether the appellant's in-service urinary symptoms were a manifestation of or caused his later diagnosed benign prostatic hypertrophy or a prostate disorder has never been directly posed to a physician. The Board believes that fairness to the appellant requires both this and that the RO consider the question of service connection for a prostate disorder prior to any Board consideration of such issue. Accordingly, the case is REMANDED to the RO for the following action: 1. Copies of complete VA hospital and outpatient treatment records at the Northport, New York, VA medical Center, to include reports of hospitalizations in 1980 and 1988, should be obtained and associated with the claims file. 2. A VA genitourinary examination should be conducted to ascertain the nature and etiology or origin of any current genitourinary pathology. Detailed history and findings should be reported. The urologist must review the appellant's claims folder, as well as a copy of this remand, which must be made available to him for review. All pertinent indicated tests and studies should be conducted, and the results thereof should be reported in detail, in accordance with the VA Physician's Guide for Disability Evaluation Examinations (IB 11-56 (1985)). The examiner should render an opinion with reasons as to whether any kidney or prostate disability which is diagnosed is related to the in-service symptomatology experienced by the appellant in 1954 or 1958. Thereafter, the case should again be reviewed by the RO. If any action remains adverse to the appellant, the case should be returned to this Board in accordance with the usual appellate procedures. No action is required of the appellant until he is further informed. The purpose of this REMAND is to assist the appellant and provide him with additional adjudicative and medical development. No inference is to be drawn regarding the final disposition of the claim. (CONTINUED ON NEXT PAGE) SAMUEL W. WARNER Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).