Citation Nr: 18159308 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 16-40 703 DATE: December 18, 2018 REMANDED Entitlement to service connection for fibromyalgia is remanded. Entitlement to service connection for a gastrointestinal disorder is remanded. Entitlement to service connection for female sexual arousal disorder (FSAD) is remanded. REASONS FOR REMAND The Veteran had active service from November 1985 to December 1985. This matter comes before the Board of Veterans’ Appeals (Board) from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. 1. Entitlement to service connection for fibromyalgia is remanded. The Veteran claims that her currently diagnosed fibromyalgia is related to her military service or secondary to her service-connected posttraumatic stress disorder (PTSD). The Veteran submitted medical evidence of a current diagnosis of fibromyalgia. See February 2017 letter. She also submitted a January 2017 opinion by a VA rheumatologist. The January 2017 rheumatologist opined that PTSD is a strong risk factor for fibromyalgia. The physician further noted that as the Veteran had service-connected PTSD, any assertion that the Veteran has service-connected fibromyalgia should be considered more likely than not. The physician did not state whether the Veteran’s fibromyalgia was caused or aggravated by her PTSD. As the claims file shows a current diagnosis for fibromyalgia and a possibility of its connection to service-connected PTSD, the evidence of record triggers VA’s duty to provide an examination and obtain an opinion. See 38 C.F.R. § 3.159(c). 2. Entitlement to service connection for a gastrointestinal disorder is remanded. The Veteran claims that her recurrent gastrointestinal disorder is directly related to service, secondary to her service-connected PTSD or secondary to fibromyalgia. She noted that she is constipated due to medication that she takes for chronic pain. See October 2013 notice of disagreement; see also February 2017 letter. As the issue of entitlement to service connection for fibromyalgia is being remanded, the issue of a gastrointestinal disorder is intertwined with that issue. The Board has therefore concludes that it would be inappropriate at this juncture to enter a final determination on the issue of entitlement to service connection for a gastrointestinal disorder. See Henderson v. West, 12 Vet. App. 11 (1998), citing Harris v. Derwinski, 1 Vet. App. 180 (1991). 3. Entitlement to service connection for FSAD is remanded. The Veteran claims that her decrease in libido or sex drive is related to her military service, secondary to service-connected posttraumatic stress disorder (PTSD), or due to medication taken for her PTSD. Specifically, she claims that Trazodone, taken as treatment for PTSD, decreases her sex drive. See May 2012 claim. In a May 2016 Gynecological Conditions Disability Benefits Questionnaire, the examiner noted the Veteran’s diagnosis of female sexual arousal disorder (FSAD). The examiner opined that FSAD is less likely as not proximately due to or the result of medication taken for her claimed PTSD. The Veteran self-reported that she was no longer taking Trazodone. The claims file corroborates that the Veteran has not taken Trazodone since 2012. See February 2012 VA treatment record. The examiner further noted that drug profile information for Trazodone note sexual side effects occurs less than one percent of the time. Instead, the examiner opined that FSAD is at least as likely as not due to a total abdominal hysterectomy. The examiner noted self-reported constant pelvic pain after hysterectomy in August 2012. The examiner did not provide an opinion as to whether the Veteran’s service-connected PTSD, or treatment for PTSD, aggravated the Veteran’s FSAD. For this reason, a remand for an opinion is needed. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from April 2017 to present. All records/responses received must be associated with the electronic claims file. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any fibromyalgia. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. The examiner must opine whether it is at least as likely as not (1) proximately due to service-connected PTSD, or (2) aggravated beyond its natural progression by service-connected PTSD. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s FSAD is at least as likely as not related to her military service. The examiner must opine whether it is at least as likely as not that FSAD is caused by her service-connected PTSD. The examiner must opine whether it is at least as likely as not that the Veteran’s FSAD is aggravated beyond natural progression by the Veteran’s service-connected PTSD. 4. Readjudicate the Veteran’s claims, with application of all appropriate laws, regulations, and case law, and consideration of any additional information obtained as a result of this remand. If the decision remains adverse to the Veteran, she and her representative should be furnished a supplemental statement of the case and afforded an appropriate period of time within which to respond thereto. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Tahirih S. Samadani, Counsel