Citation Nr: 21016058 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 17-39 271 DATE: March 19, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depression, and anxiety, is remanded. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from July 1979 to June 1983. This matter is before the Board of Veterans’ Appeals (Board) on appeal from July 2014 and March 2016 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Board hearing in February 2021; a transcript of that hearing is of record. The Board notes that the Veteran filed a claim for service connection for PTSD. However, pursuant to Clemons v. Shinseki¸ the Board finds that it is appropriate to characterize the Veteran’s claim as noted above. 23 Vet. App. 1, 5 (2009). 1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, depression, and anxiety, is remanded. The Veteran asserts service connection for an acquired psychiatric disorder. He has current diagnoses of mood disorder with depressive features, depressive disorder, chronic PTSD, and anxiety, to include as reported in his VA treatment records. See 6/29/2017, CAPRI – DX. As such, the first element of service connection has been met. The Veteran has submitted a lay statement. His friend stated that when the Veteran returned from Korea, he had mood swings, anxiety attacks, and depression. At the time, the Veteran described nightmares, flashbacks, and difficulty sleeping. He testified at the Board hearing that he believed his psychiatric disorders were due to stress from service. He had self-medicated with alcohol. The Board finds the Veteran competent and credible to describe his in-service experiences. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). However, he is not competent to provide an etiology opinion for any acquired psychiatric disorder as the issue is medically complex and requires a thorough understanding of psychiatry and/or psychology. Additionally, the Veteran has not been scheduled for an examination to assess the nature and etiology of any acquired psychiatric disorder, and whether it is related to service. As such, the Board finds that an examination is warranted as such would be useful for a full and fair adjudication of this issue. Indeed, VA has not obtained a medical opinion as to whether the Veteran’s disability is related to service. 2. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disabilities, is remanded. The Veteran asserts service connection for erectile dysfunction, to include as secondary to medications taken for his acquired psychiatric disorders. He has a current diagnosis of erectile dysfunction to include as reported in his VA treatment records. See 6/29/2017, CAPRI – DX. As such, the first element of service connection has been met. He testified at the Board hearing that he believes his erectile dysfunction is secondary to his medications for his acquired psychiatric disorders. The Board finds the Veteran competent and credible to describe that his erectile dysfunction began after or around the time when he started taking medication for his acquired psychiatric disorders. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). However, he is not competent to provide an etiology opinion for his disorder as the issue is medically complex and requires a thorough understanding of pharmacology. Additionally, the Veteran has not been scheduled for an examination to assess the nature and etiology of any erectile dysfunction disability, and whether it is secondary to any potentially service-connected disability and medication. As such, the Board finds that an examination is warranted as such would be useful for a full and fair adjudication of this issue. Indeed, VA has not obtained a medical opinion as to whether the Veteran’s disability is related to service, to include as secondary to any service-connected disabilities. The Board also finds that this issue is inextricably intertwined with the remanded claim of service connection for an acquired psychiatric disorder as it may be secondary his claim. See Harris v. Derwinksi, 1 Vet. App. 180, 183 (1991) (noting that two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). In this regard, he testified that he believed his disorder was secondary to psychiatric medications he takes. As such, this issue is deferred pending the receipt of additional evidence, as directed below. These matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records, to include all recent VA records. All requests and responses for the records must be documented. If any identified records cannot be obtained, notify the Veteran of the missing records, the efforts taken, and any further efforts that will be made by VA to obtain such evidence, and allow him an opportunity to provide the missing records. 2. After completing #1, obtain an addendum opinion. Send the file to an appropriate mental health examiner (licensed psychologist and/or psychiatrist) and ask the clinician to review the claims file. If the mental health specialist needs an in-person examination, then schedule one. --Identify any acquired psychiatric disability, to include, mood disorder with depressive features, depressive disorder, chronic PTSD, and anxiety, or any other psychiatric disorder since April 2013. If the specialist disagrees with any previously diagnosed disability, he/she must clearly explain why. Then, the mental health specialist is to address the following: (a.) For each current psychiatric disability, the examiner is to provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any of the Veteran’s current (present at any time since April 2013) psychiatric disabilities, in whole or part, had their onset in service, or are otherwise the result of a disease or injury in service, to include stressful experiences during service. **In forming a nexus opinion, please address the Veteran’s statements that he experienced significant stress during his service in Korea and he believes this is the cause of his current acquired psychiatric disorders.** See 2/1/2021, Hearing Transcript.   3. After completing #1 and #2, regarding the Veteran’s erectile dysfunction disability obtain an opinion (or schedule an examination if necessary). –Then, address whether: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s disability was caused by a disease or injury in service? (b.) If not, is it at least as likely as not (50 percent or greater) that the Veteran’s disability is either 1) proximately due to OR 2) aggravated by the Veteran’s service-connected disabilities, to include medication take for them? The term “aggravated” refers to a worsening of the underlying condition beyond the natural progression of the disease, as opposed to temporary or intermittent flare-ups or symptoms that resolve with return to the baseline level of disability. If aggravation is found, please state, to the extent possible, the baseline level of disability prior to aggravation. Inform each examiner that a comprehensive rationale for all opinions must be provided. All pertinent evidence, including both lay and medical, should be considered. (Continued on the next page)   If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Morales, 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.