Citation Nr: 21007766 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 15-03 657A DATE: February 10, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected unspecified anxiety disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1985 to August 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected unspecified anxiety disorder, is remanded. The Veteran asserts his mental health medication causes or contributes to his erectile dysfunction. In September 2020, the Board remanded the matter to afford the Veteran a VA examination addressing whether the Veteran’s mental health medications aggravate the Veteran’s erectile dysfunction. The Board regrets further delay but finds an addendum opinion is necessary before deciding this claim. In September 2020, the Board requested the Veteran be provided a supplemental medical opinion investigating whether his erectile dysfunction is aggravated by his mental health condition, specifically his mental health medications. A medical opinion was provided, and the examiner found the Veteran’s erectile dysfunction to be less likely than not caused by the Veteran’s mental health medication, Trazodone. The examiner explained onset of the Veteran’s erectile dysfunction suggested a relation to his heart condition, not medication. Further, the examiner stated, “a review of scholarly articles reveals Trazodone improves erectile dysfunction rather than causing or aggravating it.” The Board finds this opinion incomplete for two reasons. First, the September 2020 examiner did not provide separate findings and rationales for whether the Veteran’s erectile dysfunction is aggravated by his mental health condition, to include mental health medication. The aggravation prong of the examiner’s opinion is not supported with rationale that clearly explains why the erectile dysfunction is not worsened beyond its natural progression by the Veteran’s service-connected mental health condition, to include medications used to treat it. Second, the Veteran has been prescribed sertraline for his mental health condition since 2013. Documents submitted by the Veteran in January 2015 indicate sertraline may also play a role in erectile dysfunction. However, the examiner did not address this medication. Accordingly, a remand is required for another supplemental medical opinion that adequately addresses whether the Veteran’s erectile dysfunction is caused or aggravated by his mental health condition, to include both his mental health medications, Trazodone and Sertraline. The matter is REMANDED for the following action: Obtain a supplemental medical opinion concerning the etiology of the Veteran’s erectile dysfunction. The need for an in-person examination is left to the examiner’s discretion. The examiner is asked for an opinion regarding whether the Veteran’s erectile dysfunction is at least as likely as not (1) proximately due to or (2) aggravated beyond its natural progression by the Veteran’s service-connected mental health condition, to include his mental health medications, Trazodone and Sertraline. Causation and aggravation are independent concepts and should have separate findings and rationales.  See Atencio v. O’Rourke, 30 Vet. App. 74 (2018).  As such, the examiner must provide separate findings and rationales each of which specifically relates to causation and aggravation.    Aggravation under 38 C.F.R. § 3.310 (b) does not require that there be “permanent” worsening of the nonservice-connected disability.   A complete rationale for any opinion must be provided.  A complete rationale is one that contains clear conclusions with supporting data and a reasoned medical explanation connecting the two. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.A. Infante, 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.