Citation Nr: 21013385 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 17-29 519 DATE: March 9, 2021 REMANDED Entitlement to service connection for erectile dysfunction, claimed as secondary to a service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from December 1965 to December 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, the Veteran testified at a video-conference hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is associated with the claims file. The Board remanded this case in February 2020 for an addendum opinion. Entitlement to service connection for erectile dysfunction, claimed as secondary to a service-connected disability is remanded. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). In February 2020, the Board found that the October 2015 VA examination for the Veteran’s erectile dysfunction was inadequate, and remanded for an addendum opinion to determine whether the Veteran’s erectile dysfunction was caused or aggravated by any medications prescribed to the Veteran since 2004 for his service-connected heart condition, diabetes mellitus, and hypertension. An addendum opinion was provided in December 2020. The examiner opined that the Veteran’s erectile dysfunction was less likely than not caused or aggravated by prescribed medications for his service-connected PTSD, heart condition, diabetes mellitus, nephropathy, peripheral neuropathy, or hypertension. She further stated that the Veteran’s erectile dysfunction is primarily due to hypogonadism (low testosterone). She also discussed the medications for PTSD that have been prescribed to the Veteran, and determined the only medication, paroxetine, that is associated with erectile dysfunction (2-9% of patients), was not taken by the Veteran until 2007, at least one year after his diagnosis of erectile dysfunction. Additionally, the examiner opined that paroxetine could not have aggravated the Veteran’s erectile dysfunction because there is no evidence of aggravation, as the Veteran’s condition is “total and unresponsive to medications such as Viagra.” Although the examiner opined whether the Veteran’s erectile dysfunction was caused or aggravated by his prescribed medications for his service-connected disabilities, she did not explain why the medications for his heart condition, diabetes mellitus, nephropathy, peripheral neuropathy, or hypertension were not related to his erectile dysfunction. The Board finds that the opinion regarding his medications for his non-psychiatric service-connected disabilities is too conclusory for the Board to determine the basis for the opinion or how the opinion was informed. Therefore, a new opinion is necessary. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The matters are REMANDED for the following action: 1. Obtain all VA treatment records not currently associated with the claims file.   2. Obtain an addendum opinion for the Veteran’s erectile dysfunction. The entire file should be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner must answer the following: A) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s erectile dysfunction is caused by any medications prescribed for his service-connected heart condition, diabetes mellitus, nephropathy, peripheral neuropathy, or hypertension? B) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s erectile dysfunction is aggravated by any medications prescribed for his service-connected heart condition, diabetes mellitus, nephropathy, peripheral neuropathy, or hypertension? (Aggravation here means the disability increased in severity beyond its natural progression.) If the examiner determines that the Veteran’s erectile dysfunction is aggravated by one of his service-connected disabilities, the examiner should report the baseline level of severity of the erectile dysfunction prior to the onset of aggravation. If some of the increase in severity of the erectile dysfunction is due to the natural progress of the disease, the examiner should indicate the degree of such increase in severity due to the natural progression of the disease. In rendering this opinion, the examiner must also consider and address the December 2019 hearing, at which the Veteran’s spouse testified that it seemed like the Veteran’s erectile dysfunction, which started around 2004, was due to his medication for his other conditions, including diabetes and high blood pressure. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Papacalos, Law Clerk 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.