Citation Nr: 21006526 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 18-07 955 DATE: February 4, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disabilities, is remanded. Entitlement to a total disability evaluation based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran had active service from February 1977 to January 1980. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions rendered in December 2014 and August 2015. In April 2019, the Board remanded these matters for additional development. 1. Entitlement to service connection for erectile dysfunction is remanded. In April 2019, the Board remanded this matter to obtain an addendum VA medical opinion as to whether the Veteran’s erectile dysfunction was proximately due to or aggravated beyond its natural progression by his service-connected disabilities. The examiner was instructed to consider of all the Veteran’s service-connected disabilities as well as his contention that the medications he takes for his service-connected disabilities have caused or aggravated his erectile dysfunction. In a December 2019 VA medical opinion, the examiner opined that it was less likely as than not that the Veteran’s current erectile dysfunction was caused by or a result of his hypertension, cardiomegaly, and lumbar spine degenerative disc disease. In the cited rationale, the examiner detailed that medical literature review did not support a cause/effect relationship between those conditions and erectile dysfunction. It was noted that the Veteran had MMP (multiple medical problems), all well known to have side effects of erectile dysfunction, to include aging. The examiner highlighted that to what degree each of those factors had on the Veteran’s current erectile dysfunction would be mere speculation and concluded that the Veteran’s erectile dysfunction complaints of greater than 30 years later could not reasonably be connected to active service when there were multiple other aging/occupational/daily activity factors in the intervening years. Unfortunately, the examiner did not address aggravation or the Veteran’s contention that the medications he takes for his service-connected disabilities have caused or aggravated his erectile dysfunction. As there has not been substantial compliance with the Board’s previous remand directives regarding the service connection issue for erectile dysfunction, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In addition, in a May 2020 rating decision, the AOJ finalized severance of service connection for some of the Veteran’s disabilities, including lumbar spine degenerative disc disease, right and left lower extremity radiculopathy, and lumbar spine scars. Those claims are now the subject of a separate appeal stream in the modernized review system, also known as the Appeals Modernization Act (AMA), due to submission of a July 2020 VA Form 10182, Decision Review Request: Board Appeal. 2. Entitlement to a TDIU is remanded. As a decision on the remanded service connection claim for erectile dysfunction as well as on other issues in another AMA appeal stream concerning propriety of severance of service connection for lumbar spine, lower extremity radiculopathies, and lumbar spine scars could significantly impact a decision on the issue of entitlement to a TDIU, the issues are inextricably intertwined. A remand of the claim for entitlement to a TDIU is required. The matters are REMANDED for the following actions: 1. Obtain a VA medical opinion to clarify the etiology of the Veteran’s claimed erectile dysfunction from an appropriate examiner. If an opinion cannot be provided without an examination, one should be provided. The electronic claims file must be made available to the examiner, and the examiner must specify in the report that the file has been reviewed. Based on a review of the evidence of record and with consideration of lay statements submitted by the Veteran, the examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s erectile dysfunction was proximately due to any service-connected disability or aggravated beyond its natural progression by any service-connected disability. The opinion must reflect consideration of all the Veteran’s service-connected disabilities, specifically to include his hypertension, cardiomegaly, bilateral pes planus, unspecified depressive disorder, and right and left ankle arthritis and instability, as well as the Veteran’s contention that the medications he takes for his service-connected disabilities have caused or aggravated his erectile dysfunction. The examiner should also acknowledge and discuss the findings in the August 2015 and December 2019 VA examination reports/medical opinions. Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). The Veteran is hereby advised that failure to report for any scheduled VA examination without good cause shown may have adverse effects on his claims. 38 C.F.R. § 3.655 (2020). 2. After completing the above actions and any other necessary development, the claims on appeal must be re-adjudicated, taking into consideration all relevant evidence associated with the record since the April 2020 SSOC. If any benefit on appeal remains denied, an SSOC must be provided to the Veteran and his attorney. After the Veteran and his attorney have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. D. Deane, 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.