Citation Nr: 18159071 Decision Date: 12/19/18 Archive Date: 12/18/18 DOCKET NO. 17-04 780A DATE: December 19, 2018 REMANDED Entitlement to service connection for erectile dysfunction (ED) to include as secondary to service-connected adenocarcinoma of the prostate status post prostatectomy is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. The claim for a compensable rating for service connected adenocarcinoma of the prostate status post prostatectomy is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1962 to November 1962. With respect to the Veteran’s psychiatric symptomatology, the Board notes that the Veteran originally claimed entitlement to service connection for sleep disorder and claustrophobia, and was subsequently diagnosed with adjustment disorder with mixed depression and anxiety and claustrophobia. Pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009), the Board has recharacterized the claim more broadly, as noted on the title page. 1. Service connection for ED (to include as secondary to service-connected adenocarcinoma of the prostate status post prostatectomy is remanded. The Board of Veterans’ Appeals (Board) finds that a remand is warranted for a new VA examination for the reasons explained below. In the May 2014 VA examination, the examiner opined that the Veteran’s ED was not related to or aggravated by his service-connected adenocarcinoma status post prostatectomy because the Veteran was diagnosed with ED, prior to undergoing proctectomy in 2012. See May 2014 VA Compensation and Pension (C&P) Examination Note. However, the Veteran was diagnosed with chronic prostatitis in his separation examination in September 1965 and the Veteran was treated for chronic prostatitis and benign prostate hyperplasia (BPH) since January 2005. See STR-Medical; VA Urology Outpatient Note, in CAPRI received on December 2016. Private treatment records indicate the Veteran was diagnosed with minimal ED in June 2005 and was diagnosed with ED in June 2006 while being treated with PBH. See Private Treatment Records. The examiner does not address whether the Veteran’s chronic prostatitis and/or BPH caused or aggravated the Veteran’s ED. Additionally, the July 2013 VA examiner, found that the Veteran had ED and indicated the following causes: age, proctectomy, and medication. See July 2013 VA C&P Examination Note. According to the Mayo Clinic, medications for prostate conditions have been listed as a common cause for ED. See https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776 (Last visited December 17, 2018). The May 2014 VA examiner does not address the July 2013 VA examination attributing ED to proctectomy and medication. As such, a new VA examination is warranted to address whether the Veteran’s current ED was caused by or related to his diagnosed chronic prostatitis or BPH including whether medication for prostate disability is related to his current ED. Second, the VA examiner fails to provide an adequate rationale for rejecting the Veteran’s lay statement that he has had ED since he took part in an experiment during active service, wherein he wore a rectal probe and was unable to eat, bathe, or use bathroom for 52 hours. Instead the examiner states he is unaware of any medical literature that supports a link between ED and wearing a rectal probe. However, the stated rationale does not provide data and analysis why the experiment could not cause the Veteran’s current symptoms. The examiner also noted that the Veteran’s service treatment records (STRs) were silent for experiment. An examiner may not rely on the absence of treatment for the claimed condition in the service medical records, standing alone, to justify an unfavorable nexus opinion. See e.g. Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). As such, a new VA examination and opinion that addresses the Veteran’s lay statements and provides an adequate rationale is necessary. 2. An acquired psychiatric disorder is remanded. The Veteran was not provided a VA examination for his psychiatric disability claim. As discussed below, a VA examination is warranted to determine the nature and etiology of the Veteran’s psychiatric disability. A medical examination is necessary when there is (1) “competent evidence of a current disability or persistent or recurrent symptoms of a disability,” (2) evidence establishing an in-service “event, injury, or disease,” and (3) an “indication” that the disability or symptoms may be associated with service, but (4) insufficient medical evidence of record for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see also 38 U.S.C. § 5103A (d)(2). Here, the requirements for a VA examination are met. First, the Veteran’s VA treatment records confirm he was diagnosed with adjustment disorder with mixed anxiety and depression and claustrophobia in January 2014. See July 2014 VA Mental Health Nursing Note, in CAPRI received April 2014. Second, the Veteran’s STR indicates the Veteran was involved in two fights in March 1965 and October 1965. Additionally, in July 2014, the Veteran provided a statement asserting that at the end of the experiment he “reported to Lieutenant that I could not tolerate the experiment any longer. He told me to go back to the field. I then grabbed my M14 rifle by the barrel and threatened him with bodily harm.” See July 2014 Statement, in Correspondence. The Veteran further reported that during the experiment he was required to wear a mask and as a result has developed claustrophobia which he continues to suffer from. Id. Third, based on the above the record provides an indication that the Veteran’s current psychiatric disability may be related to his active service. Finally, there are no medical opinions of record which address the etiology of the Veteran’s psychiatric disability. As such, the record contains insufficient information to decide the claim. The Board, thus finds a remand is warranted for a VA examination and opinion to assess the nature and etiology of the Veteran’s acquired psychiatric disability. 3. Increased rating for service-connected adenocarcinoma of the prostate status post prostatectomy (prostate disability) is remanded. A remand is warranted for a new VA examination to address the current severity of the Veteran’s service-connected prostate disability. Specifically, the Board finds that the September 2015 VA examination failed to examine or interview the Veteran to assess his current symptoms. See September 2015 VA Prostate Cancer Disability Benefits Questionnaire (DBQ). In this regard, the examiner noted that the Acceptable Clinical Evidence (ACE) process was used and she was unable to contact the Veteran for a telephone interview. Id. This is significant because the Veteran submitted a statement in January 2017 asserting that he was not notified of a VA examination by writing or telephone. See January 2017 Correspondence. The examiner further stated that the most recent urology records available for review were from 2013. Id. Thus, it is unclear from the record the current severity of the Veteran’s service-connected prostate disability. As such a new VA examination to assess the current severity of his service-connected disability is warranted. The matters are REMANDED for the following action: 1. Obtain copies of records pertaining to any relevant and outstanding medical records the Veteran has received at the Mobile VA facility where the Veteran has received ongoing treatment since August 2016, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the claims file. 2. The Veteran should also be offered the opportunity to submit any private treatment records in support of his claim including a nexus opinion for his ED or psychiatric disability claim. The Veteran should be requested to indicate if he has received any VA or non-VA treatment for his prostate disability or ED that is not evidenced in the current record. These private treatment records pertaining for these conditions since July 2013 should be obtained and associated with the claims folder. 3. After completing the foregoing development, the Veteran should be afforded a VA examination by a an appropriate medical professional, to ascertain whether any acquired psychiatric disorder is established by the record. The claims file and a copy of this remand must be made available to the reviewing examiner, and the examiner should indicate in the report that the claims file was reviewed. Based on examination and review of the record, the examiner is asked to respond to the following: (a.) Identify the nature of each of the Veteran’s acquired psychiatric disorder(s) that meet the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5). (b.) For any diagnosed psychiatric condition, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the psychiatric disorder(s) was/were incurred in or caused by service. In providing a nexus opinion the examiner should address the March 1965 and October 1965 notations in the Veteran’s STRs indicating Veteran was in a fight as well as the Veteran’s lay statements regarding the chemical experiment he participated in and determine whether his current psychiatric disability(s) is related to these events in active service. 4. Schedule a VA examination by an appropriate medical professional to determine the etiology of the Veteran’s ED. The claims folder, and a copy of this remand, must be provided to and reviewed by the examiner. The examiner should address the following: (a.) Is it at least as likely as not (50 percent or better probability) that the Veteran’s ED had its onset in service or is otherwise related to service? In addressing this question, the examiner must discuss: i. The Veteran’s competent and credible lay statements regarding the chemical experiment with a rectal probe he participated in during service and opine whether his current ED is related to the experiment. ii. Whether the Veteran’s diagnosis of chronic prostatitis in his separation examination in September 1965 and post service treatment for chronic prostatitis is related to his current diagnosed ED. iii. Whether the Veteran’s treatment for BPH or chronic prostatitis including whether medication for prostate disability is related to his current ED. iv. The July 2013 VA examination opinion which listed proctectomy and medication as possible causes of ED. If the examiner disagrees with this opinion, he or she must provide an explanation for disagreement. 5. Schedule the Veteran for an examination by an appropriate medical processional to assess the current severity of his service connected disability. The examiner is asked to respond to the following: (a.) State whether the Veteran’s prostate cancer is in remission and, if so, identify the approximate date of remission. In so doing, the examiner is requested to support this determination by reference to any pertinent clinical and laboratory findings; (b.) Describe the treatment the Veteran received for prostate cancer, including but not limited to radiation and androgen deprivation (hormonal) therapy treatment and the date such treatment was completed. (c.) Describe in detail the nature and severity of any residual condition attributable to prostate cancer, including but not limited to radiation proctitis, voiding dysfunction, and/or renal dysfunction. Any opinion expressed by the VA examiner should be accompanied by a complete rationale. If medical literature is relied upon in rendering this determination, the VA examiner should identify and specifically cite each reference material utilized. If utilizing references within the electronic claims file, the examiner should clearly provide an identifier. If the VA examiner is unable to offer an opinion without resorting to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. The examiner should also be aware that in rendering an opinion, it must “contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two.” See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). (Continued on the next page)   The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran’s reports of symptomatology, he or she must provide a reason for doing so. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Lilly, Associate Counsel