Citation Nr: 21062000 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 17-39 464 DATE: October 6, 2021 REMANDED Service connection for erectile dysfunction, to include as a result of medications used to treat service-connected disorders, is remanded. REASONS FOR REMAND The Veteran has active service from December 2002 to August 2003. This matter is on appeal from a June 2017 rating decision. In September 2020, a hearing was held before the undersigned. The Board will not at this time assume jurisdiction over the issue of an increased rating for left leg shin splints. On October 1, 2020, a Supplemental Statement of the Case (SSOC) adjudicated this issue. On October 18, 2020, the Veteran submitted a VA Form 10182, Notice of Disagreement, appealing this issue. As the 10182 was submitted within 60 days of an SSOC that issued on or after February 19, 2019, that appeal is opted into the modernized appeals system governed by the Appeals Modernization Act. 38 C.F.R. §§ 3.2400(a)(2), (c)(2). As such, the left leg shin splints appeal is no longer governed by legacy and will be addressed in a separate Board decision. 1. Service connection for erectile dysfunction, to include as a result of medications used to treat service-connected disorders, is remanded. The earliest record indicating erectile dysfunction is a May 11, 2005 VA medical record that describes the Veteran taking "viagra as instr[ucted]." From this date, the Veteran's VA computerized problem list includes "Impotence of organic origin 05/11/05." In his February 2017 VA examination, the Veteran states that his erectile dysfunction began in 2004. In April 2019, a Board decision held that a February 2017 VA medical opinion was inadequate and remanded for a new medical opinion. In December 2019, the Board remanded for an addendum medical opinion. Two additional opinions were obtained, in December 2019 and September 2020. In a September 2020 hearing, the Veteran stated that he was diagnosed with erectile dysfunction in 2002, prior to his active duty period of service from December 2002 to August 2003. New medical opinions addressing secondary service connection are required, as the most recent opinions do not contain separate bases for causation and aggravation. Remand is also required to obtain a copy of the entrance examination for the Veteran's period of active service, which began in December 2002. As the Veteran has never identified private doctors involved in the diagnosis and treatment of erectile dysfunction, he should be given the opportunity to do so. Finally, on remand the RO should obtain all relevant VA treatment records dated from September 2021 to the present before the issues on appeal are decided on the merits. Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain all VA treatment records from September 2021 to the present. If no records are available, the claims folder must indicate this fact. 2. Request that the Veteran complete an appropriate number of VA Forms 21-4142, Authorization and Consent to Release Information to VA, for any outstanding private treatment records related to the treatment and diagnosis of erectile dysfunction. Make two attempts to obtain any identified private treatment records and inform the Veteran of any attempts to locate any records that could not be obtained. 3. After completing the above development to the extent possible, an examiner should review the entire claims file and provide the following opinions: (a.) Whether the Veteran has any current or previously-diagnosed erectile dysfunction that is proximately due to a service-connected disorder, to include as a result of medications used to treat a service-connected disorder. (b.) Whether the Veteran has any current or previously-diagnosed erectile dysfunction that was aggravated by a service-connected disorder, to include as a result of medications used to treat a service-connected disorder. This must be addressed in a separate opinion from the "proximately due to" opinion. (c.) Whether it is clear and unmistakable (obvious, manifest, and undebatable) that erectile dysfunction preexisted the Veteran's service. If yes, the examiner should additionally provide an opinion as to whether there is clear and unmistakable evidence that erectile dysfunction was not aggravated by service. In rendering these opinions, the examiner should consider the Veteran's September 2020 hearing testimony that the Veteran had erectile dysfunction prior to entering active service. (d.) Whether it is at least as likely as not that there was an increase in erectile dysfunction during service. If yes, the examiner should additionally provide an opinion as to whether there is clear and unmistakable evidence that the worsening during service was due to the natural progression of the disease. In rendering these opinions, the examiner should consider the Veteran's September 2020 hearing testimony that the Veteran had erectile dysfunction prior to entering active service. (e.) Whether it is at least as likely as not that erectile dysfunction was aggravated by service. (f.) Whether it is at least as likely as not that erectile dysfunction was incurred during service. The examiner should provide a complete rationale for any opinions offered. If the examiner is unable to provide any requested opinion without resort to speculation, he or she should explain why this is so. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cannon, Brian 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.