Citation Nr: 21010026 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 14-08 984 DATE: February 23, 2021 REMANDED Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for erectile dysfunction is remanded. REASONS FOR REMAND The Veteran served on active duty from May 2002 to April 2007. This case is before the Board of Veterans’ Appeals (Board) on appeal from January 2013 and March 2015 Regional Office (RO) rating decisions. In the January 2013 rating decision, service connection for left and right knee disorders were denied, and in the March 2015 rating decision, service connection for erectile dysfunction was denied. In February 2016, the Board remanded the issues of service connection for left and right knee disorders. In May 2018, the Board remanded the issues of service connection for left and right knee disorders and erectile dysfunction. In September 2019, the Board denied the claims of service connection for left and right knee disorders and erectile dysfunction. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). While the appeal was pending at the Court, a Joint Motion for Remand (JMR) was filed by both parties. In August 2020, the Court granted the JMR to vacate the September 2019 Board decision and remand the matter for development consistent with the terms of the JMR. The case was returned to the Board. Regarding the Veteran’s knee claims, the August 2020 JMR found that a remand was necessary because the Board erred by providing an inadequate statement of reasons or bases for its denial of the claims. Specifically, the parties agreed that in the September 2019 Board decision, the Board’s finding that there was no evidence of functional impairment of the Veteran’s left and right knees, was unsupported by an inadequate statement of reasons or bases. The Court directed the Board to consider evidence including a March 20, 2017 VA nursing note where the Veteran’s knee pain resulted in a decrease in function, quality of life, and physical activity. Service treatment records (STRs) show that the Veteran complained of knee pain shortly before discharge from service. The Veteran contends his knees began hurting since running in formation in service and remembers extending the right one into a pothole. Despite the Board’s previous finding that the Veteran does not have current diagnoses of left or right knee disorders, as indicated in the July 2016 and March 2019 VA examination reports, review of the record reveals that the Veteran has reported pain causing functional loss. VA treatment records provide a March 20, 2017 VA nursing note showing that the Veteran reported bilateral knee pain, rated as a 7 out of 10. It indicates that the effects of the pain were decreased function, quality of life, and physical activity. In addition, the Veteran underwent a VA examination in December 2012, and the VA examiner provided a diagnosis of bilateral knee pain. Therefore, after a thorough review of the record, the Board finds that the Veteran has current diagnoses of left and right knee disorders, based on his reports of pain and related functional loss. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In other words, where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability for service connection purposes. Thus, due to the report of pain during service and the reports of pain causing functional loss in 2017, the Board finds that a new VA examination is warranted, addressing the etiology of the Veteran’s knee disorders, based on reports of pain. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (a VA examination must be based on an accurate factual premise). Regarding the erectile dysfunction claim, the August 2020 JMR found that a remand was necessary because the Board erred by failing to uphold the duty to assist and presented an inadequate statement of reasons or bases. Specifically, in the September 2019 Board decision, the Board relied on an inadequate March 2019 VA medical opinion and did not consider whether obesity was a link between his service-connected PTSD and erectile dysfunction. Thus, the Court vacated the Board’s decision and remanded for the Board to obtain a new medical opinion, discussing the question of whether the Veteran’s service-connected PTSD aggravated his erectile dysfunction. The Court directed the Board to consider the reasonably raised theory of service connection and conduct any necessary development. The March 2019 VA medical opinion regarding the Veteran’s erectile dysfunction does not adequately address whether the Veteran’s PTSD aggravated his erectile dysfunction and whether obesity was a link between his service-connected PTSD and his claimed erectile dysfunction. The March 2019 examiner stated that obesity is a common cause of erectile dysfunction and that it was likely the cause of the Veteran’s erectile dysfunction. Evidence of record indicates that the Veteran’s stress and depression from PTSD may have led to overeating and obesity. However, the March 2019 VA opinion does not address the cause of the Veteran’s weight gain and if there is any correlation between the weight gain, PTSD, and erectile dysfunction. Thus, after a thorough review of the record, the Board finds that the medical evidence of record is insufficient to decide the claim, and a remand is warranted to obtain a medical opinion addressing all reasonably raised theories of the claim. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination in order to determine the nature and etiology of his left and right knee disorders, reported as pain causing functional loss. The examiner must review the Veteran’s claims file, including VA treatment records, previous VA examination reports, and the Veteran’s lay statements, in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should then opine whether the Veteran’s bilateral knee disorders, to include any bilateral knee pain, at least as likely as not (50 percent or greater probability) began in or is otherwise the result of military service, to include the noted complaints of knee pain therein. The examiner should address the Veteran’s contentions and lay statements of record, to include onset of symptomatology and any continuity of symptomatology since onset/discharge from military service. The examiner should address all pertinent evidence of record, as appropriate. The examiner must provide a complete rationale for all opinions and conclusions reached. 2. Schedule the Veteran for a VA examination with an appropriate clinician in order to determine the etiology of the Veteran’s erectile dysfunction. The examiner must review the Veteran’s claims file, including the Veteran’s lay statements, in conjunction with the examination. After review of the claims file and examination of the Veteran, the examiner should then opine whether the Veteran’s erectile dysfunction was at least as likely as not (50 percent or greater probability) either (a) caused by; or (b) aggravated (i.e., worsened) by his service-connected disabilities, either individually or on a combined/aggregated effects basis. The examiner is reminded that presently, the Veteran is service-connected for: posttraumatic stress disorder (PTSD), a lumbar spine disability with bilateral sciatic and femoral nerve radiculopathy, irritable bowel syndrome (IBS), bilateral shoulder disabilities, traumatic brain injury (TBI), tinnitus, tension headaches and hypertension. In addressing the above, the examiner should additionally opine whether the Veteran’s service-connected disabilities, individually or combined, caused him to become obese. If the examiner finds that the Veteran’s service-connected disabilities caused him to become obese, then the examiner needs to opine whether obesity was a substantial factor in causing or worsening the Veteran’s erectile dysfunction, and whether such would not have occurred/worsened if but for the obesity caused by his service-connected disabilities. The examiner should address the Veteran’s contentions and lay statements of record. The examiner should address all pertinent evidence of record, as appropriate. The examiner must provide a complete rationale for all opinions and conclusions reached. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Labi, 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.