Citation Nr: 21002785 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 19-26 096A DATE: January 14, 2021 REMANDED Service connection for hypertension is remanded. Service connection for erectile dysfunction, include sexual dysfunction, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1966 to February 1970, including service in the Republic of Vietnam. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an April 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In November 2020, the Veteran and his spouse (J.C.) testified at a hearing before the undersigned Veterans Law Judge. A transcript is associated with the claims folder. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2).   1. Service connection for hypertension is remanded. 2. Service connection for erectile dysfunction, to include sexual dysfunction, is remanded. The Veteran asserts that his hypertension and erectile dysfunction, to include sexual dysfunction, are related to in-service exposure to herbicide agent exposure. See November 2020 Board hearing transcript. Alternatively, the Veteran asserts that his disabilities are secondary to his service-connected posttraumatic stress disorder (PTSD). See also January 2018 VA 21-526 EZ. Lastly, the Veteran asserts that his erectile dysfunction, to include sexual dysfunction, is secondary to his hypertension, which is being remanded. See November 2020 Board hearing transcript. The Board has chosen to broaden the Veteran’s claim for erectile dysfunction to include sexual dysfunction. Having reviewed the lay testimony of record and the medical evidence (i.e. the March 2018 VA examination report which noted a diagnosis of sexual dysfunction, but not erectile dysfunction), such a recharacterization is in order to encompass all conditions reasonably contemplated by the claim. See Clemons v. Shinseki, 23 Vet. App. 1 (2009); The Veteran was afforded a VA examination in March 2018. While the examiner opined that neither sexual dsyfunction nor hypertension are directly caused by the service-connected PTSD; he did not offer an opinion as to whether either condition is at least as likley as not due to exposure to herbicide agents. In addition, the examiner did not offer an opinion as to the aggravation prong of secondary service connection. That is, whether the Veteran’s sexual dsyfunction or hypertension are at least as likley as not aggravated by his service-connected PTSD. Accordingly, the Board cannot make a fully-informed decision on the issues and a remand is required. The matters are REMANDED for the following action: Obtain an opinion from an appropriate clinician regarding the etiology of Veteran’s hypertension and erectile dysfunction, to include sexual dysfunction. The examiner should review the claims file and this Remand. The Board defers to the examiner’s discretion as to whether an in-person examination is required to render the requested opinion. a) The examiner is asked to clarify whether the Veteran has erectile dysfunction or sexual dysfunction. Please explain. b) The examiner is to provide an opinion as to whether it is at least as likely as not that the Veteran’s current disability of hypertension and erectile dysfunction (to include sexual dysfunction if appropriate) onset in service, or is otherwise related to his active service, to include as a result of the Veteran’s presumed exposure to herbicide agents. The examiner should consider the medical literature submitted by the Veteran, to include the findings of the National Academy of Sciences. The examiner is advised that a negative opinion related to presumed herbicide agent exposure cannot be solely based on the absence of hypertension from VA's list of diseases associated with exposure to certain herbicide agents found in 38 C.F.R. § 3.309 (e). The NAS has upgraded hypertension to the "sufficient" category from "limited or suggestive," indicating that "there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and herbicide agent exposure. c) The examiner is to provide an opinion as to whether it is at least as likely as not that hypertension manifested to a compensable degree within one year of service discharge. d) The examiner is to provide an opinion as to whether the Veteran’s hypertension and/or erectile dysfunction (to include sexual dysfunction as appropriate) is as likely as not proximately due to OR aggravated by the service-connected PTSD. d) If hypertension is etiologically related to service or manifested to a compensable degree within one year of service discharge, the examiner is to provide an opinion as to whether the erectile dysfunction, to include sexual dysfunction, is as likely as not proximately due to OR aggravated by the hypertension. In answering the questions as to secondary service connection, in sections c) and d), the examiner should note that two opinions and two supporting rationales are required: one for proximate causation and a second for aggravation. Further, the term “aggravation” means a worsening of a disability beyond its natural progression. A complete rationale for the requested opinions should be provided. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Vuong, 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.