Citation Nr: 18130147 Decision Date: 08/28/18 Archive Date: 08/28/18 DOCKET NO. 18-21 228 DATE: August 28, 2018 ISSUES 1. Whether new and material evidence has been submitted to reopen the claim for service connection for prostate cancer. 2. Entitlement to service connection for prostate cancer, as due to herbicide exposure. 3. Entitlement to service connection for ischemic heart disease, as due to herbicide exposure. 4. Entitlement to service connection for incontinence. 5. Entitlement to service connection for erectile dysfunction. ORDER New and material evidence sufficient to reopen the claim for entitlement to service connection for prostate cancer has been received, and the claim is granted. Entitlement to service connection for prostate cancer, as due to herbicide exposure is granted. Entitlement to service connection for ischemic heart disease, as due to herbicide exposure is granted. REMANDED Entitlement to service connection for incontinence is remanded. Entitlement to service connection for erectile dysfunction is remanded. FINDINGS OF FACT 1. A November 2005 rating decision denied service connection for prostate cancer. The Veteran was notified of his rights, but did not express timely disagreement or submit new evidence within one year. That decision became final. 2. The evidence associated with the record since the November 2005 rating decision relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim of service connection for prostate cancer. 3. The Veteran’s duties at Nakhon Phanom Royal Thai Air Force Base likely placed him near the perimeter of the base. Herbicide agent exposure may be presumed. 4. The Veteran has prostate cancer. 5. The Veteran has ischemic heart disease. CONCLUSIONS OF LAW 1. New and material evident sufficient to reopen the claim of service connection for prostate cancer has been received. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2017). 2. Prostate cancer is presumed to have been incurred in wartime service. 38 U.S.C. §§ 1101, 1110, 1116, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 3. Ischemic heart disease is presumed to have been incurred in wartime service. 38 U.S.C. §§ 1101, 1110, 1116, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1955 to August 1975. This matter is before the Board of Veterans Appeals (Board) on appeal from a June 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§3.102, 3.156(a), 3.159, 3.326(a) (2017). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert denied, U.S.C. Oct.3, 2016) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board....to search the record and address procedural arguments when the [appellant] fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant's failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Service Connection 1. New and material evidence sufficient to reopen the claim for entitlement to service connection for prostate cancer has been received. Service connection for prostate cancer was denied in a November 2005 rating decision. The Veteran was informed of the decision and of the right to appeal. He did not appeal or submit new and material evidence within one year of notification. That decision is final. At the time of the decision, the record included the claims, older VA treatment records, and the service records. There was no accepted evidence of prostate cancer in service. There was no evidence of a nexus to service. However, if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. 38 U.S.C. § 5108. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The United States Court of Appeals for Veterans Claims (Court) interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold. See Shade v. Shinseki, 24 Vet. App. 110 (2010). The Court emphasized that the regulation is designed to be consistent with 38 C.F.R. § 3.159(c)(4), which “does not require new and material evidence as to each previously unproven element of a claim.” See id. In November 2015, VA received the application to reopen the claim of service connection for prostate cancer. The additional evidence presented includes treatment reports from hospitals and medical centers, private examinations, and evidence and lay statements related to the Veteran’s service at Nakhon Phanom Air Force Base in Thailand. Later, the issue was revisited in a June 2016 rating decision. The evidence establishes that the Veteran served on a Royal Thai Air Force Base and may have been exposed to herbicides. Upon a successful showing of exposure to herbicides in service, the Veteran may be entitled to service connection on the basis of having a presumptive disease associated with exposure to herbicides. As a lack of evidence supporting a nexus to service was one of the bases for the previous denial of the claim, this evidence is new and material under 38 C.F.R. § 3.156. In light of this new and material evidence, the Veteran’s claim of service connection for prostate cancer is reopened. 2. Entitlement to service connection for prostate cancer, as due to herbicide exposure A. Service Connection To establish service connection a Veteran must generally show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303 (b). A disease specified in paragraph (2) of this subsection becoming manifest as specified in that paragraph in a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975; and (B) each additional disease (if any) that (i) the Secretary determines in regulations prescribed under this section warrants a presumption of service-connection by reason of having positive association with exposure to an herbicide agent, and (ii) becomes manifest within the period (if any) prescribed in such regulations in a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, and while so serving was exposed to that herbicide agent, shall be considered to have been incurred in or aggravated by such service, notwithstanding that there is no record of evidence of such disease during the period of such service. 38 U.S.C. § 1116 (a)(1). A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. The last date on which such a veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. Service in the Republic of Vietnam includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 C.F.R. § 3.307 (a)(6)(iii). Compensation Service has determined that a special consideration of herbicide exposure on a factual basis should be extended to Veterans whose duties placed them on or near the perimeters of Thailand military bases. When a Veteran with service in Thailand during the Vietnam Era claims service connection (SC) for disability based on herbicide exposure, follow the steps in the table below to verify exposure to herbicides. Did the Veteran serve in the U.S. Air Force in Thailand during the Vietnam Era at one of the following Royal Thai Air Force Bases (RTAFBs) U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, or Don Muang; and as an Air Force security policeman, security patrol dog handler, member of the security police squadron, or otherwise near the air base perimeter as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence. See M21-1, Part IV, Subpart ii, Chapter 1, Section H - Developing Claims for Service Connection (SC) Based on Herbicide Exposure. For the purposes of this section, the term herbicide agent means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram. 38 C.F.R. § 3.307 (a)(6)(i). If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of §3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of §3.307(d) are also satisfied. AL amyloidosis, chloracne or other acneform disease consistent with chloracne, type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes), Hodgkin’s disease, ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal’s angina), all chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia), multiple myeloma, non-Hodgkin’s lymphoma, Parkinson’s disease, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, Respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma). 38 C.F.R. § 3.309 (e). The diseases listed at § 3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and early-onset peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307 (a)(6)(ii). VA has determined there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Notice, 68 Fed. Reg. 27630-27641 (2003). In the instant case, the evidence from his DD-214s does not show the Veteran’s presence in the Republic of Vietnam. However, the Chronological Listing of Service in the Veteran’s Service Personnel Records (SPRs) shows that the Veteran served as a reciprocating engine technician starting on August 19, 1970 at Nakhon Phanom (NKP) Royal Thai Air Force Base (RTAFB) in Thailand. A Travel Voucher shows the same. A Citation to Accompany the Award of the Air Force Commendation Medal shows that the Veteran, “distinguished himself by meritorious service as Noncommissioned Officer in Charge of the Scheduled Engine Maintenance, 56th Field Maintenance Squadron, Nakhon Phanom Royal Thai Air Force Base, Thailand, from 15 August 1970 to 4 August 1971.” A related Performance Report confirms the Veteran’s service period and location at Nahkon Phanom RTAFB. As such, service at Nakhon Phanom RTAFB is conceded. The issue of exposure to Agent Orange will be discussed further below. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154 (a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). The Board, as fact finder, is obligated to, and fully justified in, determining whether lay evidence is credible in and of itself, i.e., because of possible bias, conflicting statements, etc. Id. B. History The Service Treatment Records (STRs) show that the Veteran’s Military Occupational Specialty (MOS) was Reciprocating Engine Mechanic 43271. His service included being stationed at Nakhon Phanom Royal Thai AFB in Thailand. The Veteran’s SPRs include a Performance Report that shows the Veteran’s duties while stationed at Nakhon Phanom (NKP) Royal Thai Air Force Base (RTAFB). In part, the Report shows: Technical Sergeant Bonner has proven to be an outstanding NCO in every respect. He is chiefly responsible for the outstanding quality achieved by the phase inspection section. He plans and coordinates the utilization of this section’s men for all phases of reciprocating engine inspections. He does this effectively in order for this section to have twelve hours daily coverage. He has accomplished many overtime hours working hand in hand with his men as the need arose to meet the phase inspection schedule. His experience and troubleshooting ability keeps his services constantly in demand. He takes a personal interest in the proper training of his assigned personnel and because of this he obtains top quality maintenance. Through his outstanding ability and tact in supervision, the number of maintenance discrepancies per phase inspection has been reduced by 30 percent. The Veteran’s STRs include a November 1974 Report of Medical Examination. It disclosed a clinically normal evaluation of the G-U system, heart, lower extremities, and vascular system. A June 1975 Report of Medical History for the purposes of retirement shows that the Veteran denied palpitation or pounding heart, heart trouble, and high or low blood pressure. He also denied frequent or painful urination and bed wetting. Decades later, service connection for prostate cancer was denied in a November 2005 rating decision. In November 2015, VA received a private Prostate Cancer Disability Benefits Questionnaire (DBQ) dated September 22, 2015. It shows that prostate cancer was identified. It shows a date of diagnosis as 1998. It was signed by the examining physician. Also in November 2015, VA received a private Heart Conditions DBQ dated October 2015. It shows that coronary artery disease was identified. It shows a date of diagnosis of June 16, 2008. Later, in November 2015, VA received a request to reopen the previous claim for service connection for prostate cancer, as well as new claims for service connection. The Veteran was afforded an April 2016 VA examination. It shows that the Veteran has coronary artery disease (diagnosed 6/16/2008), valvular heart disease (diagnosed 3/24/2009), and hypertensive heart disease (diagnosed 3/24/2009). In relevant part, it also shows, “He reports experiencing his first problems with his heart sometime in the 1990’s. The workup revealed 95% blockage and a catheterization was performed with stent placement. He was placed on blood thinner, aspirin, and heart medication.” The VA examiner opined that the Veteran’s coronary artery disease meets the medically accepted definition of ischemic heart disease (IHD). VA and private treatment records are substantially the same. In February 2017, the Veteran submitted his timely Notice of Disagreement (NOD). It reads in part, “I served in the Air Force at Nakhon Phanom AFB, Thailand. Attached are copies of my military assignment as an air plane mechanic that repaired aircrafts which exposed me to Agent Orange herbicides.” Next, in 2017, VA undertook efforts to develop the Veteran’s claim that he was exposed to Agent Orange while at Nakhon Phanom, and while his duties included repairing aircraft. After several development attempts with the Joint Services Records Research Center (JSRRC), the Veteran was directed to the Defense Personnel Records Information Retrieval System (DPRIS). In a memorandum received in February 2018, DPRIS advised that records for the histories of the 56th Field Maintenance Squadron were in the custody of the Air Force Historical Research Agency (AFHRA). Upon further development, in April 2018, the Air Force Historical Research Agency returned a three-part response. First, it contends that “The USAF installation of Nakhon Phanom Royal Thai Air Force Base, Thailand (NKP), never used any tactical herbicides, such as Agent Orange, for vegetation control along its perimeter fence at any time during its use by the USAF. NKP did, however, utilize commercial-grade herbicides along its perimeter fence line during the months of July and August 1971, months after the time period in question.” The AFHRA also noted that, “A total of four UC-123 aircraft were transferred from Agent Orange spraying to NKP’s nighttime forward air controller and flare ship mission.” Second, a list was submitted entitled, “Former UC-123 Ranch Hand Aircraft Assigned to the 56th Special Operations Wing.” It confirms the details in the statement from the AFHRA. Third, an August 11, 2015 Memorandum for the Department of Veterans Affairs shows that no “tactical herbicides, such as Agent Orange, were ever used on any USAF installation in Thailand for vegetation control during the Vietnam War era.” On April 19, 2018, VA received the Veteran’s VA Form 9 along with additional evidence and lay argument. First, the Veteran cites changes in November 2015 to the M21-1, Part IV, subpart ii, Chapter 1, Section H stating in part that VA is extending a “special consideration of herbicide exposure on a factual basis” to those Veterans whose service placed them on or near the perimeters of Thai military bases. He contends that aircraft are always inside the perimeter. Further, he explains that not only was herbicide used along the perimeter as part of his duties to do base cleanup, but a Memorandum For the Record (MFR) discussed further below shows in-house methods to control vegetation growth. Regarding his specific interactions with the perimeter, the Veteran asserts, “We constantly went pass (sic) the base perimeter on passes and utilize the base fields to play football baseball and basketball. These areas exposed me to the herbicide that was used to control vegetation.” In support of these contentions, the Veteran has submitted several documents. First, Enclosure 1 entitled “Herbicide Exposure in the Republic of Thailand” shows that VA did not distinguish between tactical and commercial herbicides until 2009. It shows that VA has determined that a special consideration should be extended to those Veterans whose duties placed them on or near the perimeters of Thai military bases. Enclosure 2, dated February 27, 2018, consists of two parts. First is an aerial photograph of NKP taken in mid-1972. It shows the layout of the base. Emails accompanying the photograph show that the flight line is in the center portion of the base, away from the perimeter. Second is a transcript of herbicide use from mid-1971. It reads in relevant part that commercial-grade herbicides were used in-house for vegetation control along the base’s perimeter fencing. The Veteran and his representative submitted a May 2018 Statement. In part, the Veteran through his representative asserts that the Veteran’s additional duties included base cleanup and moving debris from the base perimeter. They also assert that recreational facilities were cleared using herbicide to play sports. The Veteran contends that he was in charge of maintaining and repairing the equipment that supplies electricity, hydraulic pressure, and air pressure to planes, and ensuring planes were ready for flight. The Veteran states that these aircraft were used to spray the herbicide used in the Republic of Vietnam and Thailand. Consequently, the Veteran states that he was also exposed to Agent Orange while repairing airplanes, in addition to his duties around the base perimeter. C. Analysis The SPRs, lay evidence, and report from the documentation from the AFHRA collectively demonstrate that the Veteran was in Thailand during the Vietnam era at the Nakhon Phanom RTAFB. Records show that from August 1970 to August 1971 he was assigned to the 56th Field Maintenance Squadron as a reciprocating engine technician. His reported period of service at Nakhon Phanom RTAFB is consistent with the findings of the AFHRA. The Veteran also contends that he was exposed to the perimeter at NKP, and he has provided lay testimony, historical documents, and a historical photograph. There is no indication in the available service records that the Veteran served in the Republic of Vietnam. Thus, the first critical element as to whether the Veteran is entitled to the presumption of herbicide exposure is whether he served along the perimeter of the Nakhon Phanom RTAFB. The Board is satisfied that the Veteran has established this fact. The Veteran asserted that he was in and near the perimeter as part of his official duties and recreational activities. His reports are consistent with the historical records and photograph he submitted. To the extent the AFHRA contends that the Veteran’s duties only placed him in the central portion of the base, the evidence shows that the Veteran’s duties included time spent outside of the “shops and work areas.” He cleaned debris and participated in base cleanup. Additionally, the UC-123 Rand Hand Aircraft assignment log shows that some of the planes themselves had previously been exposed to herbicide agents. In short, the Veteran’s credible lay assertions collectively establish his presence in the perimeter of the base where herbicide agents were used. In the instant case, the Board finds that the Veteran has been a consistent historian regarding his duties, dates of service, and other relevant details. The Board therefore affords significant probative weight to the Veteran’s competent and credible lay testimony. His statements and MOS indicate that he regularly had contact with the aircraft and base perimeter. The Veteran asserts that he was consistently performing his duties that required bringing him into direct contact with the base perimeter. Here, based on the Veteran’s credible assertion of serving along the perimeter of NKP RTAFB, the Board finds that the weight of the evidence shows that the Veteran is presumed to have been exposed to herbicide agents during service. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102 (2017); M21-1, Part IV, Subpart ii, Chapter 1, Section H - Developing Claims for Service Connection (SC) Based on Herbicide Exposure. In rendering this decision, the Board has considered that the AFHRA found in part, “NKP did, however, utilize commercial-grade herbicides along its perimeter fence line during the months of July and August 1971, months after the time period in question.” The Board notes that contrary to the AFHRA’s statement, this period is during the Veteran’s period in service at NKP, as confirmed by contemporaneous SPRs, such as the Citation to Accompany the Award of the Air Force Commendation Medal. The Board has assigned significant probative weight to the contemporaneous documents placing the Veteran at NKP. In addition, the Veteran asserts, and the Board finds, that the Veteran has been diagnosed with prostate cancer. See November 2015 DBQ. As the Veteran is now presumed to have been exposed to herbicide agents in service, and prostate cancer is a disease that has been shown to be associated with exposure to herbicide agents, it is presumed that his disability was incurred in service even without evidence of that disease during service. 38 U.S.C. § 1116 (a); 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). Consequently, service connection for prostate cancer, as due to herbicide exposure, is warranted. 3. Entitlement to service connection for ischemic heart disease, as due to herbicide exposure The Board incorporates its discussion from the section immediately above by reference. The Veteran has been found to be credible, and the most probative evidence shows that herbicides were used at NKP, including while he was stationed there. His duties and activities during his time serving on active duty placed him in the perimeter of the base. Accordingly, as the Veteran is now presumed to have been exposed to herbicide agents in service, and ischemic heart disease (IHD) is a disease that has been shown to be associated with exposure to herbicide agents, it is presumed that his disability was incurred in service even without evidence of that disease during service. 38 U.S.C. § 1116 (a); 38 C.F.R. §§ 3.307 (a)(6), 3.309(e); see also November 2015 DBQ and April 2016 VA examination. Consequently, service connection for IHD, as due to herbicide exposure, is warranted. REASONS FOR REMAND 1. Entitlement to service connection for incontinence is remanded. The Board incorporates its discussion from the sections above by reference. The Veteran contends that he has incontinence related to service. He has not yet been afforded a VA examination regarding the nature and etiology of his claimed incontinence. As to any duty to provide an examination and/or seek a medical opinion, the Board notes that in the case of a claim for disability compensation, the assistance provided to the claimant shall include providing a medical examination or obtaining a medical opinion when such examination or opinion is necessary to make a decision on the claim. An examination or opinion shall be treated as being necessary to make a decision on the claim if the evidence of record, taking into consideration all information and lay or medical evidence (including statements of the claimant) contains competent evidence that the claimant has a current disability, or persistent or recurring symptoms of disability; and indicates that the disability or symptoms may be associated with the claimant’s active service; but does not contain sufficient medical evidence for VA to make a decision on the claim. Given the Veteran’s contentions, the Board finds that a VA examination is warranted. See 38 U.S.C § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Entitlement to service connection for erectile dysfunction is remanded. The Board incorporates its discussion from the sections above by reference. The Veteran contends that he has erectile dysfunction related to service. He has not yet been afforded a VA examination regarding the nature and etiology of his claimed disability. Given the Veteran’s contentions, the Board finds that a VA examination is warranted. See 38 U.S.C § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. If the Veteran identifies other evidence, obtain updated copies of the Veteran’s VA treatment records, and associate them with the Veteran’s claims folder. 2. Please schedule the Veteran for a VA examination to determine the nature and etiology of any incontinence disability. The claims file should be made available to the VA examiner. For each diagnosed disability, the VA examiner is requested to answer whether it is at least as likely as not (a 50 percent or greater probability) that the disability was incurred in or is otherwise related to the Veteran’s active military service. The examiner should provide a rationale for all opinions expressed. 3. Please schedule the Veteran for a VA examination to determine the nature and etiology of any erectile dysfunction. The claims file should be made available to the VA examiner. For each diagnosed disability, the VA examiner is requested to answer whether it is at least as likely as not (a 50 percent or greater probability) that the disability was incurred in or is otherwise related to the Veteran’s active military service. The examiner should provide a rationale for all opinions expressed. 4. After completing the above, and any other necessary development, the claims remaining on appeal must be readjudicated in light of all pertinent evidence and legal authority. If any benefits sought are not granted, issue the Veteran and his representative an appropriate supplemental statement of the case (SSOC). MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Bodi, Associate Counsel