Citation Nr: 21063766 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 17-08 744 DATE: October 15, 2021 REMANDED An initial rating in excess of 10 percent for a back disorder. An initial rating in excess of 10 percent for radiculopathy of the right lower extremity. Service connection for a right knee disorder. Service connection for a left knee disorder. Service connection for coronary artery disease (CAD). Service connection for erectile dysfunction. REASONS FOR REMAND The Veteran served on active duty from July 1972 to August 1974. The case is on appeal from January 2013 and July 2014 rating decisions. In the February 2017 substantive appeal, the Veteran requested a Board hearing. A Board hearing was initially scheduled for February 2020. In March 2020, the Veteran requested to have the hearing rescheduled. The hearing was rescheduled several times, most recently in August 2021. The Veteran failed to appear at the August 2021 hearing and has not requested that the hearing be rescheduled or submitted good cause for his absence. As such, the Board considers the Veteran's request for a hearing to be withdrawn. See 38 C.F.R. § 20.704. 1. An initial rating in excess of 10 percent for a back disorder. 2. An initial rating in excess of 10 percent for radiculopathy, right lower extremity. The Veteran contends a higher rating is warranted for his service-connected lumbar spine disability and associated radiculopathy of the right lower extremity. The Veteran was afforded an August 2016 VA examination in which the Veteran reported flare-ups, including pain in the back when standing, laying down and sitting. Range of motion testing revealed forward flexion to 90 degrees with pain during testing. The examiner found the examination is medically consistent with the Veteran's statements describing functional loss with repetitive use over time and during flare-ups. She reported the Veteran has localized tenderness not resulting in an abnormal gait or abnormal spinal contour. She indicated there was no evidence of pain with weight bearing. As noted above, the examiner indicated the Veteran's right lower extremity radiculopathy causes constant moderate pain, as well as moderate paresthesias, dysesthesias and numbness. The Board finds the August 2016 examiner did not adequately test for pain on both active and passive motion, and in weight-bearing and nonweight-bearing settings per Correia v. McDonald, 28 Vet. App. 158 (2016). As such, another VA examination is required to assess the severity of the Veteran's service-connected back and right lower extremity radiculopathy. To the extent possible, a retrospective opinion should also be provided which complies with the requirements of the holding in Correia. 3. Service connection for a right knee disorder. 4. Service connection for a left knee disorder. The Veteran contends that his bilateral knee disorders are related to service, to include the extensive marching and physical training required during motivational and correctional assignments. Alternatively, he asserts his knee disorders are associated with his service-connected back disability. The Veteran was afforded an August 2016 VA examination in which he was diagnosed with bilateral tendonitis/tendinosis. The examiner opined the Veteran's knee disorders are not related to his back condition. She stated the record shows the Veteran has been diagnosed with mild degenerative disc disease in the thoracic and lumbar regions of the spine. She further indicated it is less likely than not that the bilateral knee disorders are due to the back condition, as the mild back disability is not pathophysiologically associated with the mild knee conditions. The Board finds the August 2016 VA examination report is not adequate in its discussion of the etiology of the Veteran's bilateral knee disorders. There was no discussion by the examiner regarding the Veteran's assertion of direct service connection. Additionally, the discussion related to secondary service connection is conclusory and does not provide adequate rationale as to whether the knee disorders are etiologically associated with the back disability. Therefore, remand is warranted for a new VA examination to determine whether the Veteran's bilateral knee disorders are related to service or his service-connected back disability. 5. Service connection for CAD. The Veteran contends that his heart disorder is related to his service-connected psychiatric disability, to include the medication required for the condition. The Veteran's former representative submitted a January 2017 statement which indicated based on the severity of the Veteran's psychiatric disability and the medications required including Fluoxetine, the Veteran developed a heart condition. Given the evidence of a potential relationship between the Veteran's heart disorder and his service-connected depression, he should be afforded a VA examination to determine the etiology of any diagnosed heart disorder. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). 6. Service connection for erectile dysfunction. The Veteran contends that his erectile dysfunction is related to his service-connected disabilities, to include the medication required for these conditions. In the August 2016 informal conference, the Veteran reported his erectile dysfunction is causally related to his back disability. The Veteran was afforded an August 2016 VA examination in which he was diagnosed with erectile dysfunction. The examiner stated the Veteran's erectile dysfunction is not proximately due to or the result of his service-connected back disorder. She indicated although there is a pathophysiologic relationship between back disease and erectile dysfunction, there would have to be significant lumbar degenerative changes to link erectile dysfunction to back disease. The examiner reported in the Veteran's case, the degenerative changes in the thoracic region would not cause erectile dysfunction. Thereafter, the January 2017 statement indicated the Veteran's erectile dysfunction is the result of his service-connected disabilities, including the required medication. This includes discussion of the medication Fluoxetine, which is prescribed for the Veteran's depression. The statement reported Fluoxetine is a selective serotonin reuptake inhibitor with a noted side effect of sexual dysfunction. It reported The National Institute of Health recognizes that changes in sex drive or ability are side effects of Fluoxetine. The Veteran should be afforded another VA examination to determine whether his erectile dysfunction is associated with his service-connected disabilities, including the required medications for such. In light of the remand, updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain VA treatment records from October 2016. 2. Schedule the Veteran for VA examination by an appropriate medical professional to assess the severity of his service-connected back and right lower extremity radiculopathy disabilities. The examination should include testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. In addition, a retrospective assessment/opinion should be provided as to the severity of the back and right lower extremity disabilities, to include an estimate of the amount in degrees of range of motion lost due to pain in weight-bearing and nonweight-bearing positions, and on both active and passive motion, including at the time of VA examinations in December 2012 and August 2016. If the examiner cannot provide some or all of such retrospective opinion, the examiner must make clear that he or she has considered all relevant, procurable data, but that any member of the medical community at large could not provide such an opinion without resorting to speculation. 3. Schedule the Veteran for a VA examination by an appropriate medical professional to determine the nature and etiology of the bilateral knee disorders. The examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the bilateral knee disorders had their onset during, or are otherwise related to, service. If not directly related to service, the examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's knee disorders were caused or aggravated by his service-connected back disability. Aggravation is an increase in severity beyond the natural progress of the disease. 4. Schedule the Veteran for a VA examination by an appropriate medical professional to determine the nature and etiology of a heart disorder, if diagnosed. The examiner should identify if the Veteran is diagnosed with a heart disorder, to include CAD. The examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's heart disorder was caused or aggravated by his service-connected psychiatric disability, to include the medication required for such. Aggravation is an increase in severity beyond the natural progress of the disease. 5. Schedule the Veteran for a VA examination by an appropriate medical professional to determine the nature and etiology of his erectile dysfunction. The examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's erectile dysfunction was caused or aggravated by his service-connected disabilities, to include the medication required for such. Aggravation is an increase in severity beyond the natural progress of the disease. The examiner should review and address the January 2017 statement in support, including the discussion of Fluoxetine. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Isaacs, Brandon 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.