Citation Nr: 0844097 Decision Date: 12/22/08 Archive Date: 12/31/08 DOCKET NO. 07-34 752 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected diabetes mellitus, type II. ATTORNEY FOR THE BOARD S. Pflugner, Associate Counsel INTRODUCTION The veteran served on active duty from December 1963 to January 1977. This case comes to the Board of Veterans' Appeals (Board) on appeal from a July 2005 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The appeal is remanded to the RO via the Appeals Management Center in Washington, DC. REMAND Herein, the veteran is seeking service connection for erectile dysfunction secondary to this service-connected diabetes mellitus, type II. The veteran was granted service connection for diabetes mellitus, type II, by an August 2004 rating decision, wherein he was assigned a 10 percent disability evaluation. By a February 2005 rating decision, the veteran was granted an increase to a 20 percent disability evaluation for his service-connection diabetes mellitus, type II. In the February 2005 rating decision, the RO also deferred its decision on the veteran's service-connection claim for erectile dysfunction, to include as secondary to his service- connected diabetes mellitus, type II, pending a VA examination. The subsequently scheduled VA examination was to be conducted in April 2005; however, as noted on the resulting report, the examination amounted to telephonic communication between the examiner and the veteran. The veteran reported to the examiner that he had an appointment with his primary care provider in May 2005. The examiner concluded the report by stating the veteran presented with subjective complaints of erectile dysfunction without a history of counseling, medication, or medical evaluation. Further evaluation was postponed by the examiner pending referral following the veteran's May 2005 appointment with his primary care provider. In the May 2005 treatment report, it was noted that the veteran complained of decreased libido and erectile dysfunction since starting his heart medication, Coreg. The veteran also explained that, on mornings when the he forgets to take Coreg, he experiences erections. Ultimately, the veteran was assigned a diagnosis of erectile dysfunction "likely [secondary] to [C]oreg," and was given a prescription for Viagra. It was noted in the report that if the Viagra prescription did not work, adjustments to the veteran's Coreg will be considered. The veteran was denied service connection for erectile dysfunction, to include as secondary to diabetes mellitus, type II, by a July 2005 rating decision. In response to the July 2005 denial, the veteran's wife, a Registered Nurse, submitted a statement wherein she opined that the veteran's "onset of diabetes is the primary and chief reason my husband has erectile dysfunction problems. My husband's erectile dysfunction problems started years before he ever took his first dose of Coreg." She continued: At the present time, it is generally the opinion of most medical doctors that diabetes is the primary cause of erectile dysfunction problems among men. I agree that the Coreg has impacted and helped to further aggravate this problem, but in my opinion, it did not cause the initial problem that had started years before any medical doctor prescribed the medication Coreg for my husband. Based upon its review of the veteran's claims folder, the Board finds there is a further duty to assist the veteran with his claim herein. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2008). Though the veteran was scheduled for a VA examination, and the veteran did communicate with the examiner via telephone, no physical examination was conducted, nor were any diagnostic or clinical evaluations. Despite the fact that a medical professional attributed the veteran's erectile dysfunction to his heart medication, the veteran submitted a medical opinion from his wife that stands in opposition to such attribution. Moreover, none of the medical evidence of record contemplated a relationship between the veteran's service-connected diabetes mellitus, type II, and his erectile dysfunction in terms of aggravation. See Hickson v. West, 12 Vet. App. 247, 253 (1999); see also Pond v. West, 12 Vet App. 341, 346 (1999). Thus, the Board finds that the veteran must be scheduled for another VA examination. Accordingly, the case is remanded for the following action: 1. The RO must provide appropriate VCAA notice to the veteran with respect to his service connection claim for erectile dysfunction. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2008); see also Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). 2. The RO must contact the veteran to provide him an opportunity to identify all VA and non-VA medical providers who have treated him for erectile dysfunction during the course of this appeal. The RO must then obtain copies of the related medical records that are not already in the claims file. All attempts to secure this evidence must be documented in the claims file by the RO. If, after making reasonable efforts to obtain the identified records, the RO is unable to secure same, the RO must notify the veteran and (a) identify the specific records the RO is unable to obtain; (b) briefly explain the efforts that the RO made to obtain those records; and (c) describe any further action to be taken by the RO with respect to the claim. The veteran must then be given an opportunity to respond. 3. The RO must make arrangements with the appropriate VA medical facility for the veteran to be afforded a comprehensive examination conducted by the appropriate health care provider. All pertinent symptomatology and findings must be reported in detail. All indicated tests and studies must be performed. The claims folder and a copy of this remand must be made available to the examiner for review in conjunction with the examination. The examiner must review all the evidence of record, including the veteran's service medical records. After a review of the entire evidence of record, the examiner must render an opinion as to the presence, etiology, and severity of erectile dysfunction. If, and only if, erectile dysfunction is present, the examiner must opine as to whether the erectile dysfunction is related to or aggravated by the veteran's service-connected diabetes mellitus, type II. A complete rationale for any opinion expressed, to include citation to specific medical documents in the claims file and supporting clinical findings, must be included in the examination report. The report prepared must be typed. 4. The RO must notify the veteran that it is his responsibility to report for the examination and to cooperate in the development of the claim. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655 (2008). In the event that the veteran does not report for the aforementioned examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. 5. Once the above action has been completed, the RO must re-adjudicate the veteran's claim on appeal, taking into consideration any newly acquired evidence. If any benefit remains denied, a Supplemental Statement of the Case must be provided to the veteran and his representative. After the veteran has had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. No action is required by the veteran until he receives further notice; however, the veteran 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). _________________________________________________ JOY A. MCDONALD 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) (2008).