Citation Nr: 20007892 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 17-47 250 DATE: January 30, 2020 REMANDED The issue of entitlement to service connection for a right hip replacement, secondary to service-connected traumatic arthritis and/or meniscus tear of the right knee (right knee disabilities), is remanded. The issue of entitlement to service connection for a left hip replacement, secondary to service-connected right knee disabilities, is remanded. The issue of entitlement to service connection for erectile dysfunction, to include as secondary to the medications prescribed to treat any service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1961 to June 1964. In November 2019, the Veteran testified before the undersigned Veterans Law Judge during a Board videoconference hearing. A hearing transcript has been associated with the claims file. During this hearing, he had an opportunity to testify regarding all appealed issues, which are addressed herein. Consequently, his hearing scheduled for March 2020 to address the issues of entitlement to service connection for a right hip replacement, secondary to service-connected right knee disabilities, and service connection for erectile dysfunction, to include as secondary to the medications prescribed to treat any service-connected disability, was cancelled. 1. The issues of entitlement to service connection for a right hip replacement, secondary to service-connected right knee disabilities; and service connection for a left hip replacement, secondary to service-connected right knee disabilities, are remanded. The Veteran contends that his total right and left hip replacements are secondary to his service-connected right knee disabilities. See generally November 2019 Board Hearing Transcript. He underwent a VA examination for the left hip in September 2015 and one for the right hip in September 2016. Following each examination, the VA examiners confirmed his status post total hip replacement. Nevertheless, the VA examiners rendered negative nexus opinions, finding it was less likely than not the total hip replacement was proximately due to the service-connected right knee disabilities. In doing so, both VA examiners failed to address the issue of whether the degenerative joint disease of either hip leading to the total hip replacement or his status post total hip replacement of either hip was aggravated beyond its natural progression by the service-connected right knee disabilities. Cf. El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). As such, a remand is necessary for addendum VA medical opinions. 2. The issue of entitlement to service connection for erectile dysfunction, to include as secondary to the medications prescribed for the treatment of service-connected disabilities, is remanded. The Veteran contends that his erectile dysfunction is secondary to the medications prescribed for the treatment of his service-connected disabilities. See August 2016 Application for Disability Compensation and Related Compensation Benefits. He was examined by the VA in September 2016 with respect to this claim. Following examination, the VA confirmed he had a current diagnosis of erectile dysfunction. Nonetheless, the VA examiner rendered a negative nexus opinion, finding it was less likely than not proximately due to the medications prescribed to treat his service-connected right knee disabilities. In doing so, the VA examiner failed to address the issue of whether his erectile dysfunction was aggravated beyond its natural progression by the medications prescribed to treat his service-connected right knee disabilities or any other service-connected disability. Cf. El-Amin v. Shinseki, supra. For this reason, a remand is necessary for an addendum VA medical opinion. The matters are REMANDED for the following action: 1. Contact the Veteran to determine if there are any relevant, outstanding private treatment records. If so, undertake all appropriate development necessary to obtain the records from each private treatment provider and/or facility identified by him. 2. Obtain all relevant, outstanding VA treatment records. 3. Once the first two requests have been completed, to the extent possible, obtain an addendum medical opinion from an appropriate medical professional regarding the nature and etiology of the Veteran’s total right and left hip replacements. The need for an in-person examination is left to the discretion of the medical professional proffering the opinion. After reviewing the record, the examiner should: (a.) Opine was to whether it is at least as likely as not (50 percent probability or greater) the Veteran’s current diagnosis of total right and/or left hip replacement is (A) proximately due to or (B) aggravated beyond its natural progression by his service-connected right knee disabilities and explain why. The examiner is reminded that an opinion must address both causation and aggravation. (b.) In rendering an opinion, the examiner should consider the relevant medical evidence of record, to include the various VA treatment records documenting an altered gait and VA and private treatment records documenting the progression of his degenerative joint disease of the hips. (c.) In rendering an opinion, the examiner should consider a December 2017 Statement in Support of Claim, which may be from a private treatment provider. (d.) In rendering an opinion, the examiner should consider the Veteran’s relevant lay statements of record, to include his testimony during the November 2019 Board videoconference hearing. 4. Once the first two requests have been completed, to the extent possible, obtain an addendum medical opinion from an appropriate medical professional regarding the nature and etiology of the Veteran’s erectile dysfunction. The need for an in-person examination is left to the discretion of the medical professional proffering the opinion After reviewing the record, the examiner should: (a.) Opine was to whether it is at least as likely as not (50 percent probability or greater) the Veteran’s current diagnosis of erectile dysfunction is (A) proximately due to or (B) aggravated beyond its natural progression by the medications prescribed to treat any of his service-connected disabilities and explain why. The examiner is reminded that an opinion must address both causation and aggravation. (b.) In rendering an opinion, the examiner should consider the Veteran’s relevant lay statements of record, to include his testimony during the November 2019 Board videoconference hearing. 5. Once each of the above requests has been completed, to the extent possible, readjudicate the appeal. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Suh, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.