Citation Nr: 21015381 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 13-12 595 DATE: March 17, 2021 REMANDED Entitlement to service connection for a respiratory disorder to include as due to herbicide or asbestos exposure, or secondary to hypertension is remanded. Entitlement to service connection for hypertension to include as due to herbicide exposure or secondary to a respiratory disorder is remanded. Entitlement to service connection for erectile dysfunction secondary to hypertension, diabetes mellitus, and/or posttraumatic stress disorder (PTSD) is remanded. Entitlement to special monthly compensation (SMC) based on loss of use of a creative organ is remanded. Entitlement to service connection for anemia to include as due to herbicide exposure or secondary to a respiratory disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from July 1965 until May 1969. In 2020, the RO determined that exposure to Agent Orange was conceded based on the Veteran’s nautical service in offshore waters of Vietnam. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a December 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in February 2014, and a transcript of the proceeding is of record. This matter was remanded by the Board in April 2015 and February 2020. After the 2020 remand, the RO granted service connection for diabetes mellitus. Thus, this issue is no longer on appeal. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). 1. Entitlement to service connection for anemia to include as due to herbicide exposure or secondary to a respiratory disorder is remanded. The Board finds that a remand is necessary to obtain a VA examination before a final adjudication can be entered. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran's service treatment records (STRs) are silent with respect to anemia during his service and the other medical evidence of record reflects the Veteran's anemia was diagnosed well after one year from his separation from service. 38 C.F.R. § 3.307(a)(3). However, the Veteran has asserted that this condition was caused by his exposure to Agent Orange while serving in the Republic of Vietnam. While the Veteran is not competent to diagnose anemia or to provide an opinion regarding its causation, considering the low threshold articulated in McLendon for a VA examination to be obtained, the Board finds that he has articulated a theory of entitlement that warrants an examination by an appropriate VA examiner. McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Entitlement to service connection for hypertension, to include as due to service-connected diabetes mellitus, a respiratory disorder, or as due to Agent Orange exposure Remand is required for an adequate addendum opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). “[F]or a veteran to be service connected on a secondary basis under a causation theory, the primary disability need not be service connected, or even diagnosed, at the time the secondary condition is incurred.” Frost v. Shulkin 29 Vet. App. 131, 138-39 (2017). Although May 2020 and November 2020 opinions were provided, the rationale provided regarding the secondary service connection opinion for diabetes mellitus is inadequate, as the examiner merely noted that hypertension was diagnosed prior to diabetes mellitus. 3. Entitlement to service connection for a respiratory disorder to include as due to herbicide or asbestos exposure, or secondary to hypertension is denied. Remand is required for an addendum opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr, 21 Vet. App. at 311. Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). Although a May 2020 VA examiner provided opinions regarding whether emphysema was related to active duty, to include Agent Orange and asbestos exposure, and whether it was aggravated by hypertension, causation was not addressed. This must be done on remand. 4. Entitlement to service connection for erectile dysfunction secondary to hypertension, diabetes mellitus, and/or posttraumatic stress disorder (PTSD) Remand is required for an addendum opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr, 21 Vet. App. at 311. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez, 22 Vet. App. at 301. “[F]or a veteran to be service connected on a secondary basis under a causation theory, the primary disability need not be service connected, or even diagnosed, at the time the secondary condition is incurred.” Frost, 29 Vet. App. at 138-39. Although a November 2020 VA examiner provided opinions regarding whether erectile dysfunction was caused or aggravated by service-connected diabetes mellitus, the examiner only stated that it was not as it was diagnosed prior to diabetes mellitus. This is not an adequate explanation. 5. Entitlement to special monthly compensation (SMC) based on loss of use of a creative organ This issue is remanded as it is dependent upon the issue of entitlement to service connection for erectile dysfuncitno. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that issues are inextricably intertwined and must be considered together when a decision concerning one could have a significant impact on the other). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the etiology of any anemia. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the anemia had onset in, or is otherwise related to, active military service, to include Agent Orange exposure. 2. Obtain an addendum opinion regarding the etiology of the hypertension from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the hypertension was caused or aggravated by service-connected diabetes mellitus. 3. Obtain an addendum opinion regarding the etiology of the respiratory disorder from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the respiratory disorder was caused or aggravated by hypertension. 4. Obtain an addendum opinion regarding the etiology of the erectile dysfunction from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the erectile dysfunction was caused or aggravated by service-connected diabetes mellitus. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Dworkin, 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.