URINARY INCONTINENCE

Summary

The Veteran served from July 2007 to January 2019, with service periods spanning multiple years. The Veteran sought service connection for incontinence and a left knee condition, specifically on a secondary basis. The Board of Veterans' Appeals found that the Veteran had current diagnoses of urinary urge incontinence and left knee strain, and was already service-connected for vaginitis and intervertebral disc syndrome. Crucially, the Board considered a private medical opinion from a CNP that found the Veteran's urinary incontinence was at least as likely as not secondary to her service-connected vaginitis, citing medical literature supporting this link. Similarly, another private opinion concluded the Veteran's left knee condition was at least as likely as not secondary to her service-connected back condition, explaining the knee-hip-spine syndrome connection. The Board afforded these opinions significant probative weight due to their thoroughness, logical conclusions, supporting data, and reasoned medical explanations, noting the absence of contradictory opinions. Consequently, the Board resolved all doubt in the Veteran's favor and granted service connection for incontinence secondary to vaginitis, and for the left knee condition secondary to intervertebral disc syndrome.

Rationale

Favorable private medical opinion finding nexus; No contradictory opinions; Benefit of the doubt afforded

Full Decision Text

Citation Nr: A26036709
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 210831-182759
DATE: April 21, 2026

ORDER

Entitlement to service connection for incontinence, as secondary to service-connected vaginitis, is granted.

Entitlement to service connection for left knee condition, as secondary to service-connected intervertebral disc syndrome, is granted.

FINDINGS OF FACT

1. The Veteran's incontinence is due to her service-connected vaginitis.

2. The Veteran's left knee condition is due to her service-connected intervertebral disc syndrome.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for incontinence, as secondary to service-connected vaginitis, have been met.  38?U.S.C. §§?1110, 1131, 5107;?38?C.F.R. §§?3.102, 3.310.??

2. The criteria for entitlement to service connection for left knee condition, as secondary to service-connected intervertebral disc syndrome, have been met.  38?U.S.C. §§?1110, 1131, 5107;?38?C.F.R. §§?3.102, 3.310.?? 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 2007 to July 2008, September 2009 to March 2012, and July 2012 to January 2019.

The rating decision on appeal was issued in May 2021 under the modernized review system.  In August 2021, the Veteran filed VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) and elected the Hearing docket.  On May 16, 2025, the Veteran withdrew the hearing request.  Therefore, the Board may only consider the evidence of record at the time of the May 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or her representative within 90 days following receipt of the withdrawal of the hearing request.  38 C.F.R. § 20.302(b).  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(b), 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 claim s, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

SERVICE CONNECTION

The Veteran seeks entitlement to service connection for incontinence and a left knee condition, to include on a secondary basis.  See January 2021 Claim. 

Applicable Law

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service.? 38?U.S.C. §§?1110, 1131; 38?C.F.R. §?3.303.  Service connection generally requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).? 

Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury.  38?C.F.R. §?3.310(a).  A disability that is proximately due to, the result of, or chronically aggravated by a service-connected disease or injury is considered service-connected, and when thus established, this secondary condition is considered a part of the original condition.? 38?C.F.R. §?3.310(a) and (b).? Establishing service connection on this secondary basis requires evidence sufficient to show: (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability.
 secondary basis for a disability which is proximately due to or the result of service-connected disease or injury.  38?C.F.R. §?3.310(a).  A disability that is proximately due to, the result of, or chronically aggravated by a service-connected disease or injury is considered service-connected, and when thus established, this secondary condition is considered a part of the original condition.? 38?C.F.R. §?3.310(a) and (b).? Establishing service connection on this secondary basis requires evidence sufficient to show: (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability.  Allen v. Brown, 7?Vet. App.?439 (1995) (en?banc).?? 

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran.  See 38?U.S.C. §?5107;?38?C.F.R. §?3.102; see also Lynch v. McDonough, 21 F.4th 776 (2021).? 

Analysis

As to current disabilities, the AOJ favorably found the Veteran has been diagnosed with urinary urge incontinence and left knee strain.  See May 2021 Rating Decision- Narrative.  The Board is bound by the favorable finding.? ?38?C.F.R. §?3.104(c).  As to a separate disability already subject to service connection, the Veteran is in receipt of service connection for vaginitis and intervertebral disc syndrome.  See generally Rating Decision-Codesheet.

As to a nexus, or link, there is an opinion that the Veteran's urinary incontinence is at least as likely as not secondary to her service-connected vaginitis.  The examiner acknowledged the Veteran's urinary incontinence and service-connected vaginitis and detailed the Veteran's medical history specifically regarding her urinary incontinence.  In rendering the opinion, the examiner reviewed the Veteran's military service records, medical files, and current scientific research.  As a rationale, the examiner cited medical literature stating that the urinary incontinence could be caused by pregnant, childbirth, urinary tract infection, infection of the vagina, or irritation of the vagina from lack of estrogen (vaginitis).  See July 25, 2025, M.M., DNP, CNP Opinion.

There is an opinion that the Veteran's left knee is at least as likely as not secondary to her back condition.  In rendering the opinion, the examiner reviewed the Veteran's military service records, medical files, and current scientific research.  The examiner acknowledged the Veteran's service-connected back condition, motor vehicle accident during military service, and left knee issues and detailed the Veteran's medical history specifically regarding her left knee issues.  As a rationale, the examiner explained that bodies are like a chain with the knees connected to the femur connected to the pelvis, which is connected to the spine and hips.  The examiner explained that if one of the chains in the link is out of position then the rest of the chain is affected, which is known as the knee-hip-spine syndrome.  Citing medical literature, the examiner elaborated on how the spine, hip, and knee are anatomically connected.  See id.

After careful review and consideration, the Board affords the opinions significant probative weight.  The opinions are thorough, logical, and contain clear conclusions with supporting data and a reasoned medical explanation connecting the two.  See Nieves-Rodriguez v. Peake, 22?Vet. App.?295, 301 (2008) (explaining that a medical examination report must contain clear conclusions with supporting data and a reasoned medical explanation connecting the two).  Notably, there are no contradictory opinions regarding service connection on a secondary basis. 

As all three elements of service connection on a secondary basis have been met, a current disability, a separate disability already subject to service connection, and a nexus, or link, the Board resolves all doubt in favor of the Veteran and finds that?entitlement to service connection?for incontinence, as secondary to service-connected vaginitis, and entitlement to service connection for left knee condition, as secondary to service-connected intervertebral disc syndrome, is warranted.  See 38?U.S.C. §?5107;?38?C.F.R. §?3.102; Lynch v. 21 F.4th at 776.  

In reaching the foregoing decision, the Board notes that service connection on a direct basis was raised by the record and that there are negative opinions opining that the Veteran's incontinence and left knee condition are
 service connection, and a nexus, or link, the Board resolves all doubt in favor of the Veteran and finds that?entitlement to service connection?for incontinence, as secondary to service-connected vaginitis, and entitlement to service connection for left knee condition, as secondary to service-connected intervertebral disc syndrome, is warranted.  See 38?U.S.C. §?5107;?38?C.F.R. §?3.102; Lynch v. 21 F.4th at 776.  

In reaching the foregoing decision, the Board notes that service connection on a direct basis was raised by the record and that there are negative opinions opining that the Veteran's incontinence and left knee condition are not related to her military service.  However, as the Veteran advanced her claim on a secondary basis with the positive private opinions and the Board is granting the claim on a secondary basis, the Board declines to address?service connection on a direct basis. 

 

 

JIMMY L. BARDIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Ti'a Smith, 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.