Citation Nr: A21017489 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 210719-173565 DATE: October 28, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to urticaria/angioneurotic edema, is remanded. Entitlement to special monthly compensation (SMC) based on loss of use is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from December 1982 to November 1988. The rating decision on appeal was issued in June 2021 and is subject to the Appeal Modernization Act (AMA). 84 Fed. Reg. 138, 169 (Jan. 18, 2019); 38 C.F.R. § 19.2. The Veteran timely appealed this rating decision to the Board in July 2021 and requested the Evidence Submission lane. As this is an Evidence Submission lane appeal, the Board has considered the evidence of record at the time of the June 2021 rating decision, and evidence submitted within 90 days of the election of the Evidence Submission lane. In the June 2021 AMA decision, the Agency of Original Jurisdiction (AOJ) found that there was new and material evidence to reconsider the claim and a diagnosis for erectile dysfunction. The Board is bound by these favorable findings. 84 Fed. Reg. 138, 167 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.104 (c)). By way of history, the Board notes that an October 2019 rating decision originally denied the above claims. Following an October 2019 supplemental claim submission, a December 2019 rating decision continued to deny the claims based on the lack of new and relevant evidence. The Veteran appealed the decision to the Board and elected direct review of the evidence in February 2020. The matters were then remanded by the Board for further development in April 2021. Following the April 2021 remand, a June 2021 rating decision was issued and again denied the claims at which time the Veteran submitted an August 2021 VA 10182 and elected the evidence submission lane. The Board also notes the Veteran seeks appellate review for a claim related to heart arrythmia in his August 2021 VA 10182; however, a decision on the claimed issue was never made by the VA. As such, that issue is not before the Board. A letter dated September 3, 2021 was sent to the Veteran confirming such. This appeal has been advanced on the docket pursuant to 38 C.F.R. § 20.900 (c). Although the Board regrets the delay, another remand is warranted before the Board can issue an appellate decision in this matter. 1. Entitlement to service connection for erectile dysfunction, to include as secondary to urticaria/angioneurotic edema, is remanded. The Veteran contends that his erectile dysfunction is secondary to his service connected urticaria/angioneurotic edema, to include medications taken therefore. Pursuant to the April 2021 Board remand, a June 2021 VA examination was obtained. The examination demonstrated a diagnosis for erectile dysfunction and the Veteran's reports of onset for this condition during service. The examiner provided a negative nexus opinion. With regard to a direct nexus, the examiner indicated that medical records do not support any currently diagnosed condition related to erectile dysfunction that is at least as likely as not incurred in service, nor is there documentation in medical records that the Veteran had complained of or was evaluated for erectile dysfunction. With regard to a secondary nexus, the examiner indicated that there is no documented evidence or literature to conclude the Veteran's erectile dysfunction was due to or caused urticaria/angioneurotic edema or sinusitis with medication, and no known medical cause of erectile dysfunction. In addition, the examiner concluded there is no medical evidence that would suggest aggravation and that urticaria/angioneurotic edema or sinusitis, both with medication use, is not a known medical cause of aggravation for erectile dysfunction. The Board finds the June 2021 VA opinion is inadequate. The examiner concluded that there is no medical evidence or literature to support a causal or aggravating cause for erectile dysfunction by the service-connected condition nor evidence of any complaints for erectile dysfunction during service; however, these are conclusory opinions with no sufficient rationale in support thereof. Furthermore, most recently, the Veteran provided medical literature evidencing a causal relationship between erectile dysfunction and chronic spontaneous urticaria. See October 2021 Correspondence. Lastly, while service treatment records do not document complaints and treatments for erectile dysfunction, per say, there are documented complaints for right lower quadrant pain in July 1987 and inflamed prostatic urethra in September 1987. These records were not addressed by the June 2021 VA examiner. On remand, an addendum opinion is warranted to determine the nature and etiology of the claimed condition. 2. Entitlement to SMC based on loss of use is remanded. The Veteran's claim for entitlement to SMC based on loss of use of a creative organ is ancillary to the remanded claim above. Thus, the AOJ must readjudicate the claim after readjudicating the claim of service connection for erectile dysfunction. The matters are REMANDED for the following action: Obtain an addendum opinion from the June 2021 examiner, or another qualified clinician. The examiner providing the opinion must be provided access to the electronic claims file and indicate review of the file in the examination report. The claims folder and a copy of this remand in its entirety must be provided to the examiner in conjunction with the addendum opinion. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and lay statements; the examiner must indicate on the examination report that such review was undertaken. If examination of the Veteran is necessary, such should be arranged. The examiner is asked to determine the following: a) Is it as least as likely as not (50 percent probability or greater) that erectile dysfunction began during active service, or is otherwise related to service? Consideration should be given to the July and September 1987 service treatment records evidencing complaints for right lower quadrant pain and inflamed prostatic urethra. b) Is it at least as likely as not that erectile dysfunction was proximately caused by or aggravated by a service-connected disability, to specifically include urticaria/angioneurotic edema, including medication taken therefore? "Permanent worsening" of a non-service-connected disability is not required to establish secondary service connection on the basis of aggravation. Ward v. Wilkie, 31 Vet. App. 233 (2019). The examiner must provide separate findings and rationales relating to causation and aggravation. The examiner should consider medical literature submitted by the Veteran evidencing a causal relationship between erectile dysfunction and chronic spontaneous urticaria. The examiner must provide a rationale in support of all opinions provided. If the examiner cannot provide the opinion without conducting an examination of the Veteran, then an examination must be scheduled. If any opinion cannot be provided without resorting to speculation, the examiner must explain why this is so. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Asfaw, 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.