BLADDER DISEASE OF

Summary

The veteran, who served from May 1985 to July 2006, including service in the Southwest Asia theater of operations during the Persian Gulf War, appeals the denial of service connection for prostate and bladder disorders. The veteran claims these conditions were caused by service, including toxic exposure risk activities (TERAs). The Board found that current diagnoses of benign prostatic hypertrophy (BPH) and overactive bladder were present, satisfying the first element of service connection. However, the service treatment records did not reflect any complaints, treatment, or diagnosis of these conditions during service, nor did examinations reveal related issues. The veteran's own reports also denied urinary complaints. The Board noted that while the veteran is a Persian Gulf Veteran presumed to have been exposed to environmental hazards, the medical evidence did not support a link between BPH or overactive bladder and these exposures. A VA examiner opined that these conditions were less likely than not caused by TERAs, citing risk factors unrelated to service and a lack of medical evidence linking them to exposures. The Board found this opinion, along with other medical evidence, more probative than the veteran's lay statements regarding etiology, ultimately denying service connection for both conditions.

Rationale

Current disorder shown (overactive bladder); No in-service incurrence or complaints found in STRs; VA examiner opined less likely than not caused by TERAs

Full Decision Text

Citation Nr: A26036866
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 251219-617490
DATE: April 21, 2026

ORDER

Service connection for a bladder disorder is denied.

Service connection for a prostate disorder is denied.

FINDINGS OF FACT

1. The Veteran served on active duty from May 1985 to July 2006, including service in the Southwest Asia (SWA) theater of operations during the Persian Gulf War (PGW); he has been 100 percent disabled based on unemployability since January 2026 and in receipt of special monthly compensation since February 2020.

2. A bladder disorder and a prostate disorder were not shown in service and are not causally or etiologically related to service, to include service in SWA or toxic exposure risk activities (TERAs).

CONCLUSIONS OF LAW

1. A bladder disorder was not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.317 (2025).

2. A prostate disorder was not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.317 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

In September 2024, the agency of original jurisdiction (AOJ) denied the claims. In December 2024, the Veteran requested a Higher-Level Review (HLR). In March 2025, the AOJ issued the HLR decision, which considered the evidence of record at the time of the September 2024 decision. In December 2025, the Veteran appealed to the Board via a Form 10182 and elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal. 38 C.F.R. § 20.301. 

Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

Service connection may be granted on a presumptive basis for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability, including an undiagnosed illness or a medically unexplained chronic multi-symptom illness (MUCMI), that is defined by a cluster of signs or symptoms, such as chronic fatigue syndrome, fibromyalgia, and other functional disorders.

The disability must manifest either during active service in the SWA theater of operations during the Persian Gulf War (PGW), or to a degree of 10 percent or more. An undiagnosed illness is one which, by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317; 81 Fed. Reg. 71, 382-84 (Oct. 17, 2016).

The term "Persian Gulf Veteran" means a veteran who served on active military, naval, or air service in the SWA theater of operations during the PGW. 38 C.F.R. § 3.317(e)(1). The "Southwest Asia theater of operations" refers to Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317(e)(2). The PGW means the period beginning on August 2, 1990, and ending on the date thereafter prescribed by Presidential proclamation or by law. 38 C.F.R. § 3.2.

MUCMI means a diagnosed illness without conclusive pathology or etiology that is characterized by overlapping signs or symptoms and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities.
 Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317(e)(2). The PGW means the period beginning on August 2, 1990, and ending on the date thereafter prescribed by Presidential proclamation or by law. 38 C.F.R. § 3.2.

MUCMI means a diagnosed illness without conclusive pathology or etiology that is characterized by overlapping signs or symptoms and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(1)(B)(ii).

Signs and symptoms that may be manifestations or undiagnosed illnesses or an MUCMI include fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 C.F.R. § 3.317(b).

Under 38 C.F.R. § 3.317, disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The 6-month period of chronicity will be measured from the earliest date upon which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest.

On August 10, 2022, President Biden signed into law the Honoring Our Promise to Address Comprehensive Toxics (PACT) Act of 2022. The PACT Act provides that veterans who served in certain areas of SWA on or after August 2, 1990, are covered by the PACT Act, including Iraq, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar, and United Arab Emirates, Somalia, or the neutral zone between Iraq and Saudi Arabia, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, and the Red Sea. See PACT Act, 38 U.S.C. § 1119(c)(1)(A)(ii), (iii). The PACT Act does not list patellofemoral pain syndrome as a disease presumed to be service connected for covered veterans. See 38 U.S.C. § 1120(b)(10).

Notwithstanding the foregoing presumption provisions for toxic exposure, a claimant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); see also Ramey v. Gober, 120 F.3d 1239, 1247-48 (Fed. Cir. 1997), aff'd Ramey v. Brown, 9 Vet. App. 40 (1996); Brock v. Brown, 10 Vet. App. 155, 160-61 (1997).

As an initial matter, the service records reflect that the Veteran had qualifying service on active duty in SWA; therefore, he is a Persian Gulf Veteran. Nonetheless, the evidence does not reflect symptoms consistent with an undiagnosed illness or MUCMI.

The Veteran claims he has prostate and bladder disorders caused by service. As the evidence for each is similar, they will be analyzed together. Turning to the medical evidence, a June 2024 VA examiner diagnosed of benign prostatic hypertrophy (BPH) and an overactive bladder. VA and private treatment records also reflect the same diagnoses. Therefore, current disorders are shown and the first element of service connection is met for both claims.

As to in-service incurrence, the service treatment records (STRs) do not reflect complaints of, treatment for, or a diagnosis of prostate or bladder disorders. Importantly, multiple examinations performed during active duty did not reflect any complaints related to the prostate, bladder, or urination. Of note, the Veteran denied frequent or painful urination in April 1985 and December 2004 Reports of Medical History. As such, the medical evidence does not support the in-service incurrence of prostate or bladder disorders.

To the extent that the Veteran claims that the prostate and bladder disorders are related to an undiagnosed illness or MUCMI, a June 2024 VA examiner noted that the medical evidence showed that the etiologies of the diagnoses of BPH and overactive bladder were related to risk factors not associated with service. There
, treatment for, or a diagnosis of prostate or bladder disorders. Importantly, multiple examinations performed during active duty did not reflect any complaints related to the prostate, bladder, or urination. Of note, the Veteran denied frequent or painful urination in April 1985 and December 2004 Reports of Medical History. As such, the medical evidence does not support the in-service incurrence of prostate or bladder disorders.

To the extent that the Veteran claims that the prostate and bladder disorders are related to an undiagnosed illness or MUCMI, a June 2024 VA examiner noted that the medical evidence showed that the etiologies of the diagnoses of BPH and overactive bladder were related to risk factors not associated with service. There is no evidence that either BPH or an overactive bladder is an undiagnosed illness, MUCMI, or diagnosable chronic multisystem illness with partially explained etiology.

Nonetheless, as a Persian Gulf Veteran, the Veteran is presumed to have been exposed to environmental hazards while serving in SWA and such exposure constitutes an in-service element to which the disorders could be directly linked. However, the only medical opinions of record indicated that BPH and an overactive bladder were not related to environmental exposures in service.

Notably, the June 2024 VA examiner opined that the BPH and an overactive bladder were less likely than not caused by the indicated TERAs, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran. 

The examiner examined the Veteran, reviewed the claims file, and cited to medical literature. The examiner explained that there was no medical or scientific evidence available that provided any indication of a relationship between the development of BPH or an overactive bladder and Veteran's TERAs. The examiner concluded that the etiology of BPH and an overactive bladder was related to risk factors unrelated to service.

There is no conflicting medical opinion of record as to either disorder on appeal. Therefore, the medical evidence does not support service connection for prostate or bladder disorders on any basis.

The Board has considered the Veteran's lay statements that the prostate and bladder disorders were caused by service. While he is competent to report symptoms as this requires only personal knowledge as it comes to him through his senses, he is not competent to offer an opinion as to the etiology of either claimed disorder due to the medical complexity of the matters involved.

Such competent evidence concerning the nature and extent of the Veteran's prostate and bladder disorders has been provided by the medical personnel who examined him during the current appeal, and who rendered pertinent opinions in conjunction with the evaluations.

Their findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which these disorders are evaluated. The VA medical professional explained their reasoning based on an accurate characterization of the evidence. Therefore, the Board attaches greater probative weight to the examination report and clinical findings than to the lay statements regarding etiology.

In sum, after a careful review of the record, the evidence weighs persuasively against the claims for service connection and there is no doubt to be resolved. As such, the appeals are denied.

Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

 

 

L. HOWELL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	E. Redman

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.