Citation Nr: 21070078 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 15-14 116 DATE: November 22, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected major depressive and generalized anxiety disorders, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1983 to June 1986. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, this matter was initially before the Board in June 2018, when it was remanded for additional development. See June 2018 BVA Decision. Thereafter, in a July 2020 decision, the Board, in pertinent part, denied the Veteran's claim of entitlement to service connection for erectile dysfunction, and the Veteran appealed that decision to the U.S. Court of Appeals for Veterans Claims (Court). See July 2020 BVA Decision. In July 2021, the Court granted the parties' Joint Motion for Partial Remand (JMPR), which vacated the portion of the Board decision that denied entitlement to service connection for erectile dysfunction and remanded the matter for readjudication. See July 2021 CAVC Decision. The Board further notes that the Veteran filed a timely appeal to a February 2021 rating decision for the issues of entitlement to service connection for bilateral plantar fasciitis and frequent urination. See February 2021 Rating Decision Narrative; March 2021 VA Form 10182 Notice of Disagreement. The Board notes that the Veteran appealed the above mentioned claims pursuant to the Appeals Modernization Act (AMA), while the claim addressed in this decision remains under the Legacy Appeals System. By law, AMA appellate streams cannot be merged with legacy claims, and as a result, those issues will be addressed in a separate decision under a different docket number. Lastly, the Board notes that an October 2021 Board decision remanded the Veteran's claim of entitlement to service connection for vertigo. See October 2021 BVA Decision. However, as that claim is still in development, it will also be addressed in a separate decision after all due process requirements have been completed. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected major depressive and generalized anxiety disorders, is remanded. In the July 2021 JMPR, the Court found that the Board erred in relying on a November 2019 VA examination report to adjudicate the claim. Specifically, in the July 2021 decision, the Board denied the Veteran's service connection claim based on a November 2019 VA examiner's finding that the Veteran had not been diagnosed with erectile dysfunction. See July 2021 CAVC Decision; July 2020 BVA Decision. As stated above, the Veteran was afforded a VA examination for male reproductive conditions in November 2019. The examiner diagnosed the Veteran with urinary frequency but found that he did not have, and had never been diagnosed with, erectile dysfunction. However, the examiner also checked "yes" to the question of whether the Veteran had erectile dysfunction and subsequently indicated that the Veteran's erectile dysfunction did not prevent him from being able to achieve an erection sufficient for penetration and ejaculation without medication. In addition, the examiner reported that the etiology of the Veteran's erectile dysfunction was undetermined but subsequently found that it was less likely than not that it was attributable to his diagnosed urinary frequency. However, the examiner did not provide an explanation or rationale to support either of the aforementioned findings. See November 2019 C&P examination. Thus, the Board finds the November 2019 VA examination report to be internally inconsistent, and as a result, that it is unclear whether the Veteran has a current diagnosis of erectile dysfunction. The Board further notes that the November 2019 VA examiner did not proffer an opinion as to whether the Veteran's claimed erectile dysfunction was caused or aggravated by his service-connected major depressive and generalized anxiety disorders, to include as due to side effects of the Veteran's psychiatric medications. To this end, the Board notes that the Veteran referenced an article in his September 2014 notice of disagreement (NOD), titled Sexual Problems in Veterans with PTSD, which indicates that anxiety often causes sexual dysfunction and that some studies have found that 90 percent of Veteran's with PTSD also suffer from sexual dysfunction. See September 2014 NOD. Based on the foregoing, the Board finds that the November 2019 VA examination is inadequate, and that remand is warranted to afford the Veteran a new VA examination for his claimed erectile dysfunction. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (stating that a medical examination report must contain clear conclusions with supporting data); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The matter is REMANDED for the following action: 1. With any necessary identification of sources by the Veteran, request all VA treatment records not already associated with the file from the Veteran's VA treatment facilities, and all private treatment records from the Veteran not already associated with the file. 2. After completion of the above development, obtain an opinion by an appropriately qualified examiner to determine the nature and etiology of his claimed erectile dysfunction. The Veteran should be scheduled for an examination if determined necessary. The examiner should provide the following opinions: (a.) The examiner should identify, with specificity, all current diagnoses pertinent to the Veteran's claimed erectile dysfunction. By "current disability" the Board means: (1) any disability diagnosed by the examiner; (2) any relevant diagnosis during the appeal period (beginning in May 2013); and/or (3) symptoms resulting in functional impairment but not otherwise warranting a specific diagnosis. The examiner should specifically consider the November 2019 VA examination report, in which the examiner found that the Veteran did not have, and had never been diagnosed with, erectile dysfunction but subsequently checked "yes" to the question of whether the Veteran had erectile dysfunction and described its etiology as undetermined. See November 2019 C&P examination. If the examiner determines that any prior diagnoses are incorrect, they should provide an explanation for why the diagnosis was in error. (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's claimed erectile dysfunction had its onset in-service or is otherwise etiologically related to the Veteran's active duty service? Please explain why or why not. (c.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's claimed erectile dysfunction was (i) caused or (ii) aggravated by the Veteran's service-connected major depressive and generalized anxiety disorders, to include as due to side effects of the Veteran's psychiatric medications? Please explain why or why not. The examiner should observe that permanent aggravation is not required. If aggravation is found, the examiner should identify, to the extent possible, the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to the Veteran's service-connected major depressive and generalized anxiety disorders. The examiner should review pertinent documents in the Veteran's claims file in connection with the examination, to include the November 2019 VA examination report and the article referenced in the Veteran's September 2014 NOD, Sexual Problems in Veterans with PTSD, which indicates that anxiety often causes sexual dysfunction and that some studies have found that 90 percent of Veteran's with PTSD also suffer from sexual dysfunction, and any other conflicting medical evidence of record. See November 2019 C&P examination; September 2014 NOD. All indicated studies should be completed. Reasons should be provided for any opinion rendered. If the examiner is unable to provide an opinion without resort to speculation, an explanation as to why this is so should be provided and any additional evidence that would be necessary before an opinion could be rendered should be identified. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Justis, 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.