Citation Nr: 21077391 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 19-34 422 DATE: December 29, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected diabetes mellitus or coronary artery disease, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1964 to November 1969, including service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In September 2021, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the proceeding has been associated with the claims file. The Veteran appears to contend that originally he developed erectile dysfunction (ED) from a pituitary gland problem, but that the ED resolved with medication. He then redeveloped ED around the time of his diagnosis of diabetes mellitus. He considers this ED to be linked with his diabetes. He also believes medication for his service connected heart disability may play a role in his ED. Treatment records associated with the file dated in 2014, indicate the Veteran presented to VA in 2002 with ED, among other symptoms, which led to the discovery of a pituitary gland disorder. The available records do not make clear if this ED resolved entirely after 2002, but they show diabetes diagnosed in 2013, after which it also is not clear whether ED was being medically followed. Records dated in August 2019 note the Veteran as able to engage in intercourse at that time, which raises questions as to whether ED remains an appropriate diagnosis. In any event, given the reference to pertinent records dated from 2002 that do not appear to be associated with the claims file, it will be necessary to remand the case to attempt to obtain them. The Veteran was examined for VA purposes in connection with the matter in October 2019. There, it was indicated the Veteran reported he had been diagnosed to have ED in the 1990s, and the examiner referenced 2002 VA records where the Veteran apparently reported a 15 year history of ED, but that the ED resolved with the treatment for the pituitary disorder. After 2012, the Veteran indicated the ED problem returned, and although the examiner acknowledged the recent report of the ability to engage in intercourse, the examiner diagnosed the Veteran to have ED. Addressing the etiology of the condition, the examiner in one place stated it had clearly existed prior to service, and elsewhere that it was unrelated to the Veteran's diabetes because the ED had been diagnosed 20 years prior to the diagnosis of diabetes. He apparently made no distinction between the ED shown in 2002, and that about which the Veteran complained beginning in 2012. Given the confusing history of this case, and the unsupported comment that the claimed disability existed prior to service, in addition to seeking additional medical records, it will be necessary to obtain an additional opinion as detailed below. The matter is REMANDED for the following action: 1. Attempt to obtain the records of VA treatment for the Veteran's pituitary gland disorder, which apparently date from at least 2002. 2. Thereafter, provide the Veteran's claims file to an appropriate clinician for an addendum opinion as to whether the Veteran is considered to have erectile dysfunction, and if so, whether is at least as likely as not (a) caused by or (b) aggravated (i.e., worsened) by the Veteran's service-connected disabilities, including diabetes mellitus type II and coronary artery disease. The examiner must address both prongs (a) and (b). The examiner should also address whether any medication prescribed for the Veteran's service-connected disabilities has caused or aggravated the Veteran's erectile dysfunction. In addressing the above, the examiner should specifically discuss the Veteran's lay statements regarding onset of symptoms, particularly the Veteran's contention that his erectile dysfunction resolved following his pituitary gland treatment and reoccurred near the time of his diagnosis with diabetes mellitus. If the Veteran's erectile dysfunction is not linked to any service-connected disability or medication prescribed as a consequence thereof, the likely etiology of the Veteran's erectile dysfunction would be useful for adjudication purposes. If it is necessary to examine the Veteran to obtain the requested opinions, that should be arranged. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. (Continued on the next page) 3. After the above development and any additionally indicated development has been completed, readjudicate the issue on appeal. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Geer, 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.