Citation Nr: 21008752 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 20-23 027 DATE: February 17, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disabilities and medications prescribed to treat service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1965 to December 1966. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The April 2020 statement of the case included the issue of entitlement to an increased rating for migraine headaches. This issue was not perfected on the May 2020 VA Form 9. Thus, this issue is not before the Board at this time. In August 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge; a transcript is of record. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.800(c). 38 U.S.C. § 7107(b). Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disabilities and medications prescribed to treat service-connected disabilities The Veteran contends that his erectile dysfunction is due to medication taken for his service-connected migraines, fibromyalgia and residuals of a traumatic brain injury. While the Board regrets the delay, a remand is warranted to adequately evaluate the nature and etiology of the Veteran’s erectile dysfunction. The Veteran underwent a VA male reproductive organ examination in March 2020, in connection with which the examiner opined that his erectile dysfunction is less likely than not proximately due to or the result of his service-connected disabilities. As rationale, the examiner stated, in whole, “No information found to support pathophysiological connection regarding migraine headaches and/or fibromyalgia causing ED.” See March 2020 VA Examination Report. The examiner did not comment on the Veteran’s contention that Tramadol specifically, a medication he was prescribed for his service-connected fibromyalgia and that he reports he took for many years, caused his erectile dysfunction. The Board finds the March 2020 opinion to be incomplete and conclusory, and thus inadequate, and will remand for a new opinion. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Once VA undertakes the effort to provide an examination, it must obtain a fully adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Finally, the Board notes that the Veteran’s representative has submitted medical articles in support of the propositions that there is a relationship between fibromyalgia, TBI and chronic diseases in general, and erectile dysfunction. While the Veteran waived the RO’s initial consideration of this evidence, the Board is prohibited from substituting its own medical opinion to support or deny a claim. See Colvin v. Derwinski, 1 Vet. App. 171 (1991) (holding that the rating board cannot substitute its own medical judgment for that of medical professionals). The matter is REMANDED for the following action: 1. Obtain any outstanding VA and private treatment records and associate them to the record. 2. Thereafter, forward the record to an appropriate clinician for an addendum opinion as to the nature and etiology of the Veteran’s erectile dysfunction. The claims file, to include a copy of this Remand, must be made available to and reviewed by the examiner. The examiner should note such review was conducted. The need for an additional examination of the Veteran is left to the discretion of the clinician. The examiner should address the following: (a.) Whether it is at least as likely as not (a 50 percent probability or greater) that any erectile dysfunction reported during the appeal period (i.e., from July 2017 to date) is proximately due to any of his service-connected disabilities, to include migraine headaches, fibromyalgia, and traumatic brain injury, to include the medications prescribed to treat any such disability; and (b.) Whether it is at least as likely as not (a 50 percent probability or greater) that any erectile dysfunction reported during the appeal period (i.e., from July 2017 to date) is aggravated by any of his service-connected disabilities, to include migraine headaches, fibromyalgia, and traumatic brain injury, to include the medications prescribed to treat any such disability. The term “aggravation” means a worsening of a disability beyond its natural progression. If aggravation is found, then, to the extent possible, the examiner should establish a baseline level of severity of the erectile dysfunction prior to aggravation by any service-connected disability or medication prescribed to treat such disability. The examiner should address and discuss the Veteran’s lay statements, to include his specific contention that his erectile dysfunction is due to Tramadol, as well as the medical articles submitted which suggest a causal relationship between chronic disease and pain and erectile dysfunction. To the extent possible, any conflicting opinions or conclusions should be reconciled. If the examiner is unable to provide any requested opinion without resort to speculation, he or she should explain why this is so, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Battaile 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.