BLADDER DISEASE OF

MARIAH N. SIM · 2026 · Case ID: A26001764

MIXED

Summary

The veteran, who served from March 1967 to March 1969, appeals the denial of an initial compensable rating for bladder cancer prior to April 12, 2016, and the effective date for service connection for erectile dysfunction (ED) and special monthly compensation (SMC-K). The Board granted a 100 percent rating for bladder cancer from October 16, 2017, to May 1, 2018, and a 10 percent rating for residuals of bladder cancer from April 12, 2016, to October 18, 2017, and from May 1, 2018, to May 17, 2022. The Board denied an initial compensable rating prior to April 12, 2016, finding the evidence weighed against it. The Board granted service connection for ED secondary to bladder cancer with an effective date of March 4, 2022, and granted SMC-K with the same effective date, finding that the Veteran's ED symptoms were first documented and associated with his bladder cancer on that date. The Board found the Veteran's claims for an earlier effective date for ED and SMC-K were not supported by the evidence, as contemporaneous records did not reflect the claimed symptoms prior to March 4, 2022, and a private medical opinion was deemed inadequate for failing to reconcile conflicting evidence. The Board also noted that the Veteran's claims for bladder cancer residuals did not meet the criteria for higher ratings during the periods in question.

Rationale

100% rating warranted for active bladder cancer and six months post-surgery.; 10% rating for mild voiding dysfunction supported by contemporaneous records.; Higher ratings denied due to lack of severe symptoms or need for absorbent materials.

Special Benefit

SMC

Diagnostic Code

7528

Docket No.

250513-547542

Full Decision Text

Citation Nr: A26001764
Decision Date: 01/08/26 Archive Date: 01/08/26

DOCKET NO. 250513-547542
DATE: January 8, 2026

ORDER

Entitlement to a rating of 100 percent from October 18, 2017, to May 1, 2018, for bladder cancer is granted.

Entitlement to a rating of 10 percent, and not higher, from April 12, 2016, to October 18, 2017, and from May 1, 2018, to May 17, 2022, for bladder cancer is granted.

Entitlement to an initial compensable rating prior to April 12, 2016, for bladder cancer is denied.

Entitlement to an effective date of March 4, 2022, and not earlier, award of service connection for erectile dysfunction (ED) as secondary to service-connected bladder cancer is granted.

Entitlement to an effective date prior to March 4, 2022, and not earlier, for award of special monthly compensation based on loss of use of a creative organ (SMC-K) is granted.

FINDINGS OF FACT

1. On October 16, 2017, the Veteran was diagnosed with active bladder cancer, for which he underwent transurethral resection of the bladder tumor.

2. From April 12, 2016, to October 18, 2017, and from May 1, 2018, to May 17, 2022, the Veteran did not have active disease process and his residuals of bladder cancer were manifested by voiding dysfunction characterized as "mild" urological symptoms which is consistent with daytime voiding interval between two and three hours and awakening to void two times per night but he did not require the wearing of absorbent materials and there was no urinary retention with marked obstructive symptomatology.

3. Prior to April 12, 2016, the Veteran did not have active disease process and his residuals of bladder cancer did not require wearing absorbent materials that must be changed less than two times per day; nor was it manifested by urinary frequency with either a daytime voiding interval between two and three hours or awakening to void two times per night; or marked obstructive voiding symptomatology.

4. The Veteran's original claim for service connection for bladder cancer could reasonably include a claim for ED; however, the persuasive evidence of record does not show entitlement arose for ED until March 4, 2022, the date of a treatment record first shows ED associated with his bladder cancer.

5. The award of SMC based on loss of use of a creative organ is based on the award of entitlement to service connection for ED, the effective date of which is now March 4, 2022.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a rating of 100 percent, from October 18, 2017, to May 1, 2018, for bladder cancer have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124b, Diagnostic Code 7528.

2. The criteria for entitlement to a rating of 10 percent, and not higher, from April 12, 2016, to October 18, 2017, and from May 1, 2018, to May 17, 2022, for bladder cancer have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.115(a) and (b), Diagnostic Code 7528.

3. The criteria for entitlement to an initial compensable rating prior to April 12, 2016, bladder cancer have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.115(a) and (b), Diagnostic Code 7528.

4. The criteria for an effective date of March 4, 2022, and not earlier, for award of service connection for ED as secondary to service-connected bladder cancer have been met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.155, 3.400, 3.2500.

5. The criteria for an effective date of March 4, 2022, and not earlier, for award of SMC-K have been met. 38 U.S.C. §§ 1114(k), 5107, 5110; 38 C.F.R. §§ 3.
(a) and (b), Diagnostic Code 7528.

5. The criteria for an effective date of March 4, 2022, and not earlier, for award of SMC-K have been met. 38 U.S.C. §§ 1114(k), 5107, 5110; 38 C.F.R. §§ 3.155, 3.350(a), 3.400, 3.2500.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1967 to March 1969.

In July 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of claims most recently addressed in an October 13, 2023, rating decision. On May 7, 2025, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claims based on the evidence of record at the time of that decision.

In the May 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the May 7, 2025, supplemental claim decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the supplemental claim decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Preliminary Matters

The Board reasonably construes the Veteran's appeal of the denial of the assignment of 40 percent rating prior to May 17, 2022, for bladder cancer as a claim for an initial increased rating prior to May 17, 2022. See VAF 20-0995 (September 2023); VAF 20-0995 (July 2024); VAF 10182 (May 2025). The record reflects the Veteran has continuously pursued the issue of assigned rating for bladder cancer prior to May 17, 2022, since the AOJ awarded service connection, and throughout this period he asserts a compensable rating is warranted. See 38 C.F.R. § 3.2500; see also Rating Decision (December 2021); VAF 20-0995 (July 2022); Rating Decision (October 2022); VAF 20-0995 (September 2023); Rating Decision (October 2023); VAF 20-0995 (July 2024); Rating Decision (May 2025); VAF 10182 (May 2025). The Board's interpretation of this issue as an initial increased rating as opposed to an earlier effective date is consistent with the Veteran's desire for a higher rating prior to May 17, 2022, the procedural history of the appeal as well as VA guiding principles to review the Veteran's claim in a light favorable. See 38 C.F.R. § 20.202(a) (the Board will construe a claimant's arguments in a liberal manner for purpose); see also Disabled American Veterans v. Sec'y of Veterans Affairs, 327 F.3d 1339, 1349 (Fed. Cir. 2003) (noting the "uniquely pro-claimant character of the veterans' benefits system" created by Congress).

Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, including a claim for a total disability rating based on individual unemployability due to service-connected disability (TDIU). Doucette v. Shulkin, 28 Vet. App. 366 (2017); see also Rice v. Shinseki, 22 Vet. App.
in a liberal manner for purpose); see also Disabled American Veterans v. Sec'y of Veterans Affairs, 327 F.3d 1339, 1349 (Fed. Cir. 2003) (noting the "uniquely pro-claimant character of the veterans' benefits system" created by Congress).

Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, including a claim for a total disability rating based on individual unemployability due to service-connected disability (TDIU). Doucette v. Shulkin, 28 Vet. App. 366 (2017); see also Rice v. Shinseki, 22 Vet. App. 447 (2009). Here, the Veteran consistently reports he is retired, and at no point during the relevant review period does he assert nor the evidence of record indicates an inability to work due to his bladder cancer disability on appeal. See C&P Exam (July 2022); CAPRI (July 2024). Therefore, a claim for TDIU is not included on appeal.

Increased Rating Claim

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999).

Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509.

1. Entitlement to an initial compensable rating prior to May 17, 2022, for residuals of bladder cancer

In a December 2021 rating decision, the AOJ awarded service connection for bladder cancer and assigned an initial noncompensable rating under 38 C.F.R
the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509.

1. Entitlement to an initial compensable rating prior to May 17, 2022, for residuals of bladder cancer

In a December 2021 rating decision, the AOJ awarded service connection for bladder cancer and assigned an initial noncompensable rating under 38 C.F.R. §§ 4.115A, 4.115B, Diagnostic Code 7528, from August 16, 2011. See Rating Decision (December 2021). The Veteran filed a supplemental claim requesting readjudication of the initial assigned rating, and in an October 2022 supplemental claim decision, the AOJ granted an increased rating to 40 percent from May 17, 2022, for residuals of bladder cancer, and awarded a temporary 100 percent rating from June 9, 2022, to July 5, 2022, for active bladder cancer in accordance with 38 C.F.R. § 4.115B, Diagnostic Code 7528. See VAF 20-0995 (July 2022); Rating Decision (October 2022). The Veteran filed two more supplemental claims requesting readjudication concerning the assignment of the 40 percent prior to May 17, 2022, which was denied in an October 2023 and May 2025, supplement claim decisions, respectively. The Veteran appealed the denial of the assignment of 40 percent rating prior to May 17, 2022, which the Board construes as an appeal for higher initial rating prior to May 17, 2022, for residuals of bladder cancer. See VAF 20-0995 (September 2023); VAF 20-0995 (July 2024); VAF 10182 (May 2025).

As the Veteran has continuously pursued his claim, the rating review period begins on August 16, 2011, the date of service connection, and ends on May 17, 2022, the date of the award of the 40 percent schedular rating for residuals of bladder cancer. See 38 C.F.R. § 3.2500.

The Board concludes that the criteria for a rating of 100 percent from October 18, 2017, to May 1, 2018, and a rating of 10 percent, but not higher, from April 12, 2016, to October 18, 2017, and from May 1, 2018, to May 17, 2022, for bladder cancer are met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.115A, 4.115B, Diagnostic Code 7528.

However, the Board concludes that the criteria for an initial compensable rating prior to April 12, 2016, for bladder cancer are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.115A, 4.115B, Diagnostic Code 7528.

Malignant neoplasms of the genitourinary system, including bladder cancer, are rated under 38 C.F.R. § 4.115B, Diagnostic Code 7528, at 100 percent. Note provides that following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local reoccurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant. See 38 C.F.R. § 4.115B, Diagnostic Code 7528, Note. Here, there is no evidence of renal dysfunction associated with the Veteran's bladder cancer.

For voiding dysfunction, the rating is based on urine leakage, frequency, or obstructed voiding. When there is continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence, a 20 percent rating is warranted, if the Veteran is required to wear absorbent materials which must be changed less than two times per day. A
105(e) of this chapter. If there has been no local reoccurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant. See 38 C.F.R. § 4.115B, Diagnostic Code 7528, Note. Here, there is no evidence of renal dysfunction associated with the Veteran's bladder cancer.

For voiding dysfunction, the rating is based on urine leakage, frequency, or obstructed voiding. When there is continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence, a 20 percent rating is warranted, if the Veteran is required to wear absorbent materials which must be changed less than two times per day. A 40 percent rating is warranted when the Veteran is required to wear absorbent materials which must be changed 2 to 4 times per day. A 60 percent rating is warranted when the Veteran is required to wear absorbent materials which must be changed more than 4 times per day. 38 C.F.R. § 4.115A.

For urinary frequency, a 10 percent rating is warranted when there is daytime voiding interval between two and three hours, or; when the Veteran awakens to void two times per night. A 20 percent rating is warranted when there is daytime voiding interval between one and two hours, or; awakening to void three to four times per night. A 40 percent rating is warranted when there is daytime voiding interval of less than one hour, or; awakening to void five or more times per night. 38 C.F.R. § 4.115A.

For obstructed voiding, a noncompensable rating is warranted when there is obstructive symptomatology with or without stricture disease requiring dilatation 1 to 2 times per year. A 10 percent rating is warranted when there is marked obstructive symptomatology (hesitancy, slow or weak stream, decreased force of stream) with any one or combination of the following: Post void residuals greater than 150 cc; uroflowmetry; markedly diminished peak flow rate (less than 10 cc/sec); recurrent urinary tract infections secondary to obstruction; or stricture disease requiring periodic dilatation every 2 to 3 months. A 30 percent rating is warranted for voiding dysfunction when there is urinary retention requiring intermittent or continuous catheterization. 38 C.F.R. § 4.115A.

Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

At the outset, the Board notes that the claim for initial increased rating for bladder cancer is complicated by the fact that the Veteran also has a history of benign prostate hypertrophy (BPH) resulting in urological issues but for which he is not service-connected. See Medical Treatment Record - Non-Government Facility (July 2024) (a November 2015 observation of moderate obstruction of prostate with complaints of worsening of urinary tract symptoms). Symptomatology attributed to a nonservice-connected disability cannot be differentiated from symptomatology attributed to a service-connected disability unless medical evidence does so. See Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam). Here, both the Veteran's private treating urologist and a July 2022 VA urinary tract disability benefits question (DBQ) report attribute the Veteran's urological symptoms of overactive bladder symptoms, nocturia, daytime urinary frequency and urgency, and urethral strictures to his bladder cancer. See C&P Exam (July 2022); Medical Treatment Record - Non-Government Facility at 1 (July 2024). As such, the Board will consider these urinary symptoms when rating his bladder cancer based on residuals of voiding dysfunction.

Turning to the evidence of record, private treatment records show that the Veteran was first diagnosed with bladder cancer in 2008 and he required transurethral resection of bladder tumors in August 2008, February 2011, and October 2017. See Medical Treatment Record - Non-Government Facility (July 2024). These records also show the Veteran underwent regular follow-up cystoscopies to monitor his disability revealing negative findings for recurrence of bladder cancer in July 2010, August 2012, October 2013, May 2014, November 2014, May 2015, November 2015, April 2016, April 2017, June 2018, April 2020, and October 2020. See id. However, an October 16, 2017, private cystoscopy revealed a recurrence of bladder tumor requiring
ral resection of bladder tumors in August 2008, February 2011, and October 2017. See Medical Treatment Record - Non-Government Facility (July 2024). These records also show the Veteran underwent regular follow-up cystoscopies to monitor his disability revealing negative findings for recurrence of bladder cancer in July 2010, August 2012, October 2013, May 2014, November 2014, May 2015, November 2015, April 2016, April 2017, June 2018, April 2020, and October 2020. See id. However, an October 16, 2017, private cystoscopy revealed a recurrence of bladder tumor requiring surgical intervention. See id. at 42; see also CAPRI (December 2021).

VA treatment records include an April 2010 VA Agent Orange Registry note and a November 2015 VA treatment note which show the Veteran specifically denied urinary frequency, dysuria, hematuria, and nocturia, and he also denied symptoms of urinary frequency, urgency or burning in April 2018, January 2019, March 2019, June 2020 & June 2021. See CAPRI (December 2021). VA treatment records also reflect scanned documents including an April 12, 2016, private urology treatment record noting the Veteran's report of "some mild early lower urinary tract symptoms" and an April 18, 2017, private urology treatment record noting symptoms of "mild decreased force of stream" and "mild nocturia." See CAPRI (December 2021). These VA scanned documents also include the October 2017 private urology treatment summary concerning the transurethral resection of bladder tumor. See CAPRI (December 2021).

Additional private treatment records show the Veteran denied urinary symptoms in May 2015. See Medical Treatment Record - Non-Government Facility at 46 (July 2024). An October 2020 private cystoscopy shows findings of mild stricture urethra requiring dilation but otherwise good bladder emptying function. See id. at 38. In November 2021, the Veteran reported some nocturia and occasional decreased force stream, and a May 17, 2022, private treatment note shows the Veteran described "occasional decreased force of stream, without fluid restriction, and "moderate plus nocturia 5 - 6." See Medical Treatment Record - Non-Government Facility at 1, 2 (July 2022).

Foremost, following a review of the record, the Board first finds that the evidence supports the assignment of a 100 percent rating from October 16, 2017, to May 1, 2018, for the Veteran's bladder cancer. See 38 C.F.R. § 4.115B, Diagnostic Code 7528. The applicable VA regulation provides a 100 percent rating for active malignant genitourinary disease and for the six-month period following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. See id. Here, the medical records reflect the October 16, 2017 private cystoscopy revealed findings of active bladder cancer for which the Veteran underwent a surgical resection of the bladder tumor two days later. See CAPRI (December 2021); see also Medical Treatment Record - Non-Government Facility at 41, 42 (July 2024). Pursuant to provisions of Diagnostic Code 7528, the Veteran is entitled to a 100 percent rating from when active bladder cancer was noted to be present, until six months following the surgical procedure on October 18, 2017. As such, a 100 percent rating from October 16, 2017, for active bladder cancer followed by a six-month period after transurethral resection surgery is warranted. The total rating following surgical intervention is clearly a temporal element of Diagnostic Code 7528 lasting only for a period of six months as there was no local reoccurrence or metastasis and expires on May 1, 2018, the first day of the month following his six-month post-surgical period. See 38 C.F.R. § 3.31 (VA compensation based on increased awards for compensation may not be made for any period prior to the first day of the calendar month following the month in which the award became effective). Thus, a 100 percent rating from October 16, 2017, to May 1, 2018, is warranted. See 38 C.F.R. § 4.115B, Diagnostic Code 7528.

No persuasive competent evidence of record demonstrates findings of active bladder cancer nor surgical intervention for active disease process at any other point prior to May 17, 2022. The Board
2018, the first day of the month following his six-month post-surgical period. See 38 C.F.R. § 3.31 (VA compensation based on increased awards for compensation may not be made for any period prior to the first day of the calendar month following the month in which the award became effective). Thus, a 100 percent rating from October 16, 2017, to May 1, 2018, is warranted. See 38 C.F.R. § 4.115B, Diagnostic Code 7528.

No persuasive competent evidence of record demonstrates findings of active bladder cancer nor surgical intervention for active disease process at any other point prior to May 17, 2022. The Board notes that the record reflects that the Veteran had a recurrence of bladder cancer for which he underwent surgical intervention on February 25, 2011, which comes six months prior to the effectuation of service connection on August 16, 2011, and just beyond the temporal element supporting a 100 percent rating for the six-months following surgical intervention for active bladder cancer. See 38 C.F.R. § 4.115B, Diagnostic Code 7528; see also 38 C.F.R. § 3.31. Thus, an initial 100 percent rating for bladder cancer is not warranted. See 38 C.F.R. § 4.115B, Diagnostic Code 7528.

Next, based on a review of the evidence of record, the Board finds the record demonstrates that from April 12, 2016, to October 18, 2017, and from May 1, 2018, to May 17, 2022, bladder cancer more closely approximates the criteria of a 10 percent rating. See 38 C.F.R. §§ 4.115A, 4.115B, Diagnostic Code 7528. Here, the lay and medical evidence of record demonstrates that the Veteran has residuals of his bladder cancer due to "some mild early lower urinary tract symptoms," "mild nocturia" or "some nocturia," and "mild decreased force of stream." See CAPRI (December 2021); Medical Treatment Record - Non-Government Facility at 2 (July 2022); Medical Treatment Record - Non-Government Facility at 38 (July 2024). While VA regulations concerning voiding dysfunction do not use such "mild" characterization for rating urinary symptoms, the available private treatment records do not quantify the Veteran's reported symptomatology based on daytime voiding intervals, number of nighttime awakenings, or measured urinary flow used in the applicable rating criteria. However, on May 17, 2022, the same private provider identified "moderate plus nocturia" as consistent with a frequency of 5 to 6 nighttime awakenings - reflective of the 40 percent rating. See Medical Treatment Record - Non-Government Facility (July 2022).

Additionally, the Board notes that the common understanding of term of "mild" is defined as "gentle in nature" and "some" is defined as "an unspecified amount; to some degree or extent: a little" which appears to suggest similar characterization of severity. See Mild and Some Definition & Meaning - Merriam-Webster. Given the foregoing definitions, the Board finds that "mild" and "some" is consistent with no more than urinary frequence manifested by daytime voiding interval between two and three hours and awakening to void two times per night as that designates two levels lower than the private urologist's definition of "moderate plus." Resolving any doubt in the Veteran's favor, the Board finds such "mild" urology symptomatology is more consistent with urinary frequence manifested by daytime voiding interval between two and three hours and awakening to void two times per night. Moreover, the April 12, 2016, VA-scanned private treatment record first documents such reported "mild" symptomatology during the relevant review period. See generally, Swain v. McDonald, 27 Vet. App. 219, 224 (2015) (stating that, in determining when an increase is "factually ascertainable," a date should not be assigned mechanically from the date of an examination, but from the date that the increase in disability can be first factually ascertainable). Thus, the Board finds the evidence of record for the periods from April 12, 2016, to October 18, 2017, and from May 1, 2018, to May 17, 2022, supports the criteria of a 10 percent rating for voiding dysfunction as residuals of bladder cancer. 38 C.F.R. §§ 4.115A, 4.115B, Diagnostic Code 7528.

However, the Board finds that a disability
(stating that, in determining when an increase is "factually ascertainable," a date should not be assigned mechanically from the date of an examination, but from the date that the increase in disability can be first factually ascertainable). Thus, the Board finds the evidence of record for the periods from April 12, 2016, to October 18, 2017, and from May 1, 2018, to May 17, 2022, supports the criteria of a 10 percent rating for voiding dysfunction as residuals of bladder cancer. 38 C.F.R. §§ 4.115A, 4.115B, Diagnostic Code 7528.

However, the Board finds that a disability rating greater than 10 percent for bladder cancer based on residuals of voiding dysfunction is not warranted for the periods from April 12, 2016, to October 18, 2017, and from May 1, 2018, to May 17, 2022. To merit a higher rating during these periods, the record must show urinary leakage that requires wearing of absorbent materials, daytime voiding interval between one and two hours or less or awakening to void three or more times per night, or urinary retention requiring intermittent or continuous catheterization. 38 C.F.R. §§ 4.115A. Here, no lay or medical shows the Veteran is required to wear of absorbent materials due to urine leakage nor has the Veteran required intermittent or continuous catheterization for urinary retention. While the July 2022 VA urinary tract DBQ report shows he described a history of "slight leakage," the Veteran denied wearing or changing absorbent material due to urine leakage. See C&P Exam (July 2022). He also specifically denied symptoms of urinary dysfunction when seeking VA treatment between 2010 to 2022, except for a single report of urinary incontinence which was attributed to another medical condition, and his private treatment records show no more than "mild" or "some" voiding dysfunction. See CAPRI at 404 (July 2024); see Medical Treatment Record - Non-Government Facility (July 2022); Medical Treatment Record - Non-Government Facility (July 2024). Based on the above understanding, the Veteran's "mild" urology symptomatology does not more closely approximate daytime voiding interval between one and two hours or less or awakening to void three or more times per night and does not support the assignment of a rating higher than 10 percent for these periods. 38 C.F.R. §§ 4.115A, 4.115B, Diagnostic Code 7528.

Lastly, prior to April 12, 2016, the Board finds that persuasive evidence of record weighs against the assignment of a compensable rating for residuals of bladder cancer based on voiding dysfunction, urinary frequency, or obstructed voiding. See 38 C.F.R. §§ 4.115A, 4.115B, Diagnostic Code 7528. Here, neither the lay nor the medical evidence of record more nearly reflects the criteria for a higher rating in the absence of continual urine leakage requiring the Veteran to wear absorbent materials which must be changed less than two times per day; the absence of urinary frequency with either a daytime voiding interval between two and three hours or awakening to void two times per night; and the absence of urinary retention with marked obstructive symptomatology. Again, VA treatment records dated in 2010 and 2015 show that the Veteran specifically denied urinary dysfunction symptoms, and private treatment records date in 2012, 2013, and 2014 only reflect findings of normal cystoscopy results and do not record any urinary complaints. Although the Veteran believes that he meets the criteria for a higher disability rating related to his bladder cancer throughout the relevant review period, the lay and medical findings do not meet the requirements for a compensable rating prior to April 12, 2016. See 38 C.F.R. §§ 4.115A, 4.115B, Diagnostic Code 7528.

To the extent that the Veteran more recently asserts that he has nocturia at least five times a night and stress incontinence requiring him to change absorbent materials more than 4 times per day since August 2011, such lay statements are inconsistent with his reported symptomatology in contemporaneous VA and private treatment records as noted above. See VA Form 21-10210 (July 2024); see also Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant).

Similarly, the private medical statement, received in July 2024, from the Veteran's treating urologist concluding that the Veteran has overactive bladder symptoms
Veteran more recently asserts that he has nocturia at least five times a night and stress incontinence requiring him to change absorbent materials more than 4 times per day since August 2011, such lay statements are inconsistent with his reported symptomatology in contemporaneous VA and private treatment records as noted above. See VA Form 21-10210 (July 2024); see also Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant).

Similarly, the private medical statement, received in July 2024, from the Veteran's treating urologist concluding that the Veteran has overactive bladder symptoms and nocturia times 5-6 at least as likely as not stemming back to August 16, 2011, is inconsistent with the contemporaneous treatment records from that private provider which show the Veteran denied any urinary symptoms in May 2015 and he had at most "mild" or "some" nocturia between April 2016 and March 2022 compared with the May 17, 2022, notation of "moderate plus nocturia 5-6x." The Board finds the 2024 private medical opinion on severity of the Veteran's urinary dysfunction since 2011 is inadequate as it does not reconcile or address the relevant contemporaneous findings, which casts doubt on the opinion's foundation and conclusion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (most of the probative value of an opinion comes from discussion of its underlying reasoning); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

The Board has considered whether there is a different Diagnostic Code that could provide a more beneficial rating to the Veteran. However, because malignant neoplasms of the genitourinary system are specifically listed in the rating schedule, they may not be rated by analogy under a different Diagnostic Code, and thus they must be rating pursuant to Diagnostic Code 7528. Copeland v. McDonald, 27 Vet. App. 333, 337 (2015). As noted above, Code 7528 specifically directs that residuals of disabilities rated pursuant to that Code must be rated as either voiding or renal dysfunction; therefore, no other Diagnostic Codes are potentially applicable which might afford a higher rating on an alternative basis.

In sum, the record supports the assignment a 100 percent rating, from October 16, 2017, to May 1, 2018, for bladder, and a 10 percent rating, but no higher, from April 12, 2016, to October 18, 2017, and from May 1, 2018, to May 17, 2022, for residuals of bladder cancer; however, the persuasive evidence of record weighs against the assignment of an initial compensable rating prior to April 12, 2016.

Accordingly, the claim is granted to that extent only. As the evidence of record persuasively weighs against any higher rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Effective Date Claims

Generally, the effective date for service connection is the day after service separation or the date entitlement arose, whichever is later, if the claim is received within one year of the date of separation from service. Otherwise, the effective date for an award of compensation will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (b)(1); 38 C.F.R. § 3.400(b)(2)(i).

With regard to the date of entitlement, the term date entitlement arose is the date when the claimant met the requirements for the benefits sought, on a fact-found basis. 38 U.S.C. § 5110 (a); McGrath v. Gober, 14 Vet. App. 28, 35 (2000). For service connection, these facts found include the date the disability first manifested and the date entitlement to benefits was authorized by law and regulation. See generally, 38 C.F.R. § 3.400.

Where, as here, service connection was granted on a secondary basis, the effective date can be no earlier than the date of the claim for secondary service connection. Ellington v. Nicholson, 22 Vet. App. 141, 145 (2007); see also Ross v. Peake, 21 Vet. App.
a fact-found basis. 38 U.S.C. § 5110 (a); McGrath v. Gober, 14 Vet. App. 28, 35 (2000). For service connection, these facts found include the date the disability first manifested and the date entitlement to benefits was authorized by law and regulation. See generally, 38 C.F.R. § 3.400.

For claims filed before March 24, 2015, meant a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p). Any communication or action indicating intent to apply for one or more benefits under the laws administered by VA, from a veteran or his representative, may be considered an informal claim. Such informal claim must identify the benefit sought. See also Rodriguez v. West, 189 F.3d 1351, 1353 (Fed. Cir. 1999) (noting that even an informal claim for benefits must be in writing).

For claims or appeals filed on or after March 24, 2015, a claim for benefits must be submitted on a standardized form. Standard Claims and Appeals Forms, 79 Fed. Reg. 57,660, 57,686 (Sept. 25, 2014) (eff. Mar. 24, 2015). Claims or appeals pending before VA on that date are to be decided based on the regulations as they existed prior to the amendment. Standard Claims and Appeals Forms, 79 Fed. Reg. 57,660, 57,686.

Additionally, under the AMA, the effective date will be fixed in accordance with the date of receipt of the initial claim or date entitlement arose, whichever is later, if a claimant continuously pursues an issue by timely filing in succession any of the available review options within one year of the issuance of the decision. 38 C.F.R. § 3.2500(h). Continuously pursuing a claim occurs where, after notice of a decision on an initial or supplemental claim, the Veteran files a supplemental claim, requests a higher-level review, or appeals to the Board, or after notice of a decision on a higher-level review, the Veteran files a supplemental claim or appeals to the Board. 38 C.F.R. § 3.2500(c).

1. Entitlement to an effective date prior to June 24, 2022, award of service connection for ED as secondary to service-connected bladder cancer

An October 2022 rating decision awarded service connection for ED as secondary to service-connected bladder cancer effectuated from July 5, 2022, the date of receipt of a supplemental claim request, VA Form 20-0995. See Rating Decision (October 2022). The Veteran filed a supplemental claim requesting readjudication of the assigned effective date for award of service connection, and an October 2023 supplemental claim decision granted an earlier effective date of June 24, 2022, for award of service connection for ED. See VA Form 20-0995 (September 2023); Rating Decision (October 2023). The Veteran submitted another supplemental claim requesting readjudication of the assigned effective date, and in the May 2025 supplemental claim decision on appeal granted an effective date of June 9, 2022, for award of service connection. See VAF 20-0995 (July 2024); Rating Decision (May 2025). This appeal arises from the Veteran's disagreement with the assigned effective date for the award of service connection for ED. See VA Form 10182 (May 2025).

The Veteran contends he should be assigned an effective date from August 2011, the date his original claim for service connection for bladder cancer, which should be reasonably construed as including a claim for ED and that he has continuously pursued since then. See VAF 20-0995 (September 2023); Third Party Correspondence (September 2023); VAF 10182 (May 2025).

The Board concludes that the criteria for an effective date of March 4, 2022, and not earlier, for the award of service connection for ED is warranted. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400.

Turning to the evidence, the record shows that VA received the Veteran's application for VA compensation for bladder cancer on August
the date his original claim for service connection for bladder cancer, which should be reasonably construed as including a claim for ED and that he has continuously pursued since then. See VAF 20-0995 (September 2023); Third Party Correspondence (September 2023); VAF 10182 (May 2025).

The Board concludes that the criteria for an effective date of March 4, 2022, and not earlier, for the award of service connection for ED is warranted. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400.

Turning to the evidence, the record shows that VA received the Veteran's application for VA compensation for bladder cancer on August 16, 2011. See VAF 21-526 (August 2011). An August 2013 rating decision denied service connection for bladder cancer. See Rating Decision (August 2013). However, in June 2021, the AOJ undertook a special review of the claims file in accordance with Nehmer v. United States Department of Veterans Affairs after congressional amendment which added bladder cancer to the list of conditions presumptively associated with exposure to herbicide agents. See Notification Letter (June 2021); see also 38 C.F.R. § 3.816; see also Nehmer v. U.S. Veterans Admin., 712 F. Supp. 1404 (N.D. Cal. 1989) (Nehmer I); Nehmer v. U. S. Veterans Admin., 32 F. Supp. 2d 1175 (N.D. Cal. 1999) (Nehmer II); Nehmer v. Veterans Admin. of the Gov't of the U.S., 284 F.3d 1158 (9th Cir. 2002) (Nehmer III); Nehmer v. U.S. Veterans Admin., 494 F.3. 846 (2007) (Nehmer IV). Thereafter, in a December 2021 rating decision, the AOJ awarded service connection for bladder cancer effectuated from August 16, 2011, the original date of claim. See Rating Decision (December 2021). On July 5, 2022, the Veteran filed a supplemental claim requesting readjudication of an initial higher rating for bladder cancer along with a claim for secondary ED, and in the October 2022, the AOJ granted service connection for ED as secondary to service-connected bladder cancer effectuated from July 5, 2022. See VAF 20-0995 (July 2022); Rating Decision (October 2022). Thereafter, the Veteran continuously pursued his claim for an earlier effective date and most recently in the May 2025 rating decision on appeal found clear and unmistakable error and assigned an effective date of June 9, 2022, the date of a private treatment recording noting active bladder cancer. See VAF 20-0995 (September 2023); Rating Decision (October 2023); VAF 20-0995 (July 2024); Rating Decision (May 2025).

Based on a review of the record, the Board finds an effective date of March 4, 2022, the date of a private treatment record first showing ED symptoms associated with his service-connected bladder cancer. See Medical Treatment Record - Non-Government Facility at 38 (July 2024); see also 38 C.F.R. § 3.400(b)(2)(i). An effective date prior to March 4, 2022, for award of service connection for ED is not warranted. Although the Veteran's ED is reasonably encompassed by his initial claim for bladder cancer arising from August 16, 2011, which he continuously pursued, the persuasive evidence weighs against finding entitlement arose for award of service connection for ED prior to March 4, 2022.

First, the Board finds that the relevant date of claim is August 16, 2011, as ED was reasonably encompassed as a complication associated with his initial rating claim for bladder cancer, which he continuously pursued via timely filed supplemental claim requests. See 38 C.F.R. § 3.2500(c); see also Wilson v. McDonough, 35 Vet. App. 103, 110 (2022); Bailey v. Wilkie, 33 Vet. App. 188, 191 (2021) (VA is required to identify, develop, and adjudicate related claims for secondary service connection for complications arising from the primary disability that are "reasonably raised" during the adjudication of an increased rating claim for the primary disability.) Here, while the Veteran's August 2011 VA Form 21-526 only identified his service connection claim as bladder cancer and
his initial rating claim for bladder cancer, which he continuously pursued via timely filed supplemental claim requests. See 38 C.F.R. § 3.2500(c); see also Wilson v. McDonough, 35 Vet. App. 103, 110 (2022); Bailey v. Wilkie, 33 Vet. App. 188, 191 (2021) (VA is required to identify, develop, and adjudicate related claims for secondary service connection for complications arising from the primary disability that are "reasonably raised" during the adjudication of an increased rating claim for the primary disability.) Here, while the Veteran's August 2011 VA Form 21-526 only identified his service connection claim as bladder cancer and the record does not specifically note a claim for ED until July 2022, the Veteran service-connected bladder cancer is rated based on his residuals of bladder cancer, which reasonably encompasses the urinary system and complications from urinary tract surgical invention, including penile function. See id. Also, given that when the Veteran initiated his review request of the initial assigned rating for bladder cancer, he included a claim for secondary ED suggesting he reasonably believed his residuals of bladder cancer encompassed ED. See VAF 20-0995. Resolving doubt in favor of the Veteran, the Board finds that his August 2011 VA application for bladder cancer reasonably encompassed complications of his bladder cancer such as ED. See Wilson, supra, and Bailey, supra.

There was no earlier informal or formal claim for service connection for bladder cancer or ED. See 38 C.F.R. §§ 3.1(p), 3.155(a). Indeed, the Veteran has not asserted, and the record does not indicate that he submitted a claim for ED prior to 2011. See Third Party Correspondence (September 2023); VAF 10182 (May 2025). Thus, the Board finds the relevant date of claim is no earlier than August 16, 2011.

Notwithstanding, second, the Board finds that the date entitlement arose is not until March 4, 2022, the date reflected on a private treatment record first reflecting his complaints of ED that was later attributed to his bladder cancer. See Medical Treatment Record - Non-Government Facility at 38 (July 2024); see also C&P Exam (July 2022). Here, the record reflects that the Veteran met the requirements for the benefit sought - service connection for ED - on a facts-found basis on March 4, 2022, and not prior to that date. See 38 U.S.C. § 5110(a); McGrath v. Gober, 14 Vet. App. 28, 35 (2000). These facts found show the first competent evidence of a current disability required to satisfy the first criteria for award of service connection as authorized by law and regulation. See 38 C.F.R. § 3.310 (secondary service connection requires; (1) evidence of a current disability for which secondary service connection is sought; (2) a disability for which service connection has been established; and (3) competent evidence of a nexus between the two); see also 38 C.F.R. § 3.400. While the private treatment record reflects that March 4, 2022, is the date that the private treatment record was scanned and does not reflect an actual date of encounter - that is the only date identified on the private treatment record. As March 4, 2022, is the date of the first medical evidence of record that documents findings of ED, which was subsequently associated with his bladder cancer in the July 2022 VA urinary tract DBQ. See id; C&P Exam (July 2022). This is the date that the criteria for secondary service connection were met.

The persuasive evidence of record weighs against finding a current disability of ED until March 2022. Here, the available medical evidence prior to March 2022 does not show the Veteran reported ED-related complaints. For example, an August 2021 private treatment records shows that the Veteran was prescribed Sildenafil for pulmonary hypertension at bedtime and he was not prescribed Sildenafil for ED until March 2022. Additionally, VA mental health treatment records show the Veteran specifically denied sexual dysfunction in June 2010 and he did not report sexual dysfunction when asked by his VA provider in September 2020. See CAPRI (December 2021).

To the extent that the Veteran and his wife now assert he has had ED since August 2011, such lay statements are inconsistent with his prior reported symptomatology in contemporaneous records. See VA Form 21-10210 (July 2024); see also Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant). First, in a July 2022 statement, the Veteran stated: "I now have erectile dysfunction that I have to deal with" and his wife also noted his problems with ED but she did not specify an onset. See VA Form 21-10210 (July 2022). Second, as noted above, in September 2020, the Veteran did not report ED to his VA provider after being prompted to do so. As such the Board finds the current assertions are inconsistent with the Veteran's prior reported history of ED to VA. See Pond v. West, 12 Vet. App. 341 (1999) (although the Board must take into consideration a claimant's statements, it may consider whether self-interest may be a factor in making such statements); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table) (holding that, in weighing credibility of lay evidence VA may consider such elements as interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, desire for monetary gain, and demeanor of the witness). Therefore, the Board finds the current lay statements have no probative value in determining the date entitlement arose.

The Board finds the persuasive evidence of record first shows evidence of ED in the March 4, 2022, private treatment record which the July 2022 DBQ report later associated with his bladder cancer. Thus, the date of entitlement arose is no earlier than March 4, 2022.

The Board has also considered the private medical opinion, received in July 2024, that it is at least as likely as not that the Veteran had ED associated with his bladder cancer since August 2011. See Medical Treatment Record - Non-Government Facility (July 2024). The Board finds the private medical opinion is inadequate to demonstrate an earlier diagnosis of ED. Here, the private opinion appears to primarily rely on the Veteran's current lay statements and does not reconcile the prior treatment records by the same provider which reflect no complaints associated with the Veteran's bladder cancer. Thus, the Board finds the private opinion is not persuasive evidence since it does not reflect consideration of seemingly relevant evidence in formulating his conclusion. See Nieves- Rodriguez, 22 Vet. App. at 295; Stefl, 21 Vet. App. at 124.

Given the above, the record supports the date entitlement arose as March 4, 2022. However, there is no legal basis under the applicable effective date laws for the assignment of an effective date prior to March 4, 2022, as the effective date is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Although a claim for ED was reasonably encompassed by the Veteran's August 2011 VA application for compensation for bladder cancer, the persuasive evidence of records weighs against finding entitlement arose for ED as secondary service connection prior to March 4, 2022.

Accordingly, the claim is granted to that extent only. As the evidence of record persuasively weighs against an earlier effective date, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, 21 F.4th at 776.

2. Entitlement to an effective date prior to June 24, 2022, for award of SMC-K

SMC is a special statutory award granted in addition to awards based on the schedular evaluations provided by the diagnostic codes in VA's rating schedule. Claims for SMC, other than those pertaining to one-time awards and an annual clothing allowance, are governed by 38 U.S.C. § 1114 (k) through (t) and 38 C.F.R. § 3.
rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, 21 F.4th at 776.

2. Entitlement to an effective date prior to June 24, 2022, for award of SMC-K

The specific rate for SMC-K is payable if the Veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of one or more creative organs. 38 U.S.C. § 1114 (k); 38 C.F.R. § 3.350 (a). Impotence is tantamount to loss of use of a creative organ. See 38 C.F.R. § 4.115b, Diagnostic Code 7522. VA policy is to pay SMC for loss of use of a creative organ whenever a service-connected disease causes loss of erectile power. It must initially be established; however, that the loss of erectile function is a manifestation of a service-connected disease or injury.

In this case, SMC-K is based on the grant of service connection for erectile dysfunction associated with the Veteran's service-connected bladder cancer. As the effective date of the grant of service-connected compensation for erectile dysfunction is now March 4, 2022, the Board finds that criteria support an effective date of March 4, 2022, for the grant of SMC-K.

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Accordingly, the claim is granted to that extent only. The evidence weighs against assigning an earlier effective date and is not approximately balanced. There is no reasonable doubt to resolve. Lynch v. McDonough, 999 F.3rd 1391 (2021).

Mariah N. Sim

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J.M., 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.

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