Citation Nr: 21011488 Decision Date: 03/02/21 Archive Date: 03/01/21 DOCKET NO. 09-35 188 DATE: March 2, 2021 REMANDED Entitlement to service connection for erectile dysfunction, as secondary to anxiety, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1969 to January 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In a March 2017 decision, the Board denied service connection for erectile disfunction. The Veteran appealed that decision to the Court of Appeals for Veterans Claims (Court). In January 2018, the Court granted the parties' Joint Motion for Remand (JMR) and remanded the issues back to the Board finding that the VA examiner failed to consider if the Veteran's erectile disfunction was aggravated beyond its natural progression by his service-connected anxiety. In an August 2018 decision, the Board remanded the issue to the RO for an examination in compliance with the Court's order. The Veteran’s claim was returned to the Board and in a July 2019 decision, the Board again denied the appeal. The Veteran appealed that decision to the Court. In September 2020, the Court granted the parties' JMR and remanded the issues back to the Board finding that the VA examiner failed to address causation and aggravation as independent concepts. The JMR also appears to desire that the opinion address whether anxiety medication can play a role in the Veteran’s ED; and the comments from another physician (Wayne G. Stanley M.D.) on the subject. Accordingly, another opinion will be sought. The matters are REMANDED for the following action: 1. Ask the Veteran to identify and additional relevant records he wishes to be considered in connection with his appeal, which records should be sought. 2. As directed by the Court, return the claims file to the examiner who performed the Veteran's April 2019 erectile dysfunction VA examination for an addendum medical opinion, or to another appropriately qualified person. The decision to fully re-examine the Veteran is left to the discretion of the person providing the opinion. After reassessing the record, the reviewer should opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran's erectile dysfunction was caused by his service connected anxiety disorder; and if not, whether it was aggravated (an increase in severity beyond the natural progression) by his service-connected anxiety disorder. Both questions need to be addressed and in doing so, the reviewer should also indicate whether any medications for the service connected anxiety disorder may have caused or aggravated this Veteran’s erectile dysfunction. Again, both whether medication caused or aggravated the Veteran’s erectile dysfunction should be addressed. A clear and complete rationale should be provided for any opinions expressed. The opinion should acknowledge and address the article provided by the Veteran in September 2015 from the Mayo Clinic that appears to state that anxiety can cause or worsen erectile disfunction; and a letter from Wayne G. Stanley M.D. dated May 12, 2014, that indicates anxiety disorder can contribute to the Veteran’s erectile dysfunction. Further, if the erectile dysfunction is considered to have been aggravated by the service connected disability (or the medication used to treat it) it is asked that the baseline level of severity before the onset of any aggravation be identified. 3. Then, re-adjudicate the claim. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Dodd, Ryan 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.