Citation Nr: 18140266 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 16-27 830 DATE: October 2, 2018 REMANDED Entitlement to service connection for female sexual arousal disorder (FSAD) secondary to depression is remanded. REASONS FOR REMAND The Veteran had active military service from February 1982 to May 1993. 1. Entitlement to service connection for female sexual arousal disorder (FSAD) secondary to depression is remanded. The Board finds that a further VA examination with a medical opinion is warranted prior to a final adjudication of the Veteran’s claim. As part of her claim, the Veteran submitted a March 2015 disability benefits questionnaire by her primary care physician that provided a diagnosis of FSAD and indicated an association between the condition and the Veteran’s service-connected depression, although no explanation was provided. During a VA contract examination in October 2014, the examiner concluded that the Veteran’s FSAD was not at least as likely as not caused by or aggravated beyond its natural progression by her service-connected depression. The rationale for this decision was that the medical literature did not support a medical relationship between the two conditions, so a nexus had not been established. Based on this opinion, a rating decision was issued by the RO denying service connection. After the Veteran filed a Notice of Disagreement and requested RO review of the rating decision, the Veteran underwent a VA examination in March 2016 for FSAD. The examiner concluded that the Veteran’s FSAD was not at least as likely as not caused by or aggravated beyond its natural progression by her service-connected depression. The examiner also stated that a baseline could not be established for the condition due to insufficient evidence. The rationale for this decision was that the onset or degree of the Veteran’s symptoms could not be determined without resort to speculation, and some symptoms, such as vaginal dryness and dyspareunia, were attributable to the medications she had been prescribed. However, during a subsequent VA examination later in March 2016, the examiner concluded that while a baseline could not be established due to insufficient evidence, the Veteran’s FSAD was at least as likely as not aggravated by her service-connected low-back condition and PTSD. In her June 2016 Form 9 statement, the Veteran asserted that her service treatment records (STRs) contained no record of treatment for or diagnosis of FSAD, as such a condition was likely not diagnosable 25 years earlier, and military physicians would not have been sympathetic to such a claim. Additionally, the Veteran stated that because she was recovering from back surgery, any symptoms from FSAD were not her primary concern and may have gone unnoticed. At a minimum, the Board finds that the facts raise a question as to whether the Veteran’s current FSAD is in any way causally related to her service-connected depression. This matter must be further addressed on examination. 38 C.F.R. § 3.159(c)(4). The matter is REMANDED for the following action: 1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), make efforts to obtain all records identified by the Veteran and any new records of VA treatment of the Veteran. 2. Afford the Veteran a VA examination to determine the nature and etiology of the Veteran’s FSAD. The Veteran’s claims file, including a copy of this remand, must be made available to and reviewed by the examiner for review in connection with the examination. The examiner is requested to review the record, conduct an appropriate examination, and offer an opinion as to whether it is at least as likely as not that the Veteran’s FSAD had its onset in service or is otherwise related to the Veteran’s active duty service, or at least as likely as not (a probability of at least 50 percent) was caused by or aggravated by the Veteran’s service-connected depression. Consideration should be given to the Veteran’s Form 9 statement. All opinions must be supported by a complete rationale. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Evan Thomas Hicks