Citation Nr: 21004252 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 17-01 512 DATE: January 26, 2021 REMANDED Entitlement to service connection for hepatitis B is remanded. Entitlement to service connection for erectile dysfunction (ED) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1966 to October 1972. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the board in August 2019, at which time they were remanded for development. They have been returned to the Board for appellate review. 1. The claims for entitlement to service connection for hepatitis B and ED are remanded. The Board’s August 2019 remand ordered VA examinations and expert medical opinions as to etiology with respect to the above-enumerated disorders. Unfortunately, neither examination or medical opinion is adequate, and thus the matter must be remanded in order that the Veteran be afforded adequate examinations and opinions as to etiology. The VA examiner with whom the Veteran met in January 2020 for evaluation of his hepatitis B confirmed the diagnosis of hepatitis B in 1995, but indicated the disorder was no longer present, and that in any event, because it was unrelated to food consumption, as the Veteran had suggested in his Board hearing, but rather to sexual contact or needle sharing, the disorder was not likely service-related. The Board observes that the Veteran has indicated he engaged in high-risk sexual activity during service, and has also theorized that his hepatitis B may have been related to the same. Further, the examiner did not clarify whether the Veteran is beset by any current residuals of hepatitis B. With respect to ED, the January 2020 VA examiner simply concluded that the Veteran’s diagnosed ED was less likely than not secondary to his service-connected diabetes mellitus, type II, offering only that “it is more likely than not related to hypogonadism” without further explanation. The Board observes that the Veteran, through his representative, has submitted several journal articles addressing an etiological relationship between diabetes and ED, and in any event, the VA examiner’s opinion does not contain adequate explanation for its conclusion, in particular its dismissal of the possibility or likelihood of any etiological relationship between diabetes and ED. On remand, new VA examinations must be conducted, and adequate medical opinions as to etiology obtained. The matters are REMANDED for the following action: 1. After obtaining the necessary authorization, obtain any outstanding VA and private treatment records relevant to the Veteran’s claims. 2. Then, schedule the Veteran for a VA examination to explore the presence and etiology of hepatitis B. All indicated tests and studies should be conducted and all clinical findings reported in detail. The entire claims file should be made available to and be reviewed by the examiner in conjunction with this request.       Please identify whether the Veteran has had a diagnosis of hepatitis B during the current appeal period, and/or whether the Veteran is beset by current residuals of hepatitis B. If hepatitis B or its residuals have been present during the appeal period, please state whether it is at least as likely as not (e.g. at least a 50 percent probability or greater) that the condition began in service or is otherwise related to service, to include by virtue of sexual activity therein. 3. Schedule the Veteran for a VA examination to explore the etiology of his ED. All indicated tests and studies should be conducted and all clinical findings reported in detail. The entire claims file should be made available to and be reviewed by the examiner in conjunction with this request.  Please state whether it is at least as likely as not (e.g. at least a 50 percent probability or greater) that ED began in service or is otherwise related to service. If direct service connection is not shown, please state whether it is at least as likely as not that the Veteran’s ED has been caused or aggravated beyond its normal course of progression by service-connected diabetes mellitus, type II, or its treatment, including medication. In rendering an opinion, the examiner should evaluate and comment on those journal articles submitted by the Veteran in December 2020. 4. Review the opinions and any examination reports to ensure that they are in complete compliance with the directives of this remand. If an opinion or report is deficient in any manner, the AOJ must implement corrective procedures.   5. Then readjudicate the claims. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Z. Sahraie, 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.