Citation Nr: 21068648 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 18-43 537 DATE: November 12, 2021 ORDER New and material evidence has been received and the claim for service connection for macrocytic anemia, previously claimed as a blood disorder, is reopened. REMANDED Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for macrocytic anemia, previously claimed as a blood disorder is remanded. FINDING OF FACT The evidence received since the December 2014 rating decision is not duplicative or cumulative of evidence previously of record and raises a reasonable possibility of substantiating the Veteran's claim of service connection for macrocytic anemia, previously claimed as a blood disorder. CONCLUSION OF LAW 1. The December 2014 rating decision that denied service connection for blood disorder is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 3.160(d), 20.302, 20.1103. 2. Evidence received since the December 2014 rating decision is new and material; the claim of entitlement to service connection for macrocytic anemia, previously claimed as a blood disorder have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from January 1964 to January 1966, to include service in the Republic of Vietnam. These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2017 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned in February 2021. The Veteran previously submitted a claim of entitlement to service connection for a blood disorder which was denied in a December 2014 rating decision on the basis that the Veteran did not have a current disability. The December 2014 rating decision became final because the Veteran did not submit a Notice of Disagreement or new evidence in connection with the claim within the appeal period. See 38 C.F.R. § 3.156(b). In connection with the Veteran's claim to reopen, he submitted medical evidence of diagnosed macrocytic anemia. Thus, the Board finds that new and material evidence has been received sufficient to reopen his previously denied claim. 38 C.F.R. § 3.156(a); Shade v. Shinseki, 24 Vet. App. 110, 117-18 (2010); Justus v. Principi, 3 Vet. App. 510, 513 (1992). REASONS FOR REMAND 1. Entitlement to service connection for erectile dysfunction is remanded. 2. Entitlement to service connection for macrocytic anemia, previously claimed as a blood disorder, is remanded. The Veteran asserts that his erectile dysfunction and anemia are both secondary to his service-connected coronary artery disease and/or his service-connected PTSD, to include the medications used to treat those conditions. The Veteran also testified at the February 2021 Board hearing that his exposure to Agent Orange has "led on to" his conditions. Based on the above, a remand for new VA examinations to determine the nature and etiology of these conditions is required. The matters are REMANDED for the following action: 1. Reach out to the Veteran and his representative to have them identify any physicians/medical facilities relevant to his macrocytic anemia and/or erectile dysfunction. For any physician/medical facility identified, ask the Veteran to complete a VA Form 21-4142, then make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 2. Schedule the Veteran for a VA examination for his erectile dysfunction. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is erectile dysfunction at least as likely as not related to service, including exposure to herbicides? Provide a rationale to support the opinions. Is erectile dysfunction at least as likely as not proximately due to service-connected coronary artery disease, to include medications used to treat that condition? Is erectile dysfunction at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected coronary artery disease, to include medications used to treat that condition? Is erectile dysfunction at least as likely as not proximately due to service-connected PTSD, to include medications used to treat that condition? Is erectile dysfunction at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected PTSD, to include medications used to treat that condition? Is erectile dysfunction at least as likely as not related to in-service exposure to herbicide agents? The examiner must review and discuss the article titled "Coumadin and Erectile Dysfunction." The examiner is advised that a negative opinion cannot be based solely on the fact that erectile dysfunction is not on the list of diseases that are presumptively associated with exposure to herbicide agents. 3. Schedule the Veteran for a VA examination for his macrocytic anemia. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is macrocytic anemia at least as likely as not related to service, including exposure to herbicides? Provide a rationale to support the opinions. Is macrocytic anemia at least as likely as not proximately due to service-connected coronary artery disease, to include medications used to treat that condition? Is macrocytic anemia at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected coronary artery disease, to include medications used to treat that condition? Is macrocytic anemia at least as likely as not proximately due to service-connected PTSD, to include medications used to treat that condition? Is macrocytic anemia at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected PTSD, to include medications used to treat that condition? Is macrocytic anemia at least as likely as not related to in-service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that macrocytic anemia is not on the list of diseases that are presumptively associated with exposure to herbicide agents. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Keeley, 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.