Citation Nr: 18151683 Decision Date: 11/20/18 Archive Date: 11/19/18 DOCKET NO. 12-13 579 DATE: November 20, 2018 REMANDED Entitlement to service connection for a genitourinary disorder, to include erectile dysfunction, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Marine Corps from July 1980 to December 1980, from December 1990 to September 1991, and from October 2005 to August 2010, including service in Iraq from February 2006 to October 2006. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a May 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The case was later transferred to the Cleveland, Ohio RO. In May 2017, the Veteran appeared at a Board videoconference hearing before the undersigned Veterans Law Judge. In October 2017, the Board remanded the issue of entitlement to service connection for a genitourinary disorder, to include erectile dysfunction, for further development. This case was previously before the Board in October 2017, partly to schedule the Veteran for a VA examination to determine the onset and etiology of his claimed genitourinary disorder, to include erectile dysfunction. The examiner was to diagnose all current genitourinary disorders, to include erectile dysfunction, and to provide an opinion as to whether it was at least as likely as not that any currently diagnosed genitourinary disorders, to include erectile dysfunction, were etiologically related to, or had their onset during, his periods of service. The examiner was requested to specifically acknowledge and discuss the reports by the Veteran of genitourinary disorders, to include erectile dysfunction, during service and since service. In the October 2017 remand, the Board also indicated that the examiner was to opine as to whether the Veteran’s service-connected postoperative residuals of a right acoustic neuroma, with residual hearing loss, and/or PTSD, or any other service-connected disabilities, caused or aggravated any currently diagnosed genitourinary disorders, to include erectile dysfunction. Pursuant to the October 2017 remand, the Veteran was afforded a VA male reproductive system conditions examination in July 2018. There was a notation that the claims file was reviewed. The examiner discussed the Veteran’s medical history in detail. The examiner indicated that the Veteran did not have, and had never been diagnosed with, any conditions of the male reproductive system. The examiner opined that there was no current pathology or diagnosis of erectile dysfunction, or of any male reproductive and genitourinary disorder, in the currently available evidence of record. The examiner stated that, therefore, it was her medical opinion that the Veteran’s condition of no current pathology or diagnosis of erectile dysfunction, or of any male reproductive and genitourinary disorder, was less likely as not (less than 50/50 probability) incurred in, caused by, a result of, proximately due, or permanently aggravated by, service, or by any of his service-connected conditions, since there was no condition found. The examiner reported that the Veteran’s subjective complaints were not consistent with erectile dysfunction, or with any male reproductive and genitourinary disorder. The examiner indicated that the Veteran had no difficulty obtaining or maintaining an erection, and that, therefore, he did not have symptoms consistent with erectile dysfunction. The examiner maintained that the Veteran’s subjective complaints were most consistent with a possible neurological condition since his complaints were headaches during intercourse, prior to ejaculation. The examiner specifically stated that as the Veteran had a complicated neurological history, with an acoustic neuroma, trigeminal neuralgia, migraines, and a traumatic brain injury, it was her medical opinion that such would best be handled by a neurologist. The Board observes that the examiner indicated that it was her medical opinion that there was no current pathology or diagnosis of erectile dysfunction, or of any male reproductive and genitourinary disorder, in the currently available evidence of record. The Board notes, however, that there are multiple diagnoses of erectile dysfunction of record. For example, a November 2011 VA treatment entry notes that the Veteran reported that he could not sustain an erection. The diagnoses included erectile dysfunction. The examiner reported that the Veteran would have a trial of Viagra, and that possible causes of his erectile dysfunction were reviewed, including his medication side effects, and his mental health, etc. The Board observes that the “current disability” requirement for service connection is satisfied if a claimant has a disability at any time during the pendency of a claim, even if the disability resolves prior the adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Additionally, the Board notes that the examiner found that the Veteran’s complaints were most consistent with a possible neurological condition since his complaints were headaches during intercourse, prior to ejaculation. The examiner also specifically indicated that as the Veteran had a complicated neurological history, with an acoustic neuroma, trigeminal neuralgia, migraines, and a traumatic brain injury, it was her medical opinion that such would best be handled by a neurologist. The Board notes that the duty to assist includes providing additional testing or examinations recommended by a VA examiner. See Green v. Derwinski, 1 Vet. App. 121, 123-124 (1991); see also Daves v. Nicholson, 21 Vet. App. 46 (2007) (when VA’s duty to provide a medical examination is triggered, this duty includes the requirement that it provide reasonable tests and other examinations necessary to render a meaningful medical opinion). In light of the VA examiner’s recommendation that the Veteran should be seen by a neurologist, a remand for a new examination, by a neurologist, is warranted. See also Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following action: 1. Ask the Veteran to identify all medical providers who have treated him for genitourinary disorders, to include erectile dysfunction, since July 2016. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptoms regarding his claimed genitourinary disorder, to include erectile dysfunction. He should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for a VA examination, by a neurologist, to determine the onset and/or etiology of his claimed bilateral genitourinary disorder, to include erectile dysfunction. The examiner must diagnose all current genitourinary disorders and/or impairment, to include erectile dysfunction. If the examiner finds the Veteran does not currently have, and did not at any time during the course of the appeal have currently diagnosed genitourinary disorders, to include erectile dysfunction, the examiner must explain why the current diagnoses of erectile dysfunction, reflected in the record during the course of the appeal, are not valid diagnoses. The examiner must also opine as to whether it is as at least as likely as not that any genitourinary impairment, to include erectile dysfunction, is related to service or to a service-connected disability. The examiner must specifically acknowledge and discuss the reports by the Veteran of genitourinary disorders, to include erectile dysfunction, in and since service. The examiner must further opine as to whether the Veteran’s service-connected caused or aggravated the Veteran’s genitourinary impairment, to include erectile dysfunction. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. D. Regan, Counsel