Citation Nr: 18152022 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 16-44 532 DATE: November 20, 2018 REMANDED Service connection for infertility is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1978 to September 1994. The case is on appeal from a May 2015 rating decision. Service connection for infertility is remanded. The Veteran asserts that his current infertility is either directly related to his active service or secondary to his service-connected left spermatocele condition. Post-service treatment records note complaints and a diagnosis of infertility. The Veteran’s service treatment records (STRs) reflect multiple complaints and treatment for prostatitis, epididymitis, and infertility. In this regard, the Veteran was diagnosed with epididymitis in December 1983, and was referred to the urology department. A moderately symptomatic left scrotal mass was found. The Veteran’s STRs additionally document that, in December 1983, the Veteran reported attempting pregnancy with his wife for eighteen months without success. Examinations were ordered and results revealed the left globus major very enlarged and cystic, later diagnosed as a left spermatocele. In February 1984, the Veteran was seen by his urologist and a sperm count was ordered. Results revealed an adequate count at the time. In October 1984, the Veteran was diagnosed with a palpable indurated mass in the left epididymis, approximately “2 cm x 4 cm”, on top of the left testicle. The Veteran was referred to the Fitzsimons Army Medical Center for further urologic evaluation. In November 1984, the Veteran was diagnosed with acute prostatitis which as per doctor’s notes, by December 1984 it was apparently resolved. Nonetheless, in June 1985, the Veteran reported to Ellsworth AFB hospital complaining of left testicle pain. The doctor assessment was epididymitis. During a follow-up examination in July 1985, the doctor’s notes reflect a continued assessment of spermatocele and epididymitis. In September 1991, the Veteran underwent a varicocelectomy to have a left inguinal cystic mass removed. A diagnosis of infertility was noted. A new semen analysis was ordered in June 1991, the results revealed that although the Veteran’s count appeared normal, his sperm was positive for the presence of IgG antibodies. In January 1992, a separate analysis reported that the Veteran’s semen count had improved to over 100 million. Nonetheless, progress notes still reflect an infertility diagnosis. Finally, in April 1992, another semen count indicated “lower than normal fertility potential” and in addition, the Veteran’s sperm was positive for the presence of IgG and IgA anti-sperm antibodies. The Veteran was afforded a VA examination in May 2015. The examiner gave an opinion that it was not “at least as likely as not aggravated beyond its natural progression by his service-connected left spermatocele formally shown as varicocelectomy.” The rationale was provided that the “Veteran does have IgG antibodies to sperm. But the anti-sperm antibodies are not causally related to the condition of the surgery.” A second VA examination was afforded to the Veteran in July 2016. The VA examiner opined that the Veteran’s infertility is not at least as likely as not due to service since the Veteran’s sperm count (which was borderline prior to his varicocelectomy/spermatocelectomy 1991 surgery) was documented to have improved to a normal level (100 million) after this surgery. In addition, there is no evidence that the antisperm antibodies documented prior to the surgery were clinically significant. The Board finds that another VA examination is warranted so as to determine whether the Veteran does in fact have infertility and, if so, whether it had its onset during service or is related on a secondary basis. In light of the remand, updated VA treatment records should be obtained. The matter is REMANDED for the following action: 1. Obtain updated VA treatment records dated since July 2018. 2. Schedule the Veteran for a VA examination by an appropriate medical professional with respect to the Veteran’s infertility. Any clinically diagnostic testing should be performed. (i) First, determine whether the Veteran in fact has infertility. If not, explain why this is so. (ii) For any identified infertility, is it at least as likely as not (50 percent probability or greater) that it had its onset during, or is otherwise related to, service? (iii) If no to (ii), is it at least as likely as not (50 percent or greater probability) that any identified infertility was caused, or aggravated by, service-connected chronic prostatitis or left spermatocele? A complete rationale or explanation should be provided for any opinion reached. (Continued on the next page)   Consideration should be given to the Veteran’s STRs noting complaints and treatment provided for infertility during active service. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD William Pagan, Associate Counsel