Citation Nr: 18146954 Decision Date: 11/02/18 Archive Date: 11/02/18 DOCKET NO. 16-19 661 DATE: November 2, 2018 REMANDED The claim of entitlement to service connection for sleep apnea is remanded. The claim of entitlement to service connection for erectile dysfunction is remanded. The claim of entitlement to an initial rating higher than 50 percent for posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1967 to May 1971. 1. The claim of entitlement to service connection for sleep apnea is remanded. An updated medical opinion must be obtained. The March 2016 VA examiner agreed that some psychiatric medications have sedative effects, which could temporarily aggravate sleep apnea. He did not comment on the Veteran’s prescriptions, because such effect was only temporary and “certainly unlikely to permanently aggravate the condition,” which is not the correct standard. On the contrary, “[a]ny increase in severity…that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease,” will be service connected. 38 C.F.R. § 3.310. An updated VA examination opinion must be obtained. 2. The claim of entitlement to service connection for erectile dysfunction is remanded. The August 2015 VA examination opinion and December 2015 VA addendum report are not supported with an explanation that cites to evidence in the record. It appears the VA examiner is opining against a relationship on the basis that erectile dysfunction started before the Veteran was given psychiatric prescription drugs. However, the record shows that he first complained of sexual side effects when prescribed Paxil, in November 2013. He was given a trial of Viagra. The examiner indicated that PTSD and erectile dysfunction are separate entities without providing additional explanation. An updated opinion must be obtained. 3. The claim of entitlement to an initial rating higher than 50 percent for posttraumatic stress disorder (PTSD) is remanded. The record suggests the Veteran’s PTSD has increased in severity, and he has not had a VA examination since 2014. The most recent VA treatment is from 2016. The available evidence is too old to adequately determine the current state of the disability; therefore, an updated VA examination shall be conducted. Palczewski v. Nicholson, 21 Vet. App. 174 (2007); Olsen v. Principi, 3 Vet. App. 480, 482 (1992). The matters are REMANDED for the following action: 1. Obtain a VA examination opinion as to whether the Veteran’s prescriptions for his PTSD have sedative effects that as likely as not (50/50 probability or greater) aggravate his sleep apnea. (“Aggravate” means to cause any increase in severity that is beyond the normal progression of the disability.) The Board notes the March 2016 VA examiner indicated that “some” medications “could temporarily” aggravate sleep apnea due to the sedative qualities of the drugs impeding respiratory effort, but he did not comment specifically on the Veteran’s prescriptions and their effect on his sleep apnea. All opinions must be supported with explanation. 2. Obtain a VA medical opinion as to whether PTSD and/or the medications prescribed for PTSD as likely as not (50/50 probability or greater) cause or aggravate the Veteran’s erectile dysfunction. (“Aggravate” means to cause any increase in severity that is beyond the normal progression of the disability.) The record shows that he was first prescribed Paxil in or around June 2013, and that it was discontinued within a few months due to sexual side effects. Prior to that, he had been prescribed Remeron. He reported symptoms starting in 2012, which are not medically documented prior to November 2013, at which time he was given a trial of Viagra. All opinions must be supported with explanation. 3. Schedule the Veteran for an appropriate examination for a report on the current severity of his PTSD. The examiner is asked to conduct a thorough examination, along with all necessary diagnostic tests. The examiner is asked whether the Veteran has social and occupational impairment with deficiencies in most areas, or total social and occupational impairment, and if so, at what approximate date did he meet these criteria? All opinions must be supported with explanation. J. CONNOLLY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Gibson