Citation Nr: 21072884 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 18-03 011 DATE: December 6, 2021 REMANDED Entitlement to service connection for erectile dysfunction, claimed as secondary to service-connected major depressive disorder is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a right foot disability is remanded. Entitlement to an initial compensable rating for service-connected bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served in the United States Navy from February 1973 to November 1980, and from September 1990 to May 1991. This appeal comes to the Board of Veterans' Appeals (Board) from Department of Veterans Affairs (VA) April 2017 and September 2017 rating decisions of the Agency of Original Jurisdiction (AOJ). In June 2021 the Veteran appeared before the undersigned Veterans Law Judge at a virtual Board hearing. A transcript of that hearing has been reviewed by the Board, and has been associated with the claims file. 1. Entitlement to service connection for erectile dysfunction, claimed as secondary to service-connected major depressive disorder is remanded. The Veteran claims that his erectile dysfunction is caused by, or otherwise due to, his service-connected acquired psychiatric disorder, which has been diagnosed as major depressive disorder (MDD). In September 2017 the Veteran was seen for a VA examination to determine the etiology of his condition. The examiner noted that the Veteran's erectile dysfunction was less likely than not "related to [his] major depressive disorder." The examiner continued, saying that the "primary factors" for the condition are advanced age, hypertension, and diabetes. However, the examiner failed to explain how the Veteran's MDD may or may not have affected his disability. Furthermore, the examiner applied the incorrect legal standard for determining causation. It is not necessary to determine that one cause or another is the "primary factor" in the development of a disability for it to be considered service-connected. Therefore, the Board finds that the September 2017 VA examiner's opinion is inadequate for adjudicative purposes. In November 2017 the Veteran submitted a statement from Dr. R.C., a non-VA physician who has treated the Veteran for almost ten years. According to Dr. R.C., "it is possible" that the Veteran's MDD "can cause or contribute to his erectile dysfunction." The Board notes that Dr. R.C. did not expand on his reasoning, and similarly to the September 2017 VA examiner, his statement is conclusory. In addition to that, Dr. R.C.'s language does not rise to the necessary level for the Board to adjudicate the matter. Finally, in August 2021 the Veteran submitted two medical articles (Erectile Dysfunction and Depression from the Journal of Sexual Medicine, and The Relationship Between Depression and Erectile Dysfunction by Drs. S.S. and S.R.). While informative on the general relationship between depression and erectile dysfunction, the articles do not address the Veteran's specific circumstance. Furthermore, as neither the Veteran nor his representative are medical practitioners, they are not capable of providing testimony regarding the causal relationship, if any, between the Veteran's erectile dysfunction and his MDD. While the Board regrets the delay, a remand is necessary to allow the Veteran to fully develop his claim. 2. Entitlement to service connection for a right hip disability is remanded. The Veteran claims that his right hip disability is caused by, or otherwise due to, his military service. Specifically, the Veteran alleges that his degenerative arthritis, which led to him having his hip replaced, was caused by falling while he was on active duty. The Board notes that at his June 2021 hearing the Veteran had Mr. R., a friend and fellow servicemember, testify that the Veteran did in fact fall and hurt his hip while deployed to Saudi Arabia. As such, the Board is satisfied that the Veteran did fall and injure his hip while on active-duty service. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., a broken leg, separated shoulder, pes planus (flat feet), varicose veins, tinnitus (ringing in the ears), etc.), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, as the Veteran is not a medical professional, he is not capable of providing testimony regarding the etiology of a complex medical condition such as arthritis. As there is no medical opinion regarding the etiology of the Veteran's right hip disability on the record, the Board finds that a remand is necessary to allow the Veteran to fully develop his claim. 3. Entitlement to service connection for a right foot disability is remanded. The Veteran claims that his right foot disability is caused by, or otherwise due to, his active-duty service. The Veteran's medical records show that he broke his right foot in either July or August of 1990, at least one month prior to being called up to active-duty service. While the Veteran's right foot injury clearly predates his period of active-duty service, his service treatment records (STRs) from his time on active-duty show several complaints of right foot pain. A March 2017 VA examination found that the only diagnosed condition regarding the Veteran's right foot was pes planus, or flat foot. The examiner noted that "the right foot pes planus is not related [to] or incurred by the injury in 1990." The Board notes that the examiner's findings are conclusory, as there is no rationale provided as to how they came to that conclusion. Furthermore, the examiner failed to address whether or not the Veteran's active-duty service aggravated his pre-existing foot injury, or whether the Veteran's pes planus is caused by, due to, or aggravated by his service-connected right ankle disability. As such, the March 2017 examiner's opinion regarding the etiology of the Veteran's right foot disability is incomplete, and inadequate for adjudication. While the Board regrets the additional delay, a remand is necessary to allow the Veteran to fully develop his claim. 4. Entitlement to an initial compensable rating for service-connected bilateral hearing loss is remanded. The Veteran contends that his service-connected bilateral hearing loss has worsened, and as such warrants a compensable disability rating. However, the Board notes that it has been over four years since the Veteran's last audiometric examination. As such, a remand is necessary to provide the Veteran with the opportunity to undergo an examination in order to provide up-to-date information regarding his hearing loss disability. The matters are REMANDED for the following action: 1. Schedule the Veteran for VA examinations, to be performed by qualified medical professionals, to obtain the information requested below. The examiners shall be provided with a copy of the claims file, as well as a copy of these remand directives. The following medical opinions must be obtained: (a.) Whether it is as least as likely as not (approximately 50 percent chance or greater) that the Veteran's erectile dysfunction is caused by, or otherwise due to, his service-connected major depressive disorder, to include medication used to treat his psychiatric condition; and, (b.) Whether it is as least as likely as not (approximately 50 percent chance or greater) that the Veteran's erectile dysfunction is aggravated by his service-connected major depressive disorder, to include medication used to treat his psychiatric condition. For all opinions, the examiner must address the Veteran's other, non-service-connected health conditions (specifically hypertension, and diabetes mellitus type 2) that the September 2017 VA examiner indicated may or may not affect the Veteran's erectile dysfunction, as well as Dr. R.C.'s statement that there is possibly a causal relationship between the Veteran's MDD and his erectile dysfunction, and the Veteran's August 2021 submissions of two medical articles indicating that there is possibly a connection between depression and erectile dysfunction (notably, the examiner must address whether the findings of the submitted medical articles apply to the Veteran's specific condition). A complete rationale for all opinions must be provided. If the examiner is unable to provide the required opinions without resorting to mere speculation, they must explain why that is the case. (c.) Whether it is as least as likely as not (approximately 50 percent chance or greater) that the Veteran's right hip disability is caused by, or due to, his active-duty service. The examiner must accept as true the fact that the Veteran fell several times while on active duty, injuring his hip. When providing their opinion, the examiner must address the Veteran's post-service diagnosis of arthritis, and his right hip replacement. A complete rationale for all opinions must be provided. If the examiner is unable to provide the required opinions without resorting to mere speculation, they must explain why that is the case. (d.) Whether it as least as likely as not (approximately 50 percent chance or greater) that a preexisting right foot disability clearly and unmistakably increased in severity beyond the natural progression of the disease in service. The examiner must address the fact that the Veteran's STRs show numerous complaints of right foot pain, and that the Veteran did not develop pes planus until after his last period of active-duty service. A complete rationale for all opinions must be provided. If the examiner is unable to provide the required opinions without resorting to mere speculation, they must explain why that is the case. 2. The AOJ shall schedule the Veteran to be seen by a state-licensed audiologist to determine the severity of his service-connected bilateral hearing loss disability. The examiner must be provided with a copy of the Veteran's claims file, as well as a copy of these remand directives. The examiner must provide a detailed description as to the current severity of the Veteran's bilateral hearing loss disability. A complete rationale for all opinions must be provided. If the examiner is unable to provide the required opinions without resorting to mere speculation, they must explain why that is the case. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Neville, 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.