Citation Nr: 18156153
Decision Date: 12/07/18	Archive Date: 12/07/18

DOCKET NO. 16-51 704
DATE:	December 7, 2018
REMANDED
Entitlement to service connection for erectile dysfunction (ED), to include as secondary to service-connected residuals of prostate cancer status post prostatectomy, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from January 1964 to January 1968.
The Board notes that in October 2017, the Veteran filed an application to reopen previously denied claims for service connection for posttraumatic stress disorder (PTSD) and right ear hearing loss, as well as claims for increased disability ratings for tinnitus and left ear hearing loss.  With respect to these claims, the Veteran has elected to participate in VA’s test program, RAMP, the Rapid Appeals Modernization Program.  He selected the Supplemental Claim lane when he submitted his RAMP election form.  However, because a RAMP rating decision addressing these claims has not yet been issued, the Board does not have jurisdiction over these matters at this time.
Service connection for ED
The Veteran contends that his current ED is secondary to his service-connected residuals of prostate cancer, status post prostatectomy.  
The Veteran was afforded a VA examination for his ED in July 2016 (in the form of an interview and evidence review).  The examiner noted that the Veteran had a diagnosis of ED, but found that it was less likely than not that his ED was proximately due to or the result of his service-connected prostate cancer.  By way of rationale, the examiner explained that the Veteran had reported having ED for the last 15 years but that his prostate cancer had arisen many years later—thus, the two could not be causally linked.
On review, the Board finds that the VA examiner’s opinion is inadequate, particularly with respect to the question of whether the Veteran’s service-connected prostate cancer, to include his prostatectomy, aggravated his ED.  See 38 C.F.R. § 3.310(b) (any increase in severity of a nonservice-connected disease or injury 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).  Of note, the Veteran’s clinical records reflect that he has been treated for “penile rehabilitation” following his prostatectomy, and that he was prescribed different medications for his ED in the aftermath of the prostatectomy.  Notwithstanding, the July 2016 VA examiner’s opinion included merely a conclusory statement with regard to the question of aggravation, without providing any supporting rationale or meaningful discussion of the evidence of record.  On remand, an opinion with a complete, well-reasoned, and evidence- based rationale must be provided.  See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes to provide a medical examination or opinion, it must ensure that the examination or opinion is adequate).  
The matter is REMANDED for the following action:
Forward the Veteran’s claims file to an appropriate specialist for a medical opinion regarding the nature and etiology of the Veteran’s ED.  The examiner must provide an opinion as to whether the Veteran’s ED is at least as likely as not caused or aggravated by his service-connected residuals of prostate cancer status post prostatectomy.  The examiner should review the Veteran’s VA clinical records (including the December 2, 2016 treatment note reflecting plans for “penile rehab-post prostatectomy”) and discuss whether the Veteran’s ED permanently worsened following his prostatectomy, to include any changes in his medication for ED.

 
 A. S. CARACCIOLO
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	T. Minot, Associate Counsel