Citation Nr: 21015113 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 14-28 517 DATE: March 16, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include on a secondary basis, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1970 to December 1971. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2012 rating decision of the Detroit, Michigan, Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned in August 2017. A transcript of that hearing is of record. In March 2020, the Board remanded this issue for further development. Specifically, the Board instructed that any outstanding VA and pertinent private treatment records should be obtained and associated with the claims file. Additionally, the Board instructed that a VA medical opinion should be obtained that addresses whether the Veteran’s prescribed medications for his anxiety disorder could have caused or aggravated his erectile dysfunction. Additional VA treatment records were added to the Veteran’s claims file, and a letter was sent to the Veteran in April 2020, requesting that the Veteran submit, or authorize VA to obtain, any additional relevant private treatment records in support of his claim on appeal. No response was received from the Veteran. The requested VA opinions were obtained in June 2020. The RO subsequently issued a Supplemental Statement of the Case (SSOC) and the case was returned to the Board for adjudication. However, after a review of the June 2020 VA medical opinions, the Board finds that this case must be remanded again to ensure compliance with the Board’s March 2020 remand. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for erectile dysfunction, to include on a secondary basis, is remanded. The Veteran contends that erectile dysfunction is caused or aggravated by the medication prescribed for his service-connected anxiety disorder. In pertinent part, a January 2002 VA medical record notes that the Veteran had suffered from impotence for 5 years, which was noted as a side effect to his medication. A June 2012 VA psychiatric medical record noted the Veteran was on medication that caused and/or contributed to erectile dysfunction; however, this record did not identify which medication(s) were at issue. An April 2014 treatment record suggests that erectile dysfunction may be a side effect of his anxiety medication, bupropion. At an August 2017 Board hearing, the Veteran’s representative asserted that the current erectile dysfunction was caused and/or aggravated by medications used to treat his service-connected anxiety disorder. The representative further asserted that the Veteran was informed that his prescribed citalopram and bupropion had side effects that could cause or contribute to erectile dysfunction. Additionally, the Board notes that in August 2017, the Veteran submitted a list of side effects for citalopram including severe inability to have an erection, problems with ejaculation and sexual problems, and a list of side effects for bupropion including a loss of interest in sex. In its March 2020 remand, the Board requested a medical opinion addressing the etiology of the Veteran’s erectile dysfunction. Specifically, the Board instructed that the examiner should opine as to whether the Veteran’s erectile dysfunction was caused or aggravated by the medications prescribed for his service-connected anxiety disorder. The Board further instructed that the examiner should discuss the side-effects of medications prescribed for the Veteran’s anxiety disorder, the June 2012 statement from the Veteran’s physician that his medications caused and/or contributed to erectile dysfunction, and the April 2014 record suggesting that erectile dysfunction may be a side effect of his anxiety medication, bupropion. Pursuant to the Board’s previous remand, a VA medical opinion was obtained in June 2020. While the examiner noted review of prior records, the examiner indicated only that “could contribute or could cause” are not causality enough given his other significant comorbid conditions. The Board notes that it is unclear which record the examiner was referencing as the particular record was not identified. However, to the extent that this reference was made in response to the June 2012 record, the June 2012 record did not use the word “could”. As such, it is unclear to the Board whether the examiner misstated the evidence and relied on such information in formulating the opinion, or alternatively, did not consider the particular evidence requested by the Board in the previous remand. Furthermore, the opinion did not include any discussion regarding the side-effects of the medications prescribed for the Veteran’s anxiety disorder. Thus, the Board finds that the June 2020 VA examination does not comply with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Consequently, an addendum opinion is required to adequately decide the merits of the claim. The matter is remanded for the following action: Obtain a medical opinion to address the etiology of the Veteran’s erectile dysfunction. The electronic claims file must be made accessible to the examiner. If an addendum opinion is not feasible, schedule the Veteran for a VA examination to determine the etiology of his erectile dysfunction. The examiner should offer the following opinion: (a.) Is it at least as likely as not (50 percent or greater) that the Veteran’s erectile dysfunction was caused by the Veteran’s service-connected anxiety disorder and/or medications prescribed to treat his anxiety disorder? Why or why not? (b.) Is it at least as likely as not (50 percent or greater) that the Veteran’s erectile dysfunction was aggravated (made worse) by the Veteran’s service-connected anxiety disorder and/or medications prescribed to treat his anxiety disorder? Why or why not? If aggravation is found, the examiner should identify a baseline level of severity of the Veteran’s erectile dysfunction by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the erectile dysfunction. If such cannot be done, it should be explained why. (Continued on the next page)   The examiner should discuss the side-effects of medications prescribed for the Veteran’s anxiety disorder, the June 2012 statement from the Veteran’s mental health physician that his medications “caused and/or contributed” to his erectile dysfunction, and the April 2014 record suggesting that erectile dysfunction may be a side effect of his anxiety medication, bupropion. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Hite, 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.