BVA9502655 DOCKET NO. 93-07 833 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Milwaukee, Wisconsin THE ISSUES 1. Entitlement to service connection for prostate cancer secondary to the service-connected prostatitis. 2. Entitlement to an increased (compensable) disability evaluation for prostatitis. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant and wife. ATTORNEY FOR THE BOARD J.W. Engle, Counsel INTRODUCTION The appellant served on active duty from October 1941 to January 1946 and from August 1948 to July 1964. This matter came before the Board of Veterans' Appeals (the Board) on appeal from a decision dated in October 1992 by the Milwaukee, Wisconsin, Department of Veterans Affairs Regional Office (VARO). CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that his prostate carcinoma is the direct or proximate result of his service-connected prostatitis. He further argues that his service-connected prostatitis warrants a compensable disability evaluation. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), 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 entitlement to service connection for adenocarcinoma of the prostate is not warranted. However, the evidence of record supports entitlement to a 20 percent disability evaluation for chronic prostatitis. FINDINGS OF FACT 1. The record reflects that the first definitive diagnosis of adenocarcinoma of the prostate was by needle biopsy conducted on VA outpatient examination in December 1991. 2. A statement from a physician dated in February 1992 noted that in his opinion there is no relationship between prostatitis in 1964 and cancer of the prostate found 27 years later in the appellant. 3. A statement from a VA urologist dated in February 1993 noted that there is no documented relationship for an association between the appellant's prostatitis and the development of adenocarcinoma of the prostate. 4. The appellant's service-connected prostatitis is manifested by complaints of urinary frequency, occasional pain in the rectum and some dribbling and is considered to be analogous to symptoms of daytime voiding interval between one and two hours or awakening to void three to four times per night. CONCLUSIONS OF LAW 1. Adenocarcinoma of the prostate was not shown to be the direct or proximate result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (1993). 2. The schedular criteria for a 20 percent disability evaluation for prostatitis are met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.10, Diagnostic Code 7527 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, the Board finds that the appellant has submitted evidence which is sufficient to justify a belief that his claims are well grounded. 38 U.S.C.A. § 5107(a) (West 1991) and Murphy v. Derwinski, 1 Vet.App. 78 (1990). Service Connection The appellant has claimed that adenocarcinoma of the prostate is the direct or proximate result of his service-connected prostatitis. The regulations provide that service connection may be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (1993). Review of the relevant evidence of record reveals that the appellant has testified that he has asked many of his treating physicians if there is a relationship between his service- connected prostatitis and adenocarcinoma of the prostate. He indicated that while some physicians said there was no relationship and others said they did not know, still others indicated that they believe there is a relationship between the two disabilities. He argues, in essence, that in view of the above, he should be afforded the benefit of the doubt and that service connection for adenocarcinoma of the prostate should granted. In contrast to the appellant's recitation of various physicians' undocumented opinions in favor of his claim, the objective medical evidence of record reflects a statement dated in February 1993, from a VA urologist, made after review of the appellant's claims folder, noted: ... He (the appellant) is alleging that he developed adenocarcinoma of the prostate as a result of his service-connected prostatitis. There is no documented relationship in the urologic literature or scientific basis for this association between the patient's prostatitis and the development of adenocarcinoma of the prostate.... In weighing the evidence of record, the undersigned concludes that the preponderance of the evidence is against the appellant's claim to service connection for adenocarcinoma of the prostate. The appellant's contentions and testimony are found to be outweighed the February 1993 opinion provided the VA urologist. Accordingly, entitlement to service connection for adenocarcinoma of the prostate is not warranted. Increased Disability Evaluation The appellant's service-connected prostatitis is currently evaluated pursuant to Diagnostic Code 7527 which provides that post-operative residuals will be rated as voiding dysfunction or urinary tract infection, whichever is predominant. Review of the record reveals no evidence of symptoms analogous to urinary tract infection. Accordingly, the appellant's disability will be evaluated as voiding dysfunction. Pursuant to 38 C.F.R. § 4.115(a) (1993), voiding dysfunction is rated for the particular condition as urine leakage, frequency or obstructed voiding. The record reflects that the appellant's predominant urological symptom is manifested by urinary frequency. While other nonservice-connected disabilities are present and may influence the appellant's urinary frequency, the Board concludes that in light of the lack of evidence to disassociate the urinary frequency symptoms from the service-connected prostatitis, the appellant's urinary frequency will be attributed to the service- connected prostatitis. The evidence of record reveals that on VA examination in July 1992 the appellant reported that he underwent a transurethral resection of the prostate in 1978 and that procedure was a success as far as relieving his urinary symptoms. He further reported that in 1991 he developed increasing nocturia and a biopsy of the prostate was done by VA in December 1991 which identified the presence of adenocarcinoma. He subsequently underwent radiation treatment for the adenocarcinoma. On examination, the appellant's prostate gland was small and somewhat soft. No nodularity was palpable. The diagnosis was history of chronic prostatitis, postoperative status, transurethral resection of the prostate gland in 1978, with residual impotency, and phase I adenocarcinoma of the prostate gland, status post radiation therapy. In February 1993 the appellant testified at a hearing before a hearing officer. The appellant testified that he has to get up four to six times each night to urinate and that he urinates approximately ten times during the day. He further indicated that he drinks alot of water and essentially that the frequency depends upon his water intake. He further noted that he experienced some dribbling and that he had occasional pain in his rectum. Urinary frequency manifested by a daytime voiding interval between two and three hours, or awakening to void two times per night warrants a 10 percent disability evaluation. A daytime voiding interval between one and two hours, or awakening to void three to four times per night warrants a 20 percent disability evaluation. Furthermore, a daytime voiding interval less than one hour, or awakening to void five or more times per night warrants a 40 percent disability evaluation. 38 C.F.R. § 4.115(a) (1993). In view of the above, the undersigned concludes that the appellant's service-connected prostatitis, manifested by urinary frequency warrants a 20 percent disability evaluation. While the appellant testified at his hearing that he had to get up from his bed four to six times each night to urinate and that he urinates approximately ten times during the day, he further noted that he drinks alot of water and indicated that his urinary frequency is related to his water intake. Accordingly, the Board believes that the preponderance of the evidence of record weighs in favor of a finding that the appellant's urinary frequency is appropriately evaluated as analogous to a daytime voiding interval between one and two hours, similar to his account of voiding approximately 10 times during the day and awakening to void three to four times per night which approximates his reported nocturia of four to six times each night when taking into consideration the appellant's water intake. In view of the above, and the lack of additional evidence to show the presence of symptomatology such to meet the criteria for a 40 percent disability evaluation based upon urinary frequency absent excessive water intake, a 20 percent disability evaluation for chronic prostatitis is warranted. ORDER Service connection for adenocarcinoma of the prostate is denied. A 20 percent disability evaluation for chronic prostatitis is granted, subject to controlling regulations applicable to the payment of monetary benefits. C.P. RUSSELL 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. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), 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 (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.