Citation Nr: 20019793 Decision Date: 03/17/20 Archive Date: 03/17/20 DOCKET NO. 13-35 593 DATE: March 17, 2020 REMANDED Entitlement to service connection for erectile dysfunction is remanded. REASONS FOR REMAND This appeal comes before the Board of Veterans’ Appeals (Board) from an August 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In a March 2014 decision, the Board remanded the appeal to afford the Veteran a Board hearing. The Veteran testified before the undersigned Veterans Law Judge in October 2014 and a copy of that transcript is of record. In a March 2016, July 2017, and June 2019, the Board remanded the appeal for further development. 1. Entitlement to service connection for erectile dysfunction is remanded. The Veteran contends that service connection is warranted for erectile dysfunction. At the outset, the Board notes that the Veteran reported in December 2010 correspondence that he started having erectile dysfunction in 1993. Thus, in March 2016, the Board directed that the RO schedule the Veteran for a VA examination to determine the nature and etiology of his claimed erectile dysfunction. The Veteran was afforded a VA male reproductive system conditions examination in October 2016, at which time the Veteran was diagnosed with erectile dysfunction. At the time of the examination, the Veteran was 87 years old and he reported that his symptoms onset in 1993. The examiner noted that the Veteran had multiple medical problems, to include diabetes mellitus. The examiner further stated that exposure to asbestos does not cause erectile dysfunction based on medical knowledge. In July 2017, the Board remanded the matter and directed that the RO address whether the Veteran’s erectile dysfunction was due to contaminants, other than asbestos, and to address whether the Veteran’s erectile dysfunction was directly related to his military service. In a September 2017 addendum opinion, a VA examiner opined that it was less likely than not that the Veteran’s erectile dysfunction was related to service. The examiner rationed that erectile dysfunction is not caused by exposure to contaminated water in China based on current medical knowledge. In June 2019, the Board again remanded the matter, noting that the addendum opinion required clarification to identify the source of the current medical knowledge and to explain the relevance of the medical source/knowledge in addressing whether the Veteran’s erectile dysfunction was or was not caused by any in-service exposure to asbestos and/or environmental hazards (from contaminated water) in China, Guam, and Camp Lejeune; or, by any other event, injury, or illness in service, to include the Veteran’s reports of a kidney infection in service. See December 2010 claim; see also October 2014 Board hearing. The Veteran was afforded another VA examination in January 2020, conducted by a different VA examiner, in which the examiner noted the Veteran’s prior diagnosis of erectile dysfunction. The examiner opined that it was less likely than not that the Veteran’s erectile dysfunction was incurred in or caused by the claimed in-service injury, event, or illness. The examiner rationed that the Veteran has multiple medical problems, such as diabetes mellitus, and that such conditions usually cause erectile dysfunction in men. The examiner also related that the condition can stem from damage to nerves and blood vessels caused by poor long-term blood sugar control and that there are no medical evidences to connect environmental hazard exposure such as asbestos or contaminated water in China, Guam, or Camp Lejeune. The examiner further reported that while water contaminated with arsenic may cause erectile dysfunction, there was no evidence shown that the Veteran was indeed exposed to water contaminated with arsenic or shows that contaminated water in China, Guam, or Camp Lejeune, at the time of exposure, was contaminated with arsenic. The examiner also opined that it was less likely than not that the Veteran’s condition was proximately due to or the result of a service-connected condition. The examiner stated that the etiology of erectile dysfunction was unknown and likely multifactorial. Specifically, the examiner rationed that erectile dysfunction is associated with many medical conditions, to include prostate enlargement and diabetes mellitus and that records show that the Veteran has such conditions. The examiner also reported that it was not possible to determine the cause of the erection problem without resort to speculation. Regrettably, the Board must again remand the matter. In this regard, the opinion provided did not substantially comply with the remand directives established in the Board’s June 2019 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Specifically, the VA examiner did not acknowledge the Veteran’s reports of a kidney infection in service in determining whether such was related to his later development of erectile dysfunction. On remand, an addendum opinion must be obtained. The matters are REMANDED for the following action: 1. Obtain a supplemental opinion to the January 2020 VA medical opinion from a medical professional with appropriate expertise to determine the nature and cause of the Veteran’s erectile dysfunction. If a VA examination is deemed warranted by the examiner, schedule an appropriate examination of the Veteran. The claims file, including this Remand, should be made available for review by the examiner. The examiner should respond to the following: Based on a review of the procurable and assembled data contained in the Veteran’s service treatment records, does this data reflect that the Veteran presented with and/or received treatment for a kidney infection during service? If so, the examiner should comment on whether any kidney infection (as noted in the service treatment records) caused any damage to the Veteran’s genitourinary system that has resulted in, or is related to, the erectile dysfunction that the Veteran now has. In making this assessment, the examiner is asked to identify the medical source/knowledge (i.e., peer review studies, medical literature, diagnostic tests, studies, clinical data, etc.) and specifically explain the relevance of that medical source/knowledge in support of his or her conclusion. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.