Citation Nr: 21009350 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 16-53 403 DATE: February 22, 2021 ORDER The appeal with respect to the Veteran’s entitlement to a disability rating in excess of 10 percent for a scar related to left tarsal tunnel syndrome is dismissed. The previously denied claim of entitlement to service connection for depression is reopened, and service connection for an acquired psychiatric disorder is granted. The previously denied claim of entitlement to service connection for cervicalgia is reopened and denied. REMANDED Entitlement to service connection for priapism and erectile dysfunction is remanded. Entitlement to service connection for polyarthritis is remanded. Entitlement to service connection for carpal tunnel syndrome is remanded. FINDINGS OF FACT 1. On the record at an April 2019 Board hearing, prior to the promulgation of an appellate decision, the Veteran requested that the appeal with respect to entitlement to a disability rating in excess of 10 percent for a scar related to left tarsal tunnel syndrome be withdrawn. 2. In December 2006, a Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for depression and cervicalgia; although the Veteran initiated an appeal of those denials, the RO closed the appeal after he failed to perfect it by filing a timely substantive appeal following the issuance of a statement of the case (SOC) in January 2008. 3. New evidence received since the time of the RO’s December 2006 rating decision, when considered with the evidence previously of record, relates to unestablished facts necessary to substantiate the Veteran’s claims for service connection for depression and cervicalgia and raises a reasonable possibility of substantiating the claims. 4. The evidence as to whether the Veteran has an acquired psychiatric disability that is proximately due to or the result of service-connected disability is at least in equipoise. 5. The Veteran’s current cervical disability did not manifest in service and is not otherwise attributable to service; arthritis of the neck did not manifest to a compensable degree within one year of service discharge. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal as to the issue of entitlement to a disability rating in excess of 10 percent for a scar related to left tarsal tunnel syndrome have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The RO’s December 2006 decision denying service connection for depression is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.200, 20.201, 20.202, 20.302, 20.1103 (2006). 3. New and material evidence has been received to reopen the claim for service connection for depression. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 4. The RO’s December 2006 decision denying service connection for cervicalgia is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.200, 20.201, 20.202, 20.302, 20.1103 (2006). 5. New and material evidence has been received to reopen the claim for service connection for cervicalgia. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 6. Resolving reasonable doubt in the Veteran’s favor, the criteria for an award of service connection for an acquired psychiatric disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 7. The criteria for an award of service connection for cervicalgia have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1978 to April 1991. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision issued by the VARO in Guaynabo, Puerto Rico. In April 2019, the Veteran testified at a Board video-conference hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. The Board notes that the agency of original jurisdiction (AOJ) furnished the Veteran a supplemental statement of the case relative to the matters herein decided in July 2017. Although additional evidence has been added to the record since that time, none of it bears meaningfully on the outcome of the issue that is currently being denied. As such, there is no need to return the case to the AOJ for consideration of the new evidence or, alternatively, to solicit a waiver of AOJ review from the Veteran, prior to adjudicating that issue. See 38 C.F.R. §§ 19.31, 20.1304(c). In February 2019, the Board notified the Veteran that his appeal had been formally placed on the Board’s docket and that he had 90 days from the date of the letter to request a change in representation or submit additional argument or evidence, if he chose to do so. Thereafter, in January 2020, the Veteran submitted a VA Form 21-22 (Appointment of Veterans Service Organization as Claimant’s Representative) in favor of a new representative, in connection with a separate claim for benefits (service connection for a left knee disability). Inasmuch as the new appointment was received more than 90 days after the Board’s notification letter, and no good cause for the late filing has been shown, the new representative will not be recognized for present purposes. 38 C.F.R. § 20.1304(b). The Veteran’s reopened claim for service connection for depression has been recharacterized to include all psychiatric disorders reasonably raised by the record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). 1. Entitlement to a disability rating in excess of 10 percent for a scar related to left tarsal tunnel syndrome. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. See 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in an appeal. 38 C.F.R. § 19.55. Only an appellant, or an appellant’s authorized representative, may withdraw an appeal. Id. Appeal withdrawals must include the name of the veteran, the name of the claimant or appellant if other than the veteran (e.g., a veteran’s survivor, a guardian, or a fiduciary appointed to receive VA benefits on an individual’s behalf), the applicable VA file number, and a statement that the appeal is withdrawn. If the appeal involves multiple issues, the withdrawal must specify that the appeal is withdrawn in its entirety or list the issue(s) withdrawn from the appeal. Id. In this case, on the record at his April 2019 hearing, prior to the promulgation of a Board decision on the matter, the Veteran requested that his appeal with respect to entitlement to a disability rating in excess of 10 percent for a scar related to left tarsal tunnel syndrome be withdrawn. That request has since been reduced to writing in a transcript, received by the Board, which includes the Veteran’s name and his VA file number. Under the circumstances, the Board finds that the requirements for a proper withdrawal have been satisfied. See, e.g., Tomlin v. Brown, 5 Vet. App. 355 (1993). As the Veteran has withdrawn his appeal of this issue, there remain no allegations of error of fact or law for appellate consideration with respect to this issue. Accordingly, the Board does not have jurisdiction to review the issue and the appeal of the issue must be dismissed. New and Material Evidence Generally, a claim that has been denied in a final rating decision may not thereafter be reopened and allowed. 38 U.S.C. § 7105. The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New and material evidence means evidence not previously submitted to agency decision makers; which relates, either by itself or when considered with previous evidence of record, to an unestablished fact necessary to substantiate the claim; which is neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened; and which raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). To reopen a previously disallowed claim, new and material evidence must be presented or secured since the last final disallowance of the claim on any basis. The United States Court of Appeals for Veterans Claims has interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold and has characterized the phrase “raises a reasonable possibility of substantiating the claim” as “enabling rather than precluding reopening.” Shade v. Shinseki, 24 Vet. App. 11 (2010). For purposes of determining whether new and material evidence has been received, the credibility of the evidence is to be presumed unless the evidence is inherently incredible or consists of statements that are beyond the competence of the person or persons making them. See Justus v. Principi, 3 Vet. App. 510, 513 (1992); Meyer v. Brown, 9 Vet. App. 425, 429 (1996); King v. Brown, 5 Vet. App. 19, 21 (1993).  2. Whether new and material evidence has been received to reopen the previously denied claim for service connection for depression. 3. Whether new and material evidence has been received to reopen the previously denied claim for service connection for cervicalgia. The Veteran seeks to reopen his previously denied claims for service connection for depression and cervicalgia. By way of background, in a decision entered in May 2002, the Board denied service connection for an acquired psychiatric disorder (claimed as a nervous condition, anger problems, instability problems, and depression). The evidence of record at the time included the Veteran’s service treatment records, a September 1996 VA examination, lay statements, and post-service medical records. The Board found that the Veteran’s acquired psychiatric disorder was not shown to have been present in service or thereafter. The Veteran did not appeal the Board’s decision to the United States Court of Appeals for Veterans Claims (Court), and reconsideration of the decision has not requested or otherwise ordered by the Chairman of the Board. The Board’s decision, therefore, was and remains final. 38 C.F.R. § 20.1100. Accordingly, the claim may be considered on the merits only if new and material evidence has been received since the time of the prior adjudication. 38 U.S.C. § 5108; Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996). Thereafter, service connection was denied for depression and cervicalgia by a December 2006 rating decision. The December 2006 rating decision again denied service connection for depression on grounds that the currently diagnosed condition was unrelated to military service. The rating decision also denied service connection for cervicalgia because the record did not show a permanent residual or chronic disability subject to service connection. The evidence of record at the time included service treatment records and post-service treatment records. Although the Veteran initiated an appeal of those denials, the RO closed the appeal after he failed to perfect it by filing a timely substantive appeal following the issuance of a SOC in January 2008. The Veteran filed the present claims for service connection for cervicalgia and depression in April 2013. Evidence received in connection with those claims, and subsequent to the December 2006 rating decision, includes additional post-service private treatment records, lay statements, and April 2019 hearing testimony. The Veteran also submitted a January 2020 private Disability Benefits Questionnaire which includes a favorable nexus opinion as to his psychiatric condition. Additionally, a June 2015 VA neck examination noted a diagnosis of degenerative arthritis of the spine. With respect to the neck claim, the Board finds that new and material evidence has been received. Specifically, as noted above, the RO secured a VA examination that noted the Veteran had a diagnosis of degenerative arthritis of the spine. This evidence is indicative of a current disability, which relates to a previously unestablished fact and raises a reasonable possibility of substantiating the claim. It is therefore new and material. See 38 C.F.R. § 3.156. The Board also finds that new and material evidence has been received with respect to the claim for depression. The relevant evidence received since the last final rating decision includes the Veteran’s April 2019 hearing testimony and the January 2020 private Disability Benefits Questionnaire. This evidence relates to a previously unestablished element (i.e., nexus) and raises a reasonable possibility of substantiating the claim. Shade v. Shinseki, 24 Vet. App. 110, 118 (2010); see also Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir. 1998) (noting that new evidence could be sufficient to reopen a claim if it could contribute to a more complete picture of the circumstances surrounding the origin of a claimant’s injury or disability). As new and material evidence has been received in accordance with 38 C.F.R. § 3.156, the claims are reopened. Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) a chronic disease shown as such in service (or within an applicable presumptive period under 38 C.F.R. § 3.307) and (ii) subsequent manifestations of the same chronic disease, or (b) if the fact of chronicity in service in not adequately supported, by evidence of continuity of symptomatology. However, the United States Court of Appeals for the Federal Circuit has held that the provisions of 38 C.F.R. § 3.303(b) relating to continuity of symptomatology can be applied only in cases involving those conditions explicitly recognized as chronic under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Under applicable law, disability which is proximately due to or the result of a service-connected disease or injury shall also be service connected. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). A layperson is generally incapable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997), aff’d sub nom., Routen v. West, 142 F.3d 1434 (Fed. Cir. 1998). However, lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., a broken leg, separated shoulder, pes planus (flat feet), varicose veins, tinnitus (ringing in the ears), etc.), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In essence, lay testimony is competent when it pertains to the readily observable features or symptoms of injury or illness and “may provide sufficient support for a claim of service connection.” Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also 38 C.F.R. § 3.159(a)(2). A determination as to whether medical evidence is needed to demonstrate that a Veteran presently has the same condition he or she had in service or during a presumptive period, or whether lay evidence will suffice, depends on the nature of the Veteran’s present condition (e.g., whether the Veteran’s present condition is of a type that requires medical expertise to identify it as the same condition as that in service or during a presumption period, or whether it can be so identified by lay observation). See Barr v. Nicholson, 21 Vet. App. 303, 310 (2007). Thus, medical evidence is not always or categorically required when the determinative issue involves either medical diagnosis or etiology, but rather such issue may, depending on the facts of the particular case, be established by competent and credible lay evidence under 38 U.S.C. § 1154(a). See Davidson, supra. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. See also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for an acquired psychiatric disorder. The Veteran seeks to establish service connection for an acquired psychiatric disorder, which he asserts is related to service. Service treatment records reflect that the Veteran was seen in February 1989 due to an appearance of emotional instability. In July 1990, he was diagnosed as having an adjustment disorder with a depressed mood. Post-service medical records reflect diagnoses of adjustment disorder, posttraumatic stress disorder (PTSD), and somatic symptom disorder with depressive/anxiety symptoms. See, e.g., September 2017 VA treatment record; January 2020 private Disability Benefits Questionnaire. The record also reflects that service connection is in effect for lumbar strain and demyelinating neuropathy of the right and left posterior tibial nerves. In January 2020, the Veteran submitted a private examination report from D.D., Ph.D. The report indicated that the Veteran met the DSM-5 criteria for PTSD and somatic symptom disorder with depressive/anxiety symptoms. The examiner concluded that the Veteran’s somatic symptom disorder was proximately due to or aggravated by his current service-connected disabilities. The examiner indicated the Veteran’s service-connected back pain interfered with his sleep and daily life. Dr. D.D. further remarked the Veteran suffered from symptoms of depressed mood, anxiety, and irritability. She noted he had a persistently high level of anxiety about his health. She also opined that non-service-connected gastroesophageal reflux disease further interfered with his sleep and daily life. As for PTSD, Dr. D.D. indicated that the Veteran’s stressor event did meet Criterion A (adequate to support the diagnosis of PTSD), but did not specify the specific in-service stressor that led to his current disability, or whether his PTSD was the result of fear of hostile military or terrorist activity. For PTSD to be service connected based on fear of hostile military or terrorist activity, regulations require that the diagnosis must be made by a VA psychiatrist or psychologist. The Veteran was afforded a VA examination in November 2020. Following review of the claims file, the examiner opined that somatic symptom disorder was less likely than not incurred in or caused by the mental health symptoms noted during service. The examiner remarked that the Veteran’s physical issues developed during service; however, they worsened over time and his somatic disorder developed post-military. The examiner also noted that PTSD was less likely than not incurred in or caused by the mental health symptoms noted during service. The examiner stated that evidence failed to show that the Veteran witnessed or participated in a claimed stressor event despite depression and insomnia being noted in service treatment records. Finally, the examiner concluded that cannabis use disorder was also less likely than not incurred in or caused by the mental health symptoms noted during service. The diagnosis was felt to be secondary to PTSD and an attempt to self-medicate the PTSD symptoms. The Board finds that the favorable medical opinion provided by the January 2020 private health provider, indicating a link between the Veteran’s currently diagnosed somatic symptom disorder and his service-connected disabilities, is supported by an adequate rationale for the conclusion reached. Because the opinion contains data, conclusions, and a rationale connecting the two, it is entitled to significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303-304 (2008). The Board is cognizant of the fact that the November 2020 VA examiner felt that the Veteran’s currently diagnosed acquired psychiatric disabilities were not related to service. However, in so finding, the examiner failed to address the January 2020 opinion of Dr. D.D. which indicated the somatic symptom disorder was proximately due to or aggravated by his current service-connected disabilities. The Board finds that the November 2020 examiner’s opinion is no more probative than that from Dr. D.D. The evidence is at least in equipoise. Thus, the benefit-of-the-doubt doctrine is for application. Resolving reasonable doubt in the Veteran’s favor, service connection for an acquired psychiatric disorder is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. In arriving at this conclusion, the Board notes that the November 2020 VA examiner opined that it was not possible to differentiate which of the Veteran’s psychiatric symptoms were attributable to which mental health disorder diagnosis. In light of that finding, the Veteran’s service-connected psychiatric disability must be evaluated on the basis of all of his psychiatric symptomatology. See, e.g., Mittleider v. West, 11 Vet. App. 181, 182 (1998). Accordingly, there are no further issues that need to be resolved with respect to the question of service connection. 5. Entitlement to service connection for cervicalgia. The Veteran also seeks to establish service connection for cervicalgia, which he asserts is related to service. He maintains that his disability is related to his service in tactical communications. The Veteran is currently diagnosed with cervical spondylosis and degenerative arthritis. See May 2016 x-ray results; June 2015 VA examination. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. Also, the Veteran’s service treatment records note complaints of lower neck pain, diagnosed as mild neck strain. See January 1986 Record of Medical Care. In a February 1989 report of medical history, he denied having arthritis or bone or joint deformity, but reported having recurrent back pain. However, no diagnosis or objective clinical findings were reported. The Veteran was afforded a VA neck examination in June 2015. The examiner noted diagnoses of cervical spondylosis and degenerative arthritis of the spine. In an April 2016 medical opinion, the June 2015 examiner opined that the cervical condition was less likely than not service related. The examiner noted that the Veteran’s condition of pain was most likely related to cervical arthrosis and spondylosis with onset in 2006, years after service. The examiner noted acute and transient cervical pain in 1986 not related to any traumas. The examiner remarked that this incident was not seen to continue affecting the Veteran during his service period, no sequelae were seen, and no permanent impairments or chronic conditions were seen thereafter so as to account for a related disability in the cervical area. The Board finds that while the Veteran has a current disability, including degenerative arthritis, the preponderance of the evidence weighs against finding that the Veteran’s current disability began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). In that regard, the June 2015 examiner found the in-service complaints to be acute and transitory. Moreover, there is no competent and probative evidence that the Veteran’s current disability manifested to a degree of 10 percent or more within one year of separation from service. See June 2015 VA examination; April 2016 addendum opinion. As such, service connection on a presumptive basis is not warranted. The Board finds the April 2016 opinion to be probative. The VA examiner clearly reviewed the medical records in the claims folder and provided opinions that were supported by and consistent with the evidence of record. The only credible, probative opinions of record weigh against the claim, and neither the Veteran nor his representative has presented or identified any contrary medical opinion evidence that supports the Veteran’s claim. To the extent that the Veteran has himself asserted that his current disability is related to his active service, such statements lack probative value, as the Veteran is not shown to possess the medical expertise necessary to render an opinion relating his neck disability to his active service. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In any event, the Board gives more weight to the June 2015 examination and April 2016 addendum opinion. Because the preponderance of the evidence is against a finding that the Veteran’s cervicalgia is etiologically related to his active duty service, the appeal of this issue must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for priapism and erectile dysfunction is remanded. The Veteran has advanced argument to the effect that the claimed priapism and erectile dysfunction are secondary to his now service-connected acquired psychiatric disorder, to include medications taken therefor. Assessing the impact of one disability on another involves complex medical issues that require specialized medical knowledge. Here, no medical opinion has been obtained with respect to the Veteran’s theory of secondary service connection. Additional development is required. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). 2. Entitlement to service connection for polyarthritis is remanded. 3. Entitlement to service connection for carpal tunnel syndrome is remanded. The Veteran also seeks to establish service connection for polyarthritis and carpal tunnel syndrome. Under applicable law, a medical examination and/or opinion is deemed “necessary” if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability; (2) establishes that the veteran suffered an event, injury, or disease in service, or has a disease or symptoms of a disease listed in 38 C.F.R. §§ 3.309, 3.313, 3.316, and 3.317 manifesting during an applicable presumptive period, provided the claimant has the required service or triggering event to qualify for that presumption; and (3) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 86 (2006). The threshold for determining whether the evidence “indicates” that there “may” be a nexus between a current disability and an in-service event, injury, or disease is a low one. Id. at 83. In the present case, the Veteran has been diagnosed with carpal tunnel syndrome and polyarthritis. See August 2018 VA treatment record. As to polyarthritis, an August 2016 treatment record notes that the pain seems to be most prominent in the knees, shoulders, and neck. At the hearing in April 2019, the Veteran asserted that his conditions were related to 13 years of typing in the military. The Veteran and is competent to relate events that have personally been observed, see Layno v. Brown, 6 Vet. App. 465, 469 (1994). His statements, while not an adequate basis upon which to grant the claim, suggest that his conditions may be associated with service. As such, an examination is warranted. See, e.g., McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (holding, in part, that an examination may be required under the provisions of 38 C.F.R. § 3.159(c)(4) if the record on appeal contains medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation). Because no examination has thus far been obtained, further development is necessary.  These matters are REMANDED for the following action: 1. Obtain copies of records pertaining to any VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 2. After the foregoing development has been completed to the extent possible, arrange to have the Veteran scheduled for a reproductive organ examination. The examiner should review the record. All indicated tests should be conducted and the results reported. After examining the Veteran and reviewing the record, together with the results of any testing deemed necessary, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that priapism and/or erectile dysfunction has been (a) caused or (b) aggravated (i.e., worsened beyond natural progression) by the Veteran’s service-connected acquired psychiatric disorder, to include medications taken therefor. If it is the examiner’s opinion that it is unlikely that such disability has not been caused or aggravated by the Veteran’s service-connected acquired psychiatric disorder, to include medications taken therefor, the examiner should offer a further opinion as to whether it is at least as likely as not that priapism and/or erectile dysfunction had its onset in, or is otherwise attributable to, the Veteran’s period of active service. A complete rationale for all opinions expressed must be provided. 3. Also arrange to have the Veteran scheduled for a VA examination for carpal tunnel syndrome. The examiner should review the record. All indicated tests should be conducted and the results reported. After examining the Veteran and reviewing the record, together with the results of any testing deemed necessary, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran’s carpal tunnel syndrome had its onset during, or is otherwise related to, the Veteran’s military service. In so doing, the examiner should consider the Veteran’s April 2019 hearing testimony to the effect that his conditions are related to 13 years of typing in the military. A complete rationale for all opinions expressed must be provided. 4. Arrange, further, to have the Veteran scheduled for a VA examination for polyarthritis. The examiner should review the record. All indicated tests should be conducted and the results reported. After examining the Veteran and reviewing the record, together with the results of any testing deemed necessary, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran has polyarthritis that had its onset in, or is otherwise attributable to, his period of active service. In so doing, the examiner should consider the Veteran’s April 2019 hearing testimony to the effect that his conditions are related to 13 years of typing in the military. A complete medical rationale for all opinions expressed must be provided. 5. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues remaining on appeal should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Kettler, 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.