URINARY INCONTINENCE

Summary

The veteran, who served from April 1971 to April 1975, appeals the denial of service connection for urinary incontinence (UI) as secondary to his service-connected left lower extremity radiculopathy and/or degenerative arthritis of the lumbar spine. The Board reviewed the evidence of record at the time of the agency of original jurisdiction's (AOJ) supplemental claim decision. The primary issue was secondary service connection, as direct service connection was not raised. The Board found that while the veteran has a UI diagnosis, the evidence persuasively weighs against a finding that it is caused or aggravated by his service-connected disabilities. The October 2020 VA examiner opined that the UI was less likely than not proximately due to or the result of the service-connected conditions, citing medical literature indicating UI can follow prostate brachytherapy. This opinion was found highly probative and was not contradicted by other evidence. The Board noted that while the examiner did not specifically address aggravation, the opinion encompassed it. The Board applied the "but-for" causation standard from Spicer and Payne, concluding that the UI would not have been less severe but for the service-connected disabilities, and no multi-link causal chain was established. The Board also noted that the service-connected lumbar spine disability's rating criteria include evaluating associated objective neurologic abnormalities, but the UI was not shown to be such an abnormality. The Board gave more weight to the VA examiner's opinion over the veteran's lay opinion, finding the latter outside the veteran's competence. Ultimately, the Board denied the claim, finding the evidence weighed against it and the benefit-of-the-doubt rule inapplicable.

Rationale

VA examiner opined UI was less likely than not related to service-connected conditions.; Prostate brachytherapy identified as a more likely cause of UI.; No evidence of multi-link causal chain or inability to treat UI due to service-connected disabilities.

Full Decision Text

Citation Nr: A26003964
Decision Date: 01/15/26	Archive Date: 01/15/26

DOCKET NO. 220711-257270
DATE: January 15, 2026

ORDER

Entitlement to service connection for urinary incontinence (UI) to include as secondary left lower extremity radiculopathy and/or degenerative arthritis of the lumbar spine is denied. 

FINDING OF FACT

The weight of the probative evidence is against a finding that the Veteran's urinary incontinence is secondary to service-connected left lower extremity radiculopathy or degenerative arthritis of the lumbar spine. 

CONCLUSION OF LAW

The criteria for service connection for urinary incontinence as secondary to left lower extremity radiculopathy and/or degenerative arthritis of the lumbar spine are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from April 1971 to April 1975.

By way of procedural history, the claims were initially denied in a November 2020 rating decision.  In August 2021, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the November 2020 decision.  In October 2021, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior decision.  The higher-level reviewer identified duty to assist (DTA) errors that existed at the time of the October 2021 rating decision. Additional development took place and in a February 2022 rating decision, the AOJ readjudicated and continued to deny the claims.  In March 2022, the Veteran submitted a supplemental claim.  In a June 2022 rating decision, the AOJ determined that new and relevant evidence had not been submitted as to the issue of service connection for urinary incontinence and continued to deny the claim.

In the July 2022 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ's supplemental claim decision on appeal. 38 C.F.R. § 20.301. 

In a December 2024 decision, the Board, inter alia, denied the claim of entitlement to service connection for UI.  The Veteran appealed this denial to the Court of Appeals for Veterans Claims (Court).  The Court granted a Joint Motion for Partial Remand (JMPR) in June 2025, vacating the aforementioned Board decision to the extent that it denied the service connection claim for UI and remanded the appeal back to the Board.

Entitlement to service connection for UI

The Veteran contends that his urinary incontinence is secondary to service-connected left lower extremity radiculopathy and/or degenerative arthritis of the lumbar spine.

Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection.

Service connection is warranted for disability that is proximately due to or the result of service-connected disease or injury.  38 C.F.R. § 3.310(a).  Secondary service connection under 38 C.F.R. § 3.310(a) is warranted where a non-service-connected disability would have been less severe but for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.  Spicer v. McDonough, 61 F. 4th 1360, 1366 (Fed. Cir. 2023) ("but for" causation "applies to the natural progression of a condition not caused by a service-connected injury or disease, but that nonetheless would have been less severe were it not for the service-connected disability.  Stated another way...compensation [is warranted] for a worsening of functionality-whether through an inability to treat or a more direct, etiological cause").  The Court has also held that the 'causation requirement in the phrase 'the result of' is 'broad,' in that it permits entitlement to VA benefits based on a multi-link causal chain.  Payne v. Wilkie, 31 Vet. App. 373, 384 (2019).

The Board concludes that, while the Veteran has a urinary incontinence diagnosis, the evidence of record persuasively weighs against a finding that it is caused or
 injury or disease, but that nonetheless would have been less severe were it not for the service-connected disability.  Stated another way...compensation [is warranted] for a worsening of functionality-whether through an inability to treat or a more direct, etiological cause").  The Court has also held that the 'causation requirement in the phrase 'the result of' is 'broad,' in that it permits entitlement to VA benefits based on a multi-link causal chain.  Payne v. Wilkie, 31 Vet. App. 373, 384 (2019).

The Board concludes that, while the Veteran has a urinary incontinence diagnosis, the evidence of record persuasively weighs against a finding that it is caused or aggravated by a service-connected disability, or that the UI would have been less severe but for a service-connected disability.  

The October 2020 VA examiner opined that the Veteran's urinary incontinence was less likely than not proximately due to or the result of his service-connected left lower extremity radiculopathy or degenerative arthritis of the lumbar spine. The rationale was as follows: 

Degenerative disc disease (DDD) or arthritis of the lumbar spine is a multifactorial occurrence with a strong genetic component. Age and environmental factors contribute to the degenerative process.  Typical symptoms include stiffness, pain, bone spurs, loss of flexibility or range of motion, radicular pain.  Radiculopathy is when the nerve root which exits the spinal canal is irritated.  It may occur when a spinal disc bulges against the nerve, narrowing of the spinal canal, bone spurs or tumors in the spine.  This may result in the typical symptoms of numbness, tingling, sharp pain, muscle cramps and weakness down the extremities.  In some DDD cases, disc herniation is present.  Conus medullaris syndrome and cauda equina syndromes are severe forms of disc herniation that may present with paresis, sensory deficits, and urinary/bowel incontinence, and require urgent decompression via surgical intervention.  Evidence review shows no diagnosis of conus medullaris syndrome or cauda equina syndrome to support causal association to veteran's urinary incontinence claim.  Review of medical record shows previous documentations of the veteran reporting urinary incontinence present since his past prostate treatment.  According to Johns Hopkins Medicine, following Brachytherapy, 20 to 40% of men with normal urinary function at baseline will have persistently increased urinary symptoms requiring pads or medications after receiving brachytherapy.

The VA examiner then cited to several medical references supporting the occurrence of urinary incontinence following prostate brachytherapy.

In this case, the Board finds the October 2020 VA medical opinion to be highly probative as to the issue of secondary service connection because it is based on an accurate medical history and provides explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).

Notably, there are no contrary medical opinions of record.  The Board notes that although the VA examiner did not specifically address whether the Veteran's service-connected lower extremity radiculopathy and/or lumbar arthritis aggravated his urinary incontinence, the opinion, read as a whole, shows that his past prostate cancer treatment (i.e., brachytherapy) is a noted cause for his disability. Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read and in the context of the evidence of record).  Thus, the examiner's findings are broad enough to foreclose the possibility of aggravation. El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (considering the possibility that language in a medical opinion could be considered to address aggravation without specifically using that word but rejecting the argument on the facts of that case); Chavez v. McDonald, No. 13-2886 (mem. dec. Sept. 22, 2014) (medical opinion on secondary relationship was adequate even though it did not specifically say "not aggravated," because read as a whole it encompassed aggravation); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain).  Notably, this is consistent with the other medical evidence of record including VA treatment records. See, e.g., June 2021 VA Treatment Records (noting "it is likely his urinary symptoms are related to his prostate and other urological issues...").  

The Board recognizes that the parties to the June 2025 JMPR found that the Board "must address the evidence of record
medical opinion on secondary relationship was adequate even though it did not specifically say "not aggravated," because read as a whole it encompassed aggravation); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain).  Notably, this is consistent with the other medical evidence of record including VA treatment records. See, e.g., June 2021 VA Treatment Records (noting "it is likely his urinary symptoms are related to his prostate and other urological issues...").  

The Board recognizes that the parties to the June 2025 JMPR found that the Board "must address the evidence of record in light of the correct standard of causation." That is, the Board must adopt the but-for standard of causation set forth in this Court's decision in Payne and the Federal Circuit's decision in Spicer.  The Board has considered the present claim in the context of these holdings; however, nothing in the record suggests that the Veteran's UI would have been less severe but for the service connected disabilities or that a multi-link causal chain exists.  This has not been endorsed by the Veteran or otherwise raised by the record.  As noted above, the medical evidence of record has not established an etiological link (to include worsening of functionality) between the UI and the service-connected disabilities and there is no evidence to suggest that the service-connected disabilities resulted in the inability to treat the non-service-connected UI.  See Spicer, supra.   Moreover, there is no medical or lay evidence suggesting that the UI was caused by a service-connected disability via multiple steps in a causal chain.  Again, the medical evidence shows that his past prostate cancer treatment (i.e., brachytherapy) is a noted cause for his UI and the VA examiner all but rejected any etiological relationship between the UI and the service-connected disabilities based on objective evidence of record.  Thus, while the Board has considered the but-for causation standard articulated in Spicer and Payne, the Veteran's claim still fails on a secondary basis for the reasons discussed above.  

The Board further notes that the Veteran's service-connected lumbar spine disability is rated under the General Rating Formula for Diseases and Injuries of the Spine.  See 38 C.F.R. § 4.71a.  Note (1) of the General Rating Formula states to evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.  Id.  Based on this, the Veteran is service connected for radiculopathy of the left lower extremity as an associated neurological abnormality of the lumbar spine disability.  His urinary incontinence, however, has not been shown to be a neurological abnormality associated with the service connected lumbar spine disability and thus any further consideration of secondary service connection in this regard is not warranted. 

The Veteran believes the claimed urinary incontinence is secondary to his service- connected disabilities.  However, he is not competent to provide a nexus opinion regarding this issue.  The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body, anatomical relationships, and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).  Consequently, the Board gives more probative weight to the findings of the October 2020 VA examiner.

In short, as the most probative evidence of record weighs against the claim, the benefit-of-the-doubt rule is inapplicable, and the claim for service connection for urinary incontinence as secondary to service-connected left lower extremity radiculopathy and/or degenerative arthritis of the lumbar spine is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021). 

 

 

JONATHAN B. KRAMER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	H. Hoeft, 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.