Citation Nr: 18153412 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 06-00 165A DATE: November 27, 2018 ORDER Effective October 24, 2005, special monthly compensation (SMC) based on loss of use of a creative organ is granted. REMANDED Entitlement to service connection for cataracts is remanded. Entitlement to a rating in excess of 20 percent for peripheral vascular disease (PVD) of the left lower extremity is remanded. Entitlement to an initial rating in excess of 10 percent for hypothyroidism is remanded. Entitlement to an initial compensable rating for diabetic retinopathy is remanded. Entitlement to an initial rating in excess of 20 percent for diabetes mellitus is remanded. Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) prior to January 21, 2011, is remanded. FINDINGS OF FACT 1. The Veteran’s erectile dysfunction is a complication of his service-connected diabetes mellitus and had onset prior to October 25, 2005. 2. The October 24, 2005, claim for diabetes mellitus encompassed other secondary diseases, to include loss of use of a creative organ. CONCLUSION OF LAW The criteria for SMC for loss of use of creative organ, effective October 24, 2005, but not earlier, have been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.400; 4.119. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from July 1969 to February 1977. These matters initially came or have come to the Board of Veterans’ Appeals (Board) on appeal from rating decisions of the Muskogee, Oklahoma Regional Office (RO) of the Department of Veterans Affairs (VA). In July 2013, the Board, in pertinent part, remanded the issue of entitlement to an increased rating for diabetic retinopathy. In February 2016, the Board, in pertinent part, remanded the issues of entitlement to increased ratings for peripheral neuropathy and entitlement to a TDIU prior to April 29, 2013, and denied service connection for cataracts; a compensable rating for erectile dysfunction; an initial disability rating in excess of 30 percent for PTSD; an initial compensable disability rating prior to August 15, 2013, for diabetic retinopathy; an initial disability rating in excess of 10 percent for hypothyroidism; a disability rating in excess of 20 percent for peripheral neuropathy of the right and left lower extremities; an earlier effective date for SMC based on loss of use of a creative organ; a disability rating in excess of 20 percent for PVD of the left lower extremity; and entitlement to a total disability rating based on individual unemployability (TDIU) effective April 29, 2013. The Veteran appealed the Board’s decision to the Court which, in April 2018, issued a Memorandum Decision that vacated the denials and remanded the following matters to the Board for further action: service connection for cataracts; an initial disability rating in excess of 30 percent for PTSD prior to January 21, 2011; an initial compensable disability rating prior to August 15, 2013, for diabetic retinopathy; an initial disability rating in excess of 10 percent for hypothyroidism; a disability rating in excess of 20 percent for peripheral neuropathy of the right and left lower extremities; an earlier effective date for special monthly compensation based on loss of use of a creative organ; a disability rating in excess of 20 percent for PVD of the left lower extremity; and a rating in excess of 20 percent for diabetes mellitus. In April 2018, the Board, in pertinent part, granted 40 percent ratings for peripheral neuropathy of the left and right lower extremities; granted a TDIU from October 24, 2005, to April 28, 2013; and remanded the issue of entitlement to a TDIU prior to October 24, 2005, for further development, which, to date, has not been recertified to the Board. As the Board’s decision regarding increased ratings for peripheral neuropathy are final, those issues are no longer before the Board. Effective October 24, 2005, SMC based on loss of use of a creative organ is granted. Unless specifically provided otherwise in the statute, the effective date of an award based on an original claim for compensation benefits shall be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The Veteran asserts that his October 24, 2005, claim for diabetes mellitus encompassed other secondary diseases, to include loss of use of a creative organ. In April 2006, a VA examiner stated that the Veteran’s erectile dysfunction is a “complication of diabetes mellitus because the onset of the condition is deemed to be a complication of the diabetes in relation to the diabetes onset.” With respect to the date entitlement arose, the Board finds that the April 2006 VA examiner’s opinion coupled with the Veteran’s statements establish that erectile dysfunction began with diabetes mellitus, that is, no later than October 25, 2005. With respect to the date of claim, the Board finds that even though the Veteran did not expressly claim entitlement to service connection for erectile dysfunction until June 2, 2006, his October 24, 2005, claim for diabetes mellitus encompassed other secondary diseases, to include loss of use of a creative organ. This is particularly so considering the April 2006 VA examiner’s opinion that erectile dysfunction is a complication of diabetes mellitus. Additionally, this finding is consistent with the Court’s April 2018 Memorandum Decision. Prior to October 24, 2005, the Veteran does not contend, and the evidence does not suggest, that he or his representative submitted correspondence that can be construed as a service connection claim for erectile dysfunction or SMC for loss of use of a creative organ. Accordingly, October 24, 2005, represents the earliest possible effective date for SMC for loss of use of a creative organ and is granted herein. REASONS FOR REMAND Entitlement to service connection for cataracts is remanded. Further medical development is needed to address the central premise of medical treatise evidence submitted by the Veteran, which, as noted in the April 2018 Memorandum Decision, states that diabetes mellitus can aggravate or hasten the development of cataracts. Entitlement to an initial compensable rating for diabetic retinopathy is remanded. Entitlement to a rating in excess of 20 percent for PVD of the left lower extremity is remanded. Entitlement to an initial rating in excess of 10 percent for hypothyroidism is remanded. Entitlement to an initial rating in excess of 20 percent for diabetes mellitus is remanded. In September 2014, VA issued a Statement of the Case (SOC), which, in pertinent part, addressed the claims of entitlement to higher ratings for diabetes, diabetic retinopathy, PVD, and hypothyroidism. Since the September 2014 SOC, pertinent treatment records have been associated with the file. In accordance with the April 2018 Memorandum Decision, the Board finds remand is needed for initial review by the Agency of Original Jurisdiction prior to appellate review. See 38 C.F.R. § 21.1304(c). Entitlement to an initial rating in excess of 30 percent prior to January 21, 2011, for PTSD is remanded. In October 2012, the Veteran filed a notice of disagreement with the October 2011 rating decision that granted an initial 30 percent rating for PTSD. In October 2014, the AOJ issued a SOC regarding the issue of entitlement to an increased rating for PTSD from January 21, 2011. Critically, as detailed in the April 2018 Memorandum Decision, the October 2014 SOC did not address entitlement to an increased rating for PTSD prior to January 21, 2011. Accordingly, this claim must be remanded for a SOC. See Manlincon v. West, 12 Vet. App. 238 (1999). The matters are REMANDED for the following actions: 1. Forward the claims file to an appropriate medical professional to address the etiology of the Veteran’s cataracts. Based on a review of the entire claims file, the examiner is to address whether it is at least as likely as not that the Veteran’s diabetes mellitus aggravates his current cataracts. In providing an opinion, the clinician is to specifically address the medical treatise evidence submitted by the Veteran that states that diabetes mellitus can aggravate or hasten the development of cataracts. The term “aggravation” means a permanent increase in the claimed disability; that is, an irreversible worsening of the condition beyond the natural clinical course and character of the condition due to the service-connected disability as contrasted to a temporary worsening of symptoms. Another examination of the Veteran should only be performed if deemed necessary by the person providing the opinions. 2. As to the claim of entitlement to a rating in excess of 30 percent for PTSD prior to January 21, 2011, issue a SOC. Thereafter, only return this issue to the Board if the Veteran perfects his appeal by filing a timely substantive appeal. (Continued on the next page)   3. After completing the above actions, to include any other development as may be indicated by any response received because of the actions taken in the preceding paragraphs, re-adjudicate all claims on appeal based on the entirety of the evidence. If any claim remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. M. M. CELLI Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Joshua Castillo, Counsel