Citation Nr: 21070785 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 17-44 879 DATE: November 26, 2021 REMANDED The claim for service connection for erectile dysfunction, claimed as secondary to major depressive disorder (MDD), is remanded. The claim for a total rating based on individual unemployability due to service-connected disabilities (TDIU), prior to July 12, 2017, is remanded. REASONS FOR REMAND The Veteran had active service in the Army from September 1990 to November 1997. Erectile Dysfunction The Veteran contends that his erectile dysfunction that is due to his service-connected major depressive disorder (MDD). This issue is before the Board on appeal of an October 2018 rating decision that denied service connection for erectile dysfunction as secondary to service connected MDD. In August 2018 the Veteran was afforded a VA examination at which he was diagnosed with erectile dysfunction. The Veteran reported that this condition began when he started taking medications for high blood pressure and diabetes. The examiner opined that the Veteran's erectile dysfunction was less likely than not (less than 50 percent probability) caused by his MDD, because the Veteran's MDD began after his original diagnosis of erectile dysfunction. The examiner reviewed the Veteran's medical file as well as his lay statements at the examination and observed that the Veteran reported that his erectile dysfunction had begun in 2008 shortly after his diagnosis of hypertension and diabetes mellitus. Given that the Veteran's erectile dysfunction preceded his diagnoses of depression by approximately six years, the examiner concluded that his erectile dysfunction could not be due to his MDD. VA treatment records show that in February 2006, the Veteran reported that his hypertension medications were interfering with erections and stopped taking that medication as a result. A March 2013 VA treatment note indicates that the Veteran reported erectile dysfunction starting one week prior. A February 2015 VA treatment note indicated that the Veteran's blood pressure medication may contribute to his erectile dysfunction. In a December 2017 VA treatment note the Veteran indicated that his erectile dysfunction seemed to be worsening. In July 2018, the Veteran's private physicain, Dr. Jabbour, provided an opinion letter indicating links between loss of libido and PTSD and depresson. Dr. Jabbour opined that the Veteran's depression and posttraumatic stress disorder (that is not service connected) contributes to his erectile dysfuncton. Unfortunately, the Board cannot make a fully-informed decision on the issue of aggravation because no medical opinion is of record adequately addressing whether the Veteran's erectile dysfunction has been aggravated by a service connected disability. Given the allegations of worsening of the Veteran's disability, a remand for an addendum opinion is required. TDIU prior to July 12, 2017 A combined schedular evaluation of 100 percent was assigned from July 12, 2017, rendering entitlement to individual unemployability moot from that date forward. The issue before the Board is therefore whether the Veteran is entitled to individual unemployability prior to July 12, 2017. This matter was previously before the Board in April 2019 when the Board remanded the issue of entitlement to individual unemployability prior to July 2017. Remand orders requested that the Veteran be scheduled for a VA examination to address the functional and occupational effects of his service-connected disabilities prior to July 12, 2017. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding this issue and another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In addition to the need to an addendum opinion, while the Board has not specifically reviewed the evidence regarding the Veteran's employability prior to July 12, 2017, remand is required for referral of the claim for a TDIU to the Director, Compensation Service, for extraschedular consideration. Prior to July 12, 2017, the Veteran had the following disabilities that were service connected: major depressive disorder (rated 50 percent from 3/3/2016); obstructive sleep apnea (rated 10 percent from 11/23/1997); degenerative arthritis (right knee) (rated noncompensable from 11/2/31997) and pseudofolliculitis barbae (rated noncompensable from 11/23/1997). Based on the forgoing, prior to July 12, 2017 the Veteran does not meet the percentage standards set forth in § 4.16(a). Therefore, the Board may not consider his claim for a TDIU in the first instance but will refer it to the Director, Compensation Service, given there is a reasonable possibility that he is unemployable by reason of service-connected disabilities. 38 C.F.R. § 4.16(b). In VA treatment notes from March and September 2016, the Veteran asserted that he could not work due to symptomatology associated with service-connected disabilities. Accordingly, remand is required for referral of the claim for a TDIU to the Director, Compensation Service, for extraschedular consideration. In reaching this conclusion, the Board has not taken a position on the veracity of the Veteran's allegations, but feels that it is most advantageous to the Veteran for the Dirctor of Compensation and Pension to address this issue in the first instance. The matter is REMANDED for the following action: 1. Obtain an addendum medical opinion to determine the etiology of the Veteran's erectile dysfunction. If a physical examination is necessary to answer the Board's questions, one should be scheduled. The examiner is asked to answer the following question: Is it at least as likely as not (probability of at least 50 percent) that the Veteran's erectile dysfunction was aggravated (made worse) by his service-connected major depressive disorder? Why or why not? If aggravation is found, the examiner should identify the baseline level of severity of the erectile dysfunction by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the erectile dysfunction. If this cannot be done, it should be explained why. 2. Refer the Veteran's claim for TDIU to VA's Director of Compensation Service for extraschedular consideration. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jennifer M. Narvaez, 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.