Citation Nr: 20042579
Decision Date: 06/24/20	Archive Date: 06/24/20

DOCKET NO. 12-34 964
DATE: June 24, 2020

REMANDED

Entitlement to service connection for central hypogonadism, to include as secondary to medications prescribed for posttraumatic stress disorder (PTSD) or other service-connected mental disorders is remanded.

REASONS FOR REMAND

The Veteran had active duty service from February 1997 to September 1997, March 2000 to March 2003, and March 2003 to October 2008. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Board previously remanded this case in August 2017 and March 2019.

1. Entitlement to service connection for hypogonadism is remanded.

The Veteran and his representative have claimed that the Veteran’s central hypogonadism was caused by side-effects of the medications that were prescribed for the Veteran’s service-connected PTSD (previously rated as adjustment disorder with symptoms of anxiety, depression, and insomnia).

The Veteran was afforded a VA examination in January 2018 to determine the nature and etiology of his central hypogonadism disability. The examiner only assessed whether the Veteran’s central hypogonadism and resulting erectile dysfunction was related to his in-service head trauma or the testosterone boosters that he took on active duty or any other event in military service. In March 2020, VA obtained an addendum medical opinion. The VA examiner stated that the cause of this Veteran’s hypogonadism could not be determined by extensive work up by his VA endocrinologist. The examiner concluded that there is no evidence that the Veteran’s central hypogonadism was proximately due to or aggravated beyond its natural progress by any of the medications that has been proscribed for his service-connected PTSD or other service-connected mental disorders. 

The Board finds that the VA examiner’s opinion is not adequate for adjudication. The VA examiner’s rationale is essentially that the Veteran’s endocrinologist did not know the cause of his hypogonadism and therefore, it is not due to or aggravated by medication taken for his service-connected psychiatric disorders. First, it is unclear why there is insufficient evidence to determine whether hypogonadism is at least as likely as not (equal to or greater than 50 percent) proximately due to or aggravated by the Veteran’s acquired psychiatric medication. Concerning the examiner’s negative aggravation opinion, the examiner did not explain why the medication did not aggravate his hypogonadism. Simply because a disorder has an unknown cause does not mean such a disease could not be aggravated by medication. Therefore, a remand is required in order for VA to obtain adequate rationales for the opinions provided. 

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s central hypogonadism. The examiner must provide the following opinions:

(a.) Whether the Veteran’s hypogonadism is at least as likely as not proximately due to OR aggravated beyond its natural progression by the medication(s) that he has been prescribed for his service-connected PTSD or other service-connected mental disorders, to include adjustment disorder with anxiety and depression.

(b.) The examiner must provide a complete rationale for all expressed opinions.

 

 

S. L. Kennedy

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	Robert Batten

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.