Citation Nr: 18156637 Decision Date: 12/10/18 Archive Date: 12/10/18 DOCKET NO. 17-02 947 DATE: December 10, 2018 REMANDED Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran had active service in the Navy from September 1971 to September 1974. Regarding the Veteran’s increased rating claim for PTSD, he was last afforded a VA examination in November 2014. He recently has asserted that his PTSD symptoms affected his ability to function at his work, indicating a worsening of his symptoms. Accordingly, the Veteran’s medical records regarding treatment for his PTSD should be updated and he should be afforded a VA examination to determine the current nature and severity of his PTSD. Regarding the Veteran’s service connection claim for erectile dysfunction, the Veteran asserts that his erectile dysfunction is secondary to medications for his service connected PTSD. Specifically, Veteran has been prescribed Celexa for his PTSD and he has argued that erectile dysfunction is a common side effect of Celexa. Accordingly, an opinion on the etiology of the Veteran’s erectile dysfunction should be obtained. Regarding the Veteran’s service connection claim for hearing loss, his STRs show a 10 decibel shift in both ears at the 4000 Hertz level threshold shifts between his August 1971 entrance audiological testing and his September 1974 separation audiological testing. He was afforded a VA examination in December 2014. However, the examiner indicated that the Veteran’s ears were unable to obtain/maintain a seal. Accordingly, the Veteran should be afforded a new VA examination to obtain valid audiological resting results and an opinion on the significance, if any, of the threshold shifts in hearing acuity during the Veteran’s active service. The matters are REMANDED for the following action: 1. Obtain all outstanding VA and/or private medical records that pertain to the Veteran’s PTSD. 2. Schedule the Veteran for a VA examination to assess the severity of his service-connected PTSD. The examiner should describe any functional limitation the Veteran’s PTSD has on his ability to obtain or maintain substantially gainful employment. 3. Obtain a medical opinion to address the etiology of the Veteran’s erectile dysfunction. If an examination is needed to address the Board’s question, one should be scheduled. The examiner should offer the following opinions: a. Is it at least as likely as not (50 percent or greater) that the Veteran’s erectile dysfunction was caused by a service connected disability or from medications prescribed to treat a service connected disability (to include the Celexa prescribed to treat his PTSD)? Why or why not? b. Is it at least as likely as not (50 percent or greater) that the Veteran’s erectile dysfunction was aggravated (made worse) by a service connected disability or from medications prescribed to treat a service connected disability? Why or why not? If aggravation is found, the examiner should identify a baseline level of severity of the Veteran’s erectile dysfunction by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the erectile dysfunction. If such cannot be done, it should be explained why. 4. Schedule the Veteran for a VA audiology examination. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s bilateral hearing loss either began during or was otherwise caused by his military service? (Continued on the next page)   The examiner should specifically comment on the clinical significance, if any, of threshold shifts in the Veteran’s hearing acuity during his active service. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Berryman, Counsel