Citation Nr: A21020464 Decision Date: 12/23/21 Archive Date: 12/22/21 DOCKET NO. 210115-133359 DATE: December 23, 2021 REMANDED Entitlement to service connection for erectile dysfunction with painful ejaculation is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1975 to July 1978. In a February 2020 Supplemental Claim decision, entitlement to service connection for painful ejaculation with erectile dysfunction was denied by the Department of Veterans Affairs (VA) Regional Office. The Veteran submitted a request for Higher-Level Review in June 2020, and a Higher-Level Review decision was issued in October 2020, which found that there had been a duty to assist error in failing to obtain an adequate medical opinion. After a medical opinion was obtained in January 2021, the claim was again denied in January 2021. The Veteran submitted a VA Form 10182 in January 2021, requesting a hearing with a Veterans Law Judge. The case has therefore been validly appealed to the Board of Veterans' Appeals (Board) under the Appeals Modernization Act. In June 2021, a Board hearing was held before the undersigned Veterans Law Judge. The Board notes that the January 2021 rating decision did find that new and relevant evidence had been received to readjudicate the claim, and the Board will not revisit this favorable finding. Unfortunately, the Board finds that there has still been a pre-decisional error in the duty to assist, and the issue must be remanded in order to obtain an adequate medical opinion. A medical opinion was first obtained in February 2020. The examiner wrote that the condition was less likely than not incurred in or caused by the circumcision in service, but then wrote that painful ejaculation with erectile dysfunction is the expected procedure-related, long-term complication of circumcision, per the review of the medical literature. This opinion is therefore contradictory, as it appears to indicate that the symptoms are related to the Veteran's circumcision in service, although this was not the conclusion that the examiner reached. A new medical opinion was then obtained in January 2021, and this examiner found that the condition was less likely than not incurred in or caused by service, and as rationale wrote that there was no medical literature that links a direct association with erectile dysfunction with painful erection to circumcision for phimosis. This rationale is therefore exactly opposite of what the prior examiner said that the medical literature stated. Neither examiner references what, exactly, this "medical literature" is that they are relying on, and the Board, or any Regional Officer adjudicator, has no way of knowing which of these medical opinions is accurate. This issue is therefore remanded in order to obtain an adequate medical opinion that fully explains its findings, attempts to reconcile the two conflicting opinions, and which cites any medical literature which is used in its rationale. The Board notes that the Veteran has also submitted a February 2021 private nexus opinion from Dr. R.B., who wrote that the Veteran had phimosis, and that this was the direct result of his surgery while in military service. This private opinion also is not consistent with the evidence, which shows that the Veteran had a circumcision in service because he had phimosis, and the circumcision would have removed the foreskin which was causing phimosis. The examiner should address this opinion as well. The matters are REMANDED for the following action: Obtain an addendum medical opinion regarding the nature and etiology of the Veteran's erectile dysfunction with painful erection. If the examiner finds that a new examination must be held prior to providing an opinion, schedule such an examination. The examination may be held via telehealth during social distancing restrictions. The examiner must be provided access to the Veteran's entire claims file and must specify in the report that the claims file has been reviewed. The examiner should then discuss: a) Is it as likely as not that the Veteran's erectile dysfunction with painful erection was incurred in or is related to any event in his military service? Please discuss the Veteran's reports of having similar symptoms soon after his 1978 circumcision in service, the February 2020 VA opinion said that medical literature did support a link to his circumcision, and the January 2021 VA opinion that said that medical literature did not support a link to circumcision. Please specifically cite all medical literature and sources used in making this opinion. b) Does the Veteran currently have phimosis, or any other diagnosis related to the penis? Please discuss the February 2021 private opinion from Dr. R.B. who found that the Veteran had a current diagnosis of phimosis that was related to his circumcision in service. A complete, well-reasoned rationale must be provided for all conclusions and opinions. If the requested opinions cannot be rendered without resorting to speculation, the examiner must explain why. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mary E. Rude, 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.