Citation Nr: 18139980 Decision Date: 10/02/18 Archive Date: 10/01/18 DOCKET NO. 15-23 250 DATE: October 2, 2018 REMANDED Entitlement to service connection for low testosterone, including as secondary to left varicocele surgery with pain, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1995 to April 1997. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a January 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. 1. Entitlement to service connection for low testosterone, including as secondary to left varicocele surgery with pain, is remanded. The Board regrets any additional delay, but finds a remand is necessary for proper adjudication of this claim. The Board first notes that the Veteran claimed entitlement to service connection for erectile dysfunction (ED) in August 2008, and was denied service connection in a May 2009 rating decision. In association with the ED claim, the Veteran was afforded a VA examination in April 2009, to assess the nature and etiology of the claimed disability. Pertinently, while the VA examiner opined that the Veteran’s ED is less likely than not related to left varicocele and its treatment, the examiner also stated that the reason for the Veteran’s ED is his extremely low testosterone. However, the examiner did not opine as to the etiology of the Veteran’s low testosterone, nor did he explain whether left varicocele and its treatment could result in low testosterone. Similarly, the Veteran was assessed with low testosterone at a September 2018 VA examination, but no etiological opinion was provided. The Board additionally notes that a statement of the case (SOC) was issued in April 2015, addressing the Veteran’s current claim, which was received in July 2012. The SOC reflects that the Veteran’s claim was denied on the basis that low testosterone is considered a laboratory finding, and not a disability for VA purposes, and that further, the evidence does not show that his low testosterone is related to service-connected left inguinal pain, status post left varicocele surgery. The Board disagrees and finds that the Veteran may be service-connected for low testosterone. Here, as previously noted, the April 2009 VA examination clearly diagnoses the Veteran with low testosterone, and identifies this as the cause of his ED – yet does not opine as to the etiology of the low testosterone. A medical examination or medical opinion is necessary in a claim for service connection when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. 5103A(d)(2) (2012); 38 C.F.R. 3.159(c)(4)(i) (2018). The McLendon elements are satisfied with regard to the Veteran’s claim of low testosterone. Regarding the first element, the April 2009 VA examination clearly states the Veteran has extremely low testosterone. Regarding the second element, the Veteran has documented in-service treatment of varicocele and other urologic conditions. Further, the Veteran is service-connected for pain, associated with varicocele treatment and symptoms. Regarding the third and fourth elements, there is an indication that low testosterone could be related to service or the Veteran’s service-connected varicocele disability, but insufficient evidence of record by which the Board can make a decision. Indeed, the Board again notes that the April 2009 VA examination, which was conducted to examine the nature and etiology of his ED – not his low testosterone – does not explain the nature and etiology of the low testosterone itself. As the four McLendon elements are satisfied, the Veteran is entitled to a VA examination and medical opinion. The Board finds that an examination and opinion are needed in order to address the etiology of the Veteran’s claimed disability. The matter is REMANDED for the following action: 1. After securing any necessary consent forms from the Veteran, obtain any outstanding treatment records, to include any VA and/or private treatment records, pertaining to the issue on appeal. If any identified records could not be obtained, this should be noted in the claim file. 2. Upon completion of the above, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his low testosterone, including any symptomatology associated with the diagnosis. The examiner must opine whether it is at least as likely as not that the Veteran’s low testosterone is related to an in-service injury, event, or disease. The examiner must further opine as to the following: • Whether it is at least as likely as not that the Veteran’s low testosterone was caused by his service-connected left varicocele surgery with pain; and • Whether it is at least as likely as not that the Veteran’s low testosterone has been aggravated by his service-connected left varicocele surgery with pain. All examination findings, along with the complete rationale for all opinions expressed should be set forth in the examination report. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G.C., Associate Counsel