Citation Nr: 0804209 Decision Date: 02/06/08 Archive Date: 02/13/08 DOCKET NO. 05-18 153 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Boston, Massachusetts THE ISSUE Entitlement to service connection for erectile dysfunction secondary to post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD A. Hinton, Counsel INTRODUCTION The veteran served on active duty from November 1965 to October 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office in Boston, Massachusetts (RO), which, in pertinent part denied veteran's claim for service connection for erectile dysfunction as secondary to his service-connected PTSD. The veteran has subsequently raised a claim of entitlement to service connection on a direct basis, claiming that his erectile dysfunction was due to Agent Orange exposure in service. The RO denied that claim in a February 2007 rating decision, and review of the claims file does not show that the veteran has initiated an appeal for service connection for erectile dysfunction on that direct basis. Thus, that claim, for service connection for erectile dysfunction due to Agent Orange exposure in service is not on appeal before the Board at this time. The current appeal is with respect only to the veteran's claim of entitlement on a secondary basis, based on his claim that he has erectile dysfunction secondary to his service-connected PTSD. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The Board has reviewed the claims file and determined that further development is necessary prior to adjudicating the veteran's claim. The veteran claims entitlement to service connection for erectile dysfunction, as secondary to his service-connected PTSD. The veteran is service connected for PTSD, which is evaluated as 100 percent disabling. Medical evidence of record indicates that the veteran's PTSD is chronic and severe. The record includes a diagnosis of erectile dysfunction with a history over a number of years. Male erectile disorder is a listed disorder identified in the DSM-IV (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994)). Erectile dysfunction may include psychological causes such as stress, anxiety, guilt, and depression, which may be associated with PTSD. See DSM- IV; National Kidney and Urologic Diseases Information Clearing House: Erectile Dysfunction (http://kidney.niddk.nih.gov/kudiseases/pubs/impotence/ #cause). The veteran has not been examined by VA for the purpose of determining whether the veteran's erectile dysfunction is etiologically related to his service-connected PTSD; and there is currently no opinion on record addressing the question of the etiology of the veteran's diagnosed erectile dysfunction. Therefore, the RO should arrange for the veteran to be examined in order to obtain an opinion on the question of whether the veteran's erectile dysfunction is etiologically related to his service-connected PTSD. The fulfillment of the VA's statutory duty to assist the appellant includes providing a medical opinion, which takes into account the records of prior medical treatment, so that the disability evaluation will be a fully informed one. See Hyder v. Derwinski, 1 Vet. App. 221 (1991); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). (The duty to assist requires medical examination when such examination is necessary to make a decision on the claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c)(4).) Therefore, the Board is of the opinion that the veteran should be provided VA examination as instructed below. Accordingly, the case is REMANDED for the following action: 1. By appropriate means, the RO should request copies of any outstanding private or VA medical records of treatment for erectile dysfunction. 2. After accomplishing the above and obtaining any available records, the veteran should be afforded an appropriate VA examination in order to determine the nature and etiology of any erectile dysfunction. All studies deemed appropriate in the medical opinion of the examiner should be performed; and, all findings should be set forth in detail. The claims folder and a copy of this Remand must be made available to and reviewed by the examiner in conjunction with the examination, and this fact should be so indicated in the examination report. After reviewing the available medical records and examining the appellant, the examiner should render comments specifically addressing the following question: If an erectile dysfunction is diagnosed, and based upon an assessment of the entire record, is it at least as likely as not (probability of 50 percent or greater) that such disorder is proximately due to, the result of, or increased by, a service-connected disease or injury, to specifically include the veteran's PTSD. 3. Following any additional development deemed appropriate, the RO should readjudicate the claim for service connection for erectile dysfunction. If the determination remains unfavorable to the appellant, he and his representative should be furnished a supplemental statement of the case and be afforded the applicable time period in which to respond. Thereafter, the case should be returned to the Board for further appellate consideration. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). _________________________________________________ DENNIS F. CHIAPPETTA Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2007).