Citation Nr: 21076401 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 14-19 501 DATE: December 23, 2021 REMANDED Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for a skin disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1965 to July 1969. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2012 rating decision of the agency of original jurisdiction (AOJ). The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in April 2017. A transcript of the hearing has been associated with the record. These matters were previously before the Board in December 2017, June 2019, and November 2020. On each occasion, they were remanded for additional development. They have been returned to the Board for appellate review. 1. Entitlement to service connection for erectile dysfunction is remanded. In the November 2020 remand, the Board requested a new examination of the Veteran and an addendum opinion addressing the nature and etiology of the Veteran's erectile dysfunction. The Veteran opted not to attend a scheduled VA examination for his erectile dysfunction. The Veteran was notified that if he did not attend the VA examination, the claim may be decided based on the evidence of record pursuant to 38 C.F.R. § 3.655 (b). The Board finds that no new examination will be requested, but that an adequate opinion must be obtained based on the evidence of record as to whether the Veteran's service connected diabetes mellitus, to include medication used in treatment thereof, has played a role in the development of his erectile dysfunction. 2. Entitlement to service connection for a skin disorder is remanded. In the November 2020 remand, the Board requested a new examination of the Veteran and an addendum opinion addressing the nature and etiology of the Veteran's skin disorder. The Veteran opted not to attend a scheduled VA examination for his skin disorder. The Veteran was again notified that if he did not attend the VA examination, the claim may be decided based on the evidence of record. The Board finds that no new examination is required, but that an adequate opinion must be obtained based on the evidence of record as to whether the Veteran's current skin disorder is etiologically linked to his active-duty service. The matters are REMANDED for the following action: 1. After obtaining the necessary authorization, obtain any outstanding VA and private treatment records relevant to the Veteran's claims. 2. Thereafter, forward the entire claims file to the September 2020 VA examiner, or if that examiner is unavailable, to a qualified examiner for addendum opinions. Do not schedule the Veteran for an examination. Review of the claims file should be acknowledged by the examiner before responding to the following inquiries: ERECTILE DYSFUNCTION Please state whether it is at least as likely as not (e.g. at least a 50 percent probability or greater) that erectile dysfunction began in service or is otherwise related to service, to include by way of exposure to tactical herbicides. The examiner is reminded that exposure has been conceded and is thus to be assumed in the Veteran's case. If direct service connection is not shown, please state whether it is at least as likely as not that erectile dysfunction has been caused or aggravated by diabetes mellitus or its treatment. The examiner is advised that his or her inquiry is not limited to the definition of aggravation as a permanent worsening of the condition beyond its natural progression. Rather, the examiner should consider whether there has been "any incremental increase in disability or any additional impairment of earning capacity in the nonservice-connected disabilities resulting from the service-connected conditions regardless of its permanence." SKIN CONDITION Please state whether it is at least as likely as not (e.g. at least a 50 percent probability or greater) that a diagnosed skin disorder began in service or is otherwise related to service, to include by way of exposure to tactical herbicides. The examiner is again reminded that exposure has been conceded and is thus to be assumed in the Veteran's case. Further, the examiner is directed to consider as credible the Veteran's lay account of the history of symptoms attributable to his skin disorder. The examiner is advised that a complete rationale must be given for all opinions and conclusions expressed. The examiner cannot simply base the rationale on the fact that the condition is not one of the ones listed as a presumptive condition. The examiner must explain why it is at least as likely as not that the condition is or is not caused by herbicide exposure. 3. Review the opinions and any examination reports to ensure that they are in complete compliance with the directives of this remand. If the opinion or report is deficient in any manner, the AOJ must implement corrective procedures. Then re-adjudicate the claims. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Sherman 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.