Citation Nr: 21012290 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 20-21 287 DATE: March 4, 2021 REMANDED Entitlement to service connection for erectile dysfunction (ED), to include as secondary to service-connected prostate cancer, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1966 to March 1970 and January 1991 to March 1991, with additional service in the National Guard and Reserve. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from the April 2016 rating decision. The Board notes that the Veteran was scheduled for a hearing for a separate issue related to the rating assigned to his service-connected prostate cancer. The Board will not address that issue in this appeal. The Veteran contends that his ED is a result of his service-connected prostate cancer. The record does not contain sufficient information to adjudicate the appeal. While it is clear that the Veteran had been diagnosed with ED, no examination specific to ED has been provided. The Veteran was provided with seven examinations for his separate appeal regarding the rating assigned to his service-connected prostate cancer; however, these contain conflicting information regarding whether his ED is related to his service-connected prostate cancer. These examinations each addressed the question of whether the Veteran had ED attributable to his prostate cancer. An April 2016 VA compensation examination and report found his ED existed prior to the diagnosis of prostate cancer, and was “probably multifactorial,” resulting from age and blood pressure medications. An April 2017 VA compensation examination and report noted the ED did not correlate to his prostate cancer; yet, the etiology of the erectile dysfunction was found to be unknown. A January 2018 VA compensation examination and report noted the implant of a penile prosthesis in 2017, and found the ED was related to prostate cancer. However, an addendum medical opinion clarified that the April 2016 examiner was correct that the ED predated the cancer. An August 2018 VA compensation examination and report found his ED was related to prostate cancer, noting the implant of the penile prosthesis. Subsequent reports from VA compensation examinations in March 2019, January 2020, and September 2020 all found it was less likely as not his ED was related to prostate cancer because it predated his diagnosis of prostate cancer. They found it was more likely related to his age and hypertension medications. However, none of these examiners addressed whether the Veteran’s ED was aggravated by his service-connected prostate cancer. See El-Amin v. Shinseki, 26 Vet. App. 136 (2012). Nor did they address evidence in the Veteran’s service treatment records that he was regularly diagnosed with prostatitis prior to his diagnosis of prostate cancer. Prostatitis is noted in his August 1969 and February 1997 service treatment records, and a summary of medical care which noted he was treated for prostatitis in October 1971. Additionally, the Veteran’s military service records indicate that he served in the Air Force Reserve from March 1970 to May 1972; Army Reserve from November 1974 to July 1977; Air National Guard from May 1978 to June 1986; then again in the Army Reserve from June 1986 until his retirement from the military. However, the Board notes that medical records from his past Reserve or National Guard service prior to 1980 are absent from his claims file. As such, the RO should attempt to obtain a complete set of service treatment records. The matters are REMANDED for the following action: 1. Make reasonable efforts to obtain the Veteran’s complete service records, including from his service in the Air Force Reserve, Army Reserve, and Air National Guard. Records indicate that the Veteran served in the Air Force Reserve from March 1970 to May 1972; Army Reserve from November 1974 to July 1977; Air National Guard from May 1978 to June 1986; then again in the Army Reserve from June 1986 until his retirement from the military. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified, and this should be documented for the record. Required notice must be provided to the Veteran. 2. After any additional service records are received, schedule the Veteran for an examination regarding the nature and etiology of his erectile dysfunction. The examiner should opine: (a) whether it is at least as likely as not related to service; (b) whether it is at least as likely as not caused by his service-connected prostate cancer; and, (c) whether it is at least as likely as not aggravated by his service-connected prostate cancer. The examiner should address the multiple prior VA prostate cancer examination reports. Specifically, (i) the April 2016 VA examination report which found the erectile dysfunction predated the diagnosis of prostate cancer and was related to age and medications; and (ii) the August 2018 VA examination report which found his erectile dysfunction was related to prostate cancer, noting the implant of the penile prosthesis; (iii) the December 2016 penile prosthesis implant; and, (iv) prostatitis diagnosed in his service treatment records in August 1969, October 1971, and February 1997. A complete medical rationale should be provided for each opinion. Marissa Caylor Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Moldawer, 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.