Citation Nr: 21075166 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 16-02 794 DATE: December 17, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected lumbar spine degenerative joint disease and/or chronic prostatitis, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1983 to December 1985. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. This appeal was remanded in May 2019, July 2020, December 2020, and September 2021. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected lumbar spine degenerative joint disease and/or chronic prostatitis is remanded. The Veteran contends that his erectile dysfunction is due to his lumbar spine degenerative joint disease or his chronic prostatitis. See Hearing Transcript (January 2019). The Board finds that remand is warranted to obtain compliance with a prior remand. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As noted above, this appeal has been remanded multiple times and multiple VA examinations, opinions, and addendums have been obtained. See BVA Decision (May 2019); BVA Decision (July 2020); BVA Decision (December 2020); BVA Decision (September 2021); VA Examination (April 2013); C&P Exam (March 2019); C&P Exam (December 2019); C&P Exam (September 2020); C&P Exam (January 2021); C&P Exam (March 2021); C&P Exam (June 2021); C&P Exam (October 2021). Most recently, in a September 2021 remand, the Board directed that an opinion be obtained. See BVA Decision (September 2021). The Board directed that an examiner provided an opinion regarding whether the Veteran's erectile dysfunction was at least as likely as not proximately due to, or aggravated by, service-connected chronic prostatitis. See BVA Decision (September 2021). The examiner provided a negative nexus regarding whether erectile dysfunction is aggravated y chronic prostatitis, noting that worsening over time was the natural progression of ED, especially with multiple potential causes, including chronic prostatitis. See BVA Decision (September 2021). First, no opinion was provided regarding whether chronic prostatitis caused the Veteran's ED. Second, the aggravation opinion explanation is unclear and inadequate as it does not address why having multiple potential causes means that ED is not aggravated by prostatitis. See BVA Decision (September 2021). Accordingly, remand is once again required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician, other than the December 2019 or September 2020 examiners, regarding whether the Veteran's erectile dysfunction is at least as likely as not (1) proximately due to service-connected chronic prostatitis, or (2) aggravated (even intermittently) by service-connected chronic prostatitis. If aggravation is found, a baseline level of severity prior to the aggravation should be identified. The medical opinion should, at a minimum, reflect consideration of (i) the documented history; (ii) the lay contentions, to include that his observable symptoms of erectile dysfunction dating back to 2001, but that the Veteran began receiving treatment in 2009; and (iii) the medical evidence of record. The opinion should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge, or literature, etc., relied upon in reaching the conclusion(s). If an etiology other than chronic prostatitis is the more likely cause of the Veteran's erectile dysfunction, indicate fully the bases for this conclusion and whether it is the only cause. Explain. NOTE: Separate findings and rationales are required to address the causation and aggravation prongs of secondary service connection because these are independent concepts. 2. Ensure that the medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.M., 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.