Citation Nr: 21075986 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 18-55 271A DATE: December 22, 2021 REMANDED Entitlement to service connection for erectile dysfunction as secondary to service-connected diabetes mellitus type II (diabetes) is remanded. Entitlement to service connection for hypertension as secondary to service-connected coronary artery disease is remanded. Entitlement to an initial rating in excess of 20 percent for diabetes is remanded. Entitlement to an initial rating in excess of 10 percent for coronary artery disease is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1966 to July 1968, including service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge. The Board notes the Veteran is attempting to claim service connection claim for tinnitus; however, that issue is not currently on appeal. The Board encourages the Veteran to file a claim on the appropriate standardized claims file should he wish to pursue this matter. 1. Entitlement to service connection for erectile dysfunction as secondary to service-connected diabetes is remanded. During the August 2021 Board hearing, the Veteran reported erectile dysfunction due to his diabetes disability. On remand, a VA examination and nexus opinion is warranted that addresses the nature and etiology of his erectile dysfunction. See Morgan v. Wilkie, 31 Vet. App. 162 (2019) (explaining that VA's duty to maximize benefits may require it to consider secondary service connection as part of an increased rating claim). 2. Entitlement to service connection for hypertension as secondary to service-connected coronary artery disease is remanded. During the August 2021 Board hearing, the Veteran reported hypertension due to his heart disability. On remand, a VA examination and nexus opinion is warranted that addresses the nature and etiology of his hypertension. See Morgan, 31 Vet. App. 162. 3. Entitlement to an initial rating in excess of 20 percent for diabetes is remanded. During the August 2021 Board hearing, the Veteran reported new symptoms reflective of a potential worsening of his diabetes since he was last examined in January 2018. Moreover, the Veteran stated that the January 2018 VA examination was proper as the examiner did not discuss necessary details and symptoms he experienced, including his reported erectile dysfunction due to diabetes as noted above. As such, an updated VA examination is needed, as the January 2018 VA examination may no longer be reflective of the Veteran's current level or nature of his disability. See Palczewski v. Nicholson, 21 Vet. App. 174, 182-83 (2007); Snuffer v. Gober, 10 Vet. App. 400 (1997). 4. Entitlement to an initial rating in excess of 10 percent for coronary artery disease is remanded. During the August 2021 Board hearing, the Veteran reported new symptoms reflective of a potential worsening of his coronary artery disease since he was last examined in January 2018, including the Veteran's assertion that his hypertension is due to his coronary artery disease as noted above. As such, an updated VA examination is needed, as the January 2018 VA examination may no longer be reflective of the Veteran's current level or nature of his disability. See Palczewski, 21 Vet. App. 174, 182-83; Snuffer, 10 Vet. App. 400. Any outstanding treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records, including records since October 2018. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Then schedule the Veteran for a VA examination to determine the etiology of his claimed erectile dysfunction. The entire claims file, including any newly obtained treatment records, must be reviewed by the examiner. The examiner should address the following: (a) Determine whether the Veteran has a current diagnosis of erectile dysfunction at any time since March 2017, even if resolved. (b) If erectile dysfunction is diagnosed in part (a), the examiner must opine as to whether it is at least as likely as not (a 50 percent or greater probability) that such disability (i) had its onset in service or is otherwise related to service, to include conceded herbicide agent exposure therein; (ii) is proximately due to diabetes or (iii) has been aggravated (worsened beyond natural progression) by diabetes. In addressing questions (b)(ii) and (b)(iii), please provide two separate opinions, and please note the primary disability (diabetes) need not be diagnosed or service-connected at the time the secondary disability (here, erectile dysfunction) is incurred, and reliance on this fact in support of a negative opinion will render it inadequate. If unable to provide a medical opinion, provide a statement as to whether there is any 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. 4. Then schedule the Veteran for a VA examination to determine the etiology of his hypertension. The entire claims file, including any newly obtained treatment records, must be reviewed by the examiner. The examiner should address the following: (a) Determine whether the Veteran has a current diagnosis of hypertension at any time since March 2016, even if resolved. If a diagnosis of hypertension is not warranted, please reconcile your finding with diagnosis of the same in a November 2017 Ischemic Heart Disease Disability Questionnaire (DBQ). (b) If hypertension is diagnosed in part (a), the examiner must opine as to whether it is at least as likely as not (a 50 percent or greater probability) that such disability (i) had its onset in service or is otherwise related to service, to include conceded herbicide agent exposure therein; (ii) is proximately due to diabetes or (iii) has been aggravated (worsened beyond natural progression) by diabetes. In addressing question (b)(i), please discuss the National Academy of Sciences' report indicating "sufficient evidence of an association" between herbicide agent exposure and hypertension. In addressing questions (b)(ii) and (b)(iii), please provide two separate opinions, and please note the primary disability (coronary artery disease) need not be diagnosed or service-connected at the time the secondary disability (here, hypertension) is incurred, and reliance on this fact in support of a negative opinion will render it inadequate. If unable to provide a medical opinion, provide a statement as to whether there is any 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. 5. Then schedule the Veteran for a VA examination to determine the current nature and severity of his diabetes and any associated complications. The entire claims file, including a copy of this remand, must be made available to the examiner, and the examiner should confirm that such records were reviewed. All findings should be reported in detail. 6. Then schedule the Veteran for a VA examination to determine the current nature and severity of his coronary artery disease. The entire claims file, including a copy of this remand, must be made available to the examiner, and the examiner should confirm that such records were reviewed. All findings should be reported in detail. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Asante, Ruby 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.