Citation Nr: 21066208 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 20-23 027 DATE: October 29, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disabilities and medications prescribed to treat service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1965 to December 1966. This matter comes before the Board of Veterans' Affairs (Board) on appeal from an October 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ); a transcript is of record. The Board remanded the appeal in February 2021 to the agency of original jurisdiction (AOJ) for further development. The Veteran's appeal has been advanced on the docket. 38 C.F.R. § 20.902. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disabilities and medications prescribed to treat service-connected disabilities Upon review of all evidence of record, although the Board regrets the need for further delay, another remand is necessary to protect the Veteran's due process rights and ensure compliance with the Board's prior remand instructions. When the Board remands an appeal, the claimant obtains a right to compliance with its remand orders. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In this regard, the Board finds that the record contains a May 2021 VA opinion. The May 2021 VA examiner opined on causation and provided a rationale discussing the potential of the Veteran's service-connected disabilities and medication prescribed to treat any such disabilities to cause erectile dysfunction issues. However, the examiner did not specifically opine on whether it is at least as likely as not (a 50 percent probability or greater) that any erectile dysfunction reported during the appeal period (i.e., from July 2017 to date) is aggravated by any of the Veteran's service-connected disabilities, to include migraine headaches, fibromyalgia, and traumatic brain injury, to include the medications prescribed to treat any such disability. A medical opinion addressing secondary service connection must address causation and aggravation. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Further, the May 2021 VA examiner noted that the Veteran is on 14 medication, many of which are known to have the potential to create sexual side effects. The Board finds that a clarification is needed as to whether any specific medication prescribed to treat the Veteran's service-connected disabilities causes or aggravates his erectile dysfunction. In his September 2021 Statement in Support of Claim, the Veteran also reported that the May 2021 VA examiner did not address the onset of his erectile dysfunction and how the specific medications that he takes impact his ability to perform sexually. Consequently, the Board finds that a remand is needed, to obtain an additional addendum opinion addressing the above. Stegall, supra. The matter is REMANDED for the following action: 1. Forward the Veteran's claims file to a qualified VA examiner to provide an addendum medical opinion addressing the nature and etiology of the Veteran's erectile dysfunction, to include as secondary to service-connected disabilities and medications prescribed to treat service-connected disabilities. A full examination should not be scheduled unless it is deemed necessary by the examiner or otherwise required by the evidence. The examiner must review the claims file, including a copy of this Remand and should note so in the report. Thereafter, the examiner is asked to provide an opinion with respect to the following: (a) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's erectile dysfunction is proximately due to any of his service-connected disabilities, to include migraine headaches, fibromyalgia, and traumatic brain injury, to include the specific medication prescribed to treat any such disability. (b) Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's erectile dysfunction is aggravated by any of his service-connected disabilities, to include migraine headaches, fibromyalgia, and traumatic brain injury, to include the specific medication prescribed to treat any such disability. The requested opinion must adequately consider and address the Veteran's lay statements and discuss whether, if so which, specific medication prescribed to treat the Veteran's service-connected disabilities causes or aggravates his erectile dysfunction. The examiner must set forth a complete rationale for any conclusion reached, citing to the examiner's own expertise, medical literature, and/or evidence in the Veteran's claims file as necessary. If an opinion cannot be reached without resorting to speculation, the examiner must fully explain why that is so. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Kuzniar, 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.