URINARY INCONTINENCE

Summary

The veteran, an Army veteran who served from November 2007 to April 2011, appeals the denial of service connection for urinary incontinence and left ankle sprain. The Board granted service connection for urinary incontinence, finding that the Veteran's current symptoms of urinary leakage, coupled with an in-service diagnosis of acute cystitis, established a nexus to service. Although a VA examiner initially provided a negative addendum opinion, the Board found the initial positive opinion more persuasive, noting the examiner's failure to explain why the Veteran's credible account of ongoing symptoms should be disbelieved. For the left ankle sprain, the Board denied direct service connection, as service treatment records did not indicate an ankle injury. However, service connection was granted on a secondary basis. The Board found that the Veteran's service-connected right knee disability, secondary to her right knee injury, placed additional strain on her left ankle, citing medical opinions that explained how limping from a knee injury stresses other joints. Applying the benefit of the doubt, the Board found the reasoning sufficient to establish a secondary nexus for the left ankle disability.

Rationale

Current disability of urinary incontinence established.; In-service diagnosis of acute cystitis.; Conflicting VA examiner opinions; Board found initial positive opinion persuasive over negative addendum.

Full Decision Text

Citation Nr: A26037161
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 250412-537606
DATE: April 21, 2026

ORDER

Entitlement to service connection for urinary incontinence is granted.

Entitlement to service connection for left ankle sprain is granted.

FINDINGS OF FACT

1. The Veteran's urinary incontinence had its onset during active duty service and has continued since that time.

2. The Veteran's left ankle sprain was caused by her service-connected right knee disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for urinary incontinence are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for left ankle sprain as secondary to service-connected right knee strain are 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 in the United States Army from November 2007 to April 2011. This matter comes to the Board of Veterans' Appeals (Board) from a pair of rating decisions issued by a Regional Office (RO) of the Department of Veterans Affairs (VA) in October 2024 (for the ankle claim) and March 2025 (for the urinary incontinence claim).

In the April 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 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ 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. 

Service Connection

A Veteran is entitled to service connection for a disability resulting from a disease or injury incurred or aggravated during active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). To substantiate a claim of service connection, there must be evidence of (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury in service; and (3) a causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Service connection may be established on a secondary basis for a disability that is proximately due to or the result of, or aggravated by, a service-connected disability. 38 C.F.R. § 3.310 (a). To establish secondary service connection there must be evidence: (1) of a current disability (for which secondary service connection is sought); (2) of an already service-connected disability; and (3) that the current disability for which service connection is sought was either (a) caused or (b) aggravated by the service-connected disability. 38 C.F.R. § 3.310 (a); see Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).

Entitlement to service connection for urinary incontinence is granted.

VA grants service connection for disabilities, not diagnoses. While the two concepts are closely related, they are not the same: a diagnosis is the specific identity of a medical condition, whereas a disability is the functional limitation imposed by a medical condition. Thus, in some cases service connection can be granted without an underlying diagnosis. In others, multiple diagnoses can be grouped and assigned a single disability rating. In still others, a single diagnosis can be assigned multiple disability ratings.
b) aggravated by the service-connected disability. 38 C.F.R. § 3.310 (a); see Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).

Entitlement to service connection for urinary incontinence is granted.

VA grants service connection for disabilities, not diagnoses. While the two concepts are closely related, they are not the same: a diagnosis is the specific identity of a medical condition, whereas a disability is the functional limitation imposed by a medical condition. Thus, in some cases service connection can be granted without an underlying diagnosis. In others, multiple diagnoses can be grouped and assigned a single disability rating. In still others, a single diagnosis can be assigned multiple disability ratings. See generally Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) ("pain alone, absent a specific diagnosis or otherwise identified disease or injury, [can] constitute a disability"); Amberman v. Shinseki, 570 F.3d 1377 (Fed. Cir. 2009) (permitting VA to assign a single rating for a pair of psychiatric disabilities); Walleman v. McDonough, 35 Vet. App. 294 (2022) (multiple musculoskeletal ratings may be assigned for a single knee).

In this case, the evidence persuasively shows that Veteran suffers from symptoms of urinary incontinence. See December 2024 VA Urinary Tract Conditions DBQ (noting ongoing symptoms of voiding dysfunction). While the specific nature of her underlying diagnosis is in some dispute, VA recognizes urinary incontinence as a disability. See 38 C.F.R. § 4.115a (assigning disability ratings for varying degrees of severity of urine leakage). Therefore, the evidence before the Board persuasively shows that the Veteran suffers from a current disability, satisfying the first element of a claim for service connection.

During service, the Veteran sought treatment for symptoms of urinary frequency, and was diagnosed with acute cystitis and a urinary tract infection. See service treatment records dated June 8, 2020. This evidence is sufficient to show an in-service disease for the purpose of a claim for service connection.

VA arranged a medical examination in December 2024, and obtained a nexus opinion from the medical examiner. The examiner noted the 2010 diagnosis of acute cystitis, noted the Veteran's report that her symptoms have stayed the same since, and that she currently suffers from ongoing symptoms of urinary leakage. The examiner noted that the etiology of the current leakage was unknown, and did not note a specific current diagnosis. See December 2024 VA Urinary Tract Conditions DBQ. However, the examiner noted: "although rare, vet is deemed to be a reliable historian and urinary issues now can be linked to cystitis in service. At least as likely as not." See December 2024 VA Medical Opinion DBQ.

The Board notes that VA obtained an addendum opinion from the same examiner in March 2025 due to the apparent contradiction in an "acute" diagnosis continuing from 2010 to the present. The examiner responded by stating that there was "no evidence of chronic condition," and that there was therefore no nexus to service.

The Board finds the March 2025 addendum to be unpersuasive. There is evidence of a chronic condition: the Veteran's subjective reports of her medical history, as described by the examiner in the December 2024 questionnaire. The March 2025 addendum provides no explanation for why the Veteran's account, deemed credible in December 2024, should now be disbelieved.

Therefore, the evidence supports a nexus between the current disability and the in-service diagnosis of acute cystitis. Entitlement to service connection is granted. 

Entitlement to service connection for left ankle sprain is granted.

The Veteran has been diagnosed with left ankle collateral ligament and deltoid ligament sprains, both described as chronic/recurrent. See October 2024 VA Ankle Conditions DBQ. This evidence is sufficient to satisfy the first element of a claim for service connection.

The Veteran contends that her current left ankle disability has a direct nexus to a fall injury from July 2009. Briefly, the Board finds no evidence to support this contention. See service treatment records dated August 2, 2009; August 20, 2009 (both reporting right knee injuries related to the fall, but silent regarding any left ankle injury).

However, the Board notes that the Veteran has been granted service connection for lumbar spine, left hip, and left knee, all secondary to her right knee disability. In providing a positive nexus opinion for those disabilities, a medical examiner stated the following: "Overcompensating puts additional pressure on other joints, resulting in increased wear-and-tear of the unaffected joint over time." See December 202
 current left ankle disability has a direct nexus to a fall injury from July 2009. Briefly, the Board finds no evidence to support this contention. See service treatment records dated August 2, 2009; August 20, 2009 (both reporting right knee injuries related to the fall, but silent regarding any left ankle injury).

However, the Board notes that the Veteran has been granted service connection for lumbar spine, left hip, and left knee, all secondary to her right knee disability. In providing a positive nexus opinion for those disabilities, a medical examiner stated the following: "Overcompensating puts additional pressure on other joints, resulting in increased wear-and-tear of the unaffected joint over time." See December 2023 VA Medical Opinion DBQ. Speaking at greater length, another examiner stated the following: 

"If you've suffered any kind of knee injury, you know how much strain limping puts on other parts of your body. Not only does it add pressure to your other leg, but it also stresses the muscles around your back and hip. Over time, this wear and tear can put you at risk of further joint problems...." See January 2024 VA Medical Opinion DBQ.

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The Veteran's left ankle is just as much a part of the "other leg" as are her left hip and left knee. Therefore, affording the Veteran the benefit of the doubt, the Board finds that this reasoning provides sufficient support to find that the Veteran's left ankle disability is also service connected secondary to her right knee disability.  Entitlement to service connection for left ankle sprain is granted. 

 

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Sparks, Robert S.

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.