Citation Nr: 21004038 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 18-51 216 DATE: January 25, 2021 REMANDED Entitlement to service connection for erectile dysfunction secondary to a service-connected lumbar spine disability is remanded. REASONS FOR REMAND The Veteran had active service from October 1971 to July 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2017 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Board denied the Veteran’s claim for service connection for erectile dysfunction secondary to a service-connected lumbar spine disability. The Veteran appealed the August 2019 Board decision to the United States Court of Appeals for Veterans Claims (CAVC). In a Joint Motion for Partial Remand (JMPR), the CAVC vacated and remanded the portion of the Board’s decision that denied entitlement to service connection for erectile dysfunction claimed as secondary to a service-connected lumbar spine disability because the Board erred when it relied on an inadequate examination. Specifically, the JPMR indicates that the Board relied on an October 2017 VA medical opinion that did not address aggravation and provided an unclear rationale regarding whether the Veteran’s low back disability caused his erectile dysfunction. The JPMR thus instructs that a remand for a new medical opinion that adequately addresses the issues of secondary causation and aggravation is necessary. The matter is now again before the Board for action consistent with the terms of the JMPR. Entitlement to service connection for erectile dysfunction secondary to a service-connected lumbar spine disability is remanded. Once VA undertakes the effort to provide an examination in connection with a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one, or at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion will be considered adequate when it is based upon consideration of the Veteran’s prior medical history and examinations and provides a sufficiently detailed description of the disability so that the Board’s evaluation will be a fully informed one. Id.; Green v. Derwinski, 1 Vet. App. 121, 124 (1991). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Additionally, aggravation of a condition by a service-connected disability must be considered independently of direct causation, and medical examinations must provide adequate reasoning and conclusions on both points. Atencio v. O’Rourke, 30 Vet. App. 74, 91 (2018). In an October 2017 VA opinion, the examiner opined that the Veteran’s erectile dysfunction is less likely than not proximately due to or the result of his service-connected lumbar spine degenerative disc disease and arthritis condition. Based on the given history, the onset of the erectile dysfunction preceded the suspicion of a spinal lesion by many years; there is also insufficient evidence from the record, including previous back DBQs, to support a relationship between the erectile dysfunction and his lumbar condition. However, although the examiner provided a secondary causation opinion, it is unclear how a spinal lesion relates to the Veteran’s service-connected disabilities. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Moreover, no opinion addressing whether the whether the Veteran’s service-connected lumbar spine disability aggravated his erectile dysfunction was provided. See Atencio v. O’Rourke, 30 Vet. App. 74, 91 (2018). For these reasons, the October 2017 VA opinion is inadequate, and a new VA opinion is necessary to adjudicate the claim. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the nature and etiology of the Veteran’s erectile dysfunction. The electronic claims file must be made accessible to the examiner for review in conjunction with the examination. The VA examiner should address whether the Veteran’s erectile dysfunction is at least as likely as not (50% probability or greater) caused or aggravated (increased in severity beyond the natural progress of the disorder) by his service-connected lumbar spine disability, considering each individually (that is, whether it was caused, and whether it was aggravated) and providing adequate rationale on both points. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should indicate such and provide a supporting rationale as to why the opinion cannot be made without resorting to speculation. (Continued on the next page)   An explanation of all opinions expressed must be provided, with consideration given to all evidence of record. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Hite, 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.