Citation Nr: 21076028 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 15-03 924 DATE: December 22, 2021 REMANDED Entitlement to service connection for erectile dysfunction (ED) is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1968 to December 1970 to include service in the Republic of Vietnam. This case comes before the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2020, the Board remanded the claims of entitlement to service connection for an acquired psychiatric disorder, back disability, and ED, along with the claim of entitlement to a total disability rating based upon individual unemployability (TDIU). During remand status, a July 2020 rating decision granted service connection for hypertension and a May 2021 rating decision granted service connection for psychiatric disability and TDIU, among other things. With regard to the hypertension, psychiatric, and TDIU claims, there remains no controversy for the Board to consider. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). As to the back claim, pursuant to the Board's June 2020 remand, the RO issued a Statement of the Case to the Veteran in May 2021. Thus, there has been substantial compliance with the Board's prior remand directives in this matter. See Stegall v. West, 11 Vet. App. 268 (1998). The claim for ED remains in appellate status and has been returned to the Board for consideration. Entitlement to service connection for erectile dysfunction is remanded. The Veteran contends that his erectile dysfunction is due to service-connected diabetes mellitus. The June 2020 Board decision remanded the appeal for a medical opinion regarding whether the Veteran's erectile dysfunction is caused or aggravated by his service-connected disabilities. See BVA Decision (June 2020). Specifically, the examiner was asked to opine whether erectile dysfunction "is at least as likely as not proximately caused or aggravated (permanently worsened) by any of the Veteran's service-connected disabilities, to include diabetes mellitus, type II, and hypertension." Id. Although a May 2021 medical opinion was obtained, it is inadequate because it does not provide the requested opinion. The VA medical opinion concluded that the condition was less likely than not proximately due to or the result of or aggravated beyond its natural progression by the Veteran's diabetes mellitus or hypertension. The rationale was stated as "There is no evidence in the records, literature, or history to support that the current diagnosed Erectile Dysfunction condition is due or aggravated by Veteran's Diabetes Mellitus, Type II and Hypertension. At this time, there is no data to establish this relationship." See C&P Exam (May 2021). The opinion provides no meaningful discussion of the Veteran's theory of entitlement or medical principles as they pertain to whether the condition is caused or aggravated by service-connected diabetes mellitus and/or hypertension. Further, aggravation is not the same as causation, and the examiner's rationale does not address aggravation and causation as independent concepts. See Atencio v. O'Rourke, 30 Vet. App. 74 (2018) (questions of causation and aggravation are independent concepts that require separate findings and rationales). Therefore, the May 2021 VA medical opinion is inadequate for adjudicative purposes. It is also noted that a 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. See Stefl v. Nicholson, 21Vet. App.102, 124-25. A "medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." Nieves-Rodriguez v. Peake, 22Vet. App.295, 301 (2008). A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician as to the etiology of the Veteran's erectile dysfunction. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, detail the Veteran's reported symptoms of erectile dysfunction, including the nature, onset, progression, and severity of any symptoms consistent with ED. The opinion should also 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). The clinician should opine on: Whether the Veteran's erectile dysfunction is at least as likely as not (1) proximately due to service-connected disability, to include diabetes mellitus and hypertension, or (2) aggravated beyond the natural progression by service-connected disability. NOTE (1): An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. NOTE (2): An adequate medical opinion will provide separate findings and rationales addressing the causation and aggravation prongs of secondary service connection. NOTE (3): An adequate opinion may not be predicated solely on general medical literature without discussing the specific facts pertaining to the Veteran. 2. Ensure that the VA medical opinion obtained include 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. (CONTINUED ON NEXT PAGE) 3. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Edwards 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.