Citation Nr: 21069361 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 18-51 882 DATE: November 18, 2021 REMANDED Entitlement to service connection for pituitary microadenoma is remanded. Entitlement to service connection for a psychiatric disability to include an anxiety disorder is remanded. Entitlement to service connection for erectile dysfunction is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1982 to December 1987. The case is on appeal from an April 2016 rating decision. In an August 2019 decision, the Board denied the claims on appeal. The Veteran then appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In a March 2021 Memorandum Decision, the Court vacated the Board's August 2019 decision and remanded the case to the Board for further action consistent with the Memorandum Decision. 1. Entitlement to service connection for pituitary microadenoma is remanded. 2. Entitlement to service connection for a psychiatric disability to include an anxiety disorder is remanded. 3. Entitlement to service connection for erectile dysfunction is remanded. The March 2021 Memorandum Decision indicated that it was unclear why the Board's analysis focused solely on the Veteran's in-service radiation exposure aboard the U.S.S. Florida ballistic missile submarine and minimized the his complaints of prolonged exposure to hazardous or toxic materials due to his duties as a missile checkout technician and also failed to explain why prolonged exposure to toxic chemicals in-service did not contribute to the Veteran's development of a pituitary microadenoma. Therefore, the Board finds that remand is warranted for a VA examination and medical opinion which directly addresses whether the pituitary microadenoma is related to or onset during active service to include reported hazardous or toxic materials exposure aboard the U.S.S. Florida. Regarding the Veteran's claim for entitlement to service connection for a psychiatric condition the Court concluded that the Board relied upon an inadequate June 2015 VA mental disorders examination report, as the examiner only provided an etiological opinion regarding a diagnosed adjudgment disorder but did not address a diagnosed anxiety disorder and whether that condition was related to the Veteran's in-service stressful experiences. Therefore, the Board finds that remand is warranted for a VA examination and medical opinion which directly addresses whether any diagnosed psychiatric disorder to include an anxiety disorder is related to or onset during active service. Regarding the Veteran's claim for erectile dysfunction, the Court noted that that the evidence suggested that the disability was secondary to pituitary microadenoma. All issues "inextricably intertwined" with the issue certified for appeal, are to be identified and developed prior to appellate review. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The issue of entitlement to erectile dysfunction is intertwined with the service connection claim for pituitary microadenoma because a decision on the latter claim may have an impact on the former claim. Thus, the claim of entitlement to erectile dysfunction must be remanded for the appropriate development, as well as contemporaneous adjudication. These matters are REMANDED for the following actions: 1. Provide the Veteran with an appropriate examination to determine the etiology of the diagnosed pituitary microadenoma. The entire claims file should be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. The examiner must review the VA examination reports of record. (a) The examiner must provide an opinion regarding whether it is at least as likely as not (probability of approximately 50 percent) that pituitary microadenoma had onset in, or is otherwise related to, active service, to include as due to the Veteran's reported exposure to harmful fumes and toxic chemicals while service aboard a ballistic missile submarine as a missile checkout technician. The examiner is to state whether a nexus between the Veteran's current pituitary microadenoma and service is medically consistent with the information provided by the Veteran. (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time making an assessment of the credibility of his statements. A full credibility determination will be made at a later date, if needed, once additional evidence has been added to the claims file.) A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If medical literature is reference, please provide a copy of it or a full citation that allows general access. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training)..** 2. Provide the Veteran with an appropriate examination to determine the etiology of any diagnosed psychiatric disability to include an adjustment disorder and anxiety disorder. The entire claims file should be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. The examiner must review the VA examination reports of record. (a) The examiner must provide an opinion regarding whether it is at least as likely as not (probability of approximately 50 percent) that any diagnosed psychiatric disability had onset in, or is otherwise related to, active service, to include as due stressful events reported by the Veteran. Please provide a nexus opinion for EACH psychiatric diagnosis, to include anxiety and adjustment disorders. The examiner must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dworkin, 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.