Citation Nr: 21021027 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 20-05 929 DATE: April 9, 2021 ORDER Entitlement to an effective date earlier than November 29, 2016 for grant of service connection for post-traumatic stress disorder (PTSD) is denied. The application to reopen a previously denied claim for service connection for bilateral hearing loss is granted. The application to reopen a previously denied claim for service connection for tinnitus is granted. The application to reopen a previously denied claim for service connection for sleep disturbance is granted. The application to reopen a previously denied claim for service connection for hypertension is granted. The application to reopen a previously denied claim for service connection for glaucoma of the left eye is granted. The application to reopen a previously denied claim for service connection for erectile dysfunction is granted. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for sleep disturbance is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for glaucoma of the left eye is remanded. Entitlement to service connection for glaucoma of the right eye is remanded. Entitlement to service connection for erectile dysfunction is remanded. FINDINGS OF FACT 1. In a November 2014 rating decision, the Veteran’s claims for service connection for PTSD, bilateral hearing loss, tinnitus, sleep disturbance, hypertension, glaucoma of the left eye, and erectile dysfunction were denied. 2. The Veteran filed a timely notice of disagreement (NOD) and a statement of the case (SOC) for each claim issued in April 2013 but the Veteran did not perfect his appeal for any of these claims. 3. The Veteran’s entitlement to service connection for PTSD arose in November 2015 when a psychologist diagnosed him with PTSD by history. 4. After the November 2014 rating decision, the Veteran’s first attempt to reopen his claim for service connection for PTSD was his Intent to File a Claim form, received on his current effective date of November 29, 2016. 5. Since the November 2014 rating decision, the Veteran has submitted evidence in support of his claim for service connection for hearing loss which is not cumulative or duplicative and had not previously been submitted to either the RO or the Board. 6. Since the November 2014 rating decision, the Veteran has submitted evidence in support of his claim for service connection for tinnitus which is not cumulative or duplicative and had not previously been submitted to either the RO or the Board. 7. Since the November 2014 rating decision, the Veteran has submitted evidence in support of his claim for service connection for sleep disturbance which is not cumulative or duplicative and had not previously been submitted to either the RO or the Board. 8. Since the November 2014 rating decision, the Veteran has submitted evidence in support of his claim for service connection for hypertension which is not cumulative or duplicative and had not previously been submitted to either the RO or the Board. 9. Since the November 2014 rating decision, the Veteran has submitted evidence in support of his claim for service connection for glaucoma of the left eye which is not cumulative or duplicative and had not previously been submitted to either the RO or the Board. 10. Since the November 2014 rating decision, the Veteran has submitted evidence in support of his claim for service connection for erectile dysfunction which is not cumulative or duplicative and had not previously been submitted to either the RO or the Board. CONCLUSIONS OF LAW 1. The November 2014 rating decision denying service connection for PTSD, bilateral hearing loss, tinnitus, sleep disturbance, hypertension, glaucoma of the left eye, and erectile dysfunction is final. 38 U.S.C. § 7105(d)(3) (2018); 38 C.F.R. §§ 20.302, 20.1103 (2018). 2. The criteria for entitlement to an effective date earlier than November 29, 2016 for grant of service connection for PTSD have not been met. 38 U.S.C. § 5110(a) (2020); 38 C.F.R. § 3.400(r) (2020). 3. New and material evidence has been received to reopen the Veteran’s claim for service connection for bilateral hearing loss. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 4. New and material evidence has been received to reopen the Veteran’s claim for service connection for tinnitus. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 5. New and material evidence has been received to reopen the Veteran’s claim for service connection for sleep disturbance. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 6. . New and material evidence has been received to reopen the Veteran’s claim for service connection for hypertension. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 7. New and material evidence has been received to reopen the Veteran’s claim for service connection for glaucoma of the left eye. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 8. New and material evidence has been received to reopen the Veteran’s claim for service connection for erectile dysfunction. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Army from January 1964 to January 1966. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO); this case is in the Board’s legacy appeals system. The Veteran testified at a February 2021 Board hearing before the undersigned; a transcript is associated with the claims file. 1. Entitlement to an effective date earlier than November 29, 2016 for grant of service connection for PTSD The Veteran is seeking an effective date earlier than the November 29, 2016 for grant of service connection for PTSD. He has suggested March 27, 2013, the date of his first claim for service connection for PTSD, as the appropriate effective date. The effective date for an award of service connection based on an initial claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400. The effective date for award of service connection based on a claim reopened after a final denial will be the date of receipt of claim to reopen or date entitlement arose, whichever is later, except in certain circumstances related to changing representatives as outlined in 38 C.F.R. § 20.1304. 38 C.F.R. § 3.400(r). In VA’s legacy appeals system, a rating decision became final when a Veteran who was properly notified of the decision did not perfect an appeal under the then current version of Rule 302 (38 C.F.R. § 20.302). 38 C.F.R. § 20.1103 (2018). Rule 302 allowed 60 days from the mailing of the SOC to perfect an appeal, or the remainder of the one-year period after the mailing of the rating decision, whichever period ended later. 38 C.F.R. § 20.302 (2018). A claimant may reopen a finally adjudicated claim by submitting new and material evidence. 38 C.F.R. § 3.156. New evidence means existing evidence not previously submitted to agency decisionmakers. Id. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. Id. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. Id. Because there has been considerable confusion regarding the status of the Veteran’s claim for service connection for PTSD at different times, the Board will provide a summary of the relevant procedural history. The Veteran first filed a claim for service connection for PTSD in March 2013. In October 2013, a rating decision denied the Veteran’s claim. In July 2014, the Veteran filed a new claim for service connection for PTSD. Because this was within one year of the October 2013 rating decision, the October 2013 rating decision did not become final. In November 2014, a rating decision again denied the Veteran’s claim. In January 2015, the Veteran filed a claim form listing both a claim for service connection for PTSD and a request to reopen his claim for service connection for PTSD. Because this was within one year of the November 2014 rating decision, that decision had not yet become final and there was therefore no finally adjudicated claim to attempt to reopen. In May 2015, the RO, clearly confused about this issue, issued a rating decision on the request to reopen a previously denied claim for service connection for PTSD. The rating decision first stated, without supporting reasoning, that the claim was considered reopened. Then, again without supporting reasoning, the rating decision concluded that there was no new and material evidence received to justify reopening this claim. In August 2015, the Veteran filed a timely NOD to the November 2014 rating decision. In November 2016, the Veteran filed a notice of intent to file a claim. In April 2017, the RO issued an SOC in response to the Veteran’s August 2015 NOD. The Veteran did not perfect his appeal within 60 days of the mailing of the April 2017 SOC. In July 2017, the Veteran filed an appeal form attempting to perfect his appeal on the issue of service connection for PTSD and the RO responded with a letter explaining that this appeal could not be accepted because the period for perfecting his appeal had lapsed. Still during July 2017, and within one year of filing his Intent to File form, the Veteran filed a new claim for service connection for PTSD. In November 2017, a rating decision which did not explicitly discuss the issue of reopening a previously denied claim granted service connection for PTSD with an effective date of November 29, 2016. The Veteran appealed the November 2017 rating decision, seeking an earlier effective date. The Veteran argues that the May 2015 rating decision improperly treated the Veteran’s January 2015 claim as a request to reopen a (non-existent) finally adjudicated claim and did not address the Veteran’s claim for service connection for PTSD on the merits that the Veteran’s claim for service connection was never properly adjudicated by the RO and therefore did not become final. The Board regrets the confusion caused by the RO’s failure to properly respond to the Veteran’s January 2015 communication, but is ultimately unpersuaded by the Veteran’s argument. A claim filed with VA for a benefit that is already the subject of a pending claim before VA cannot be accepted. The January 2015 claim form was filed within one year of the November 2014 rating decision and could at most have served to keep that decision from becoming final if the Veteran had failed to file a timely NOD. However, because the Veteran did file a timely NOD, the January 2015 claim form had no procedural effect on the Veteran’s claim. The May 2015 rating decision was issued in error and had no procedural effect on the Veteran’s claim. It was only in June 2017, when the Veteran failed to perfect his appeal within 60 days of the April 2017 SOC, that the November 2014 rating decision became final. The Veteran’s medical records show that there has been disagreement over the years as to the accurate diagnosis for his mental health condition. November 2015 is the earliest record of a diagnosis of PTSD, which was later determined to be related to his active military service. The date entitlement arose is would therefore be in November 2015. The Veteran’s date of claim to reopen a finally adjudicated claim is November 29, 2016, the date of receipt of his Intent to File form. Applying the criteria of 38 C.F.R. § 3.400(r), the later of these two dates, November 29, 2016, is the appropriate effective date for the award of service connection for PTSD. Because the preponderance of the evidence is against the Veteran’s claim for an earlier effective date for award of service connection for PTSD is denied. 2. The application to reopen a previously denied claim for service connection for bilateral hearing loss A rating decision of November 2014 denied service connection for bilateral hearing loss. One of the reasons given for the denial was that the evidence did not show an event, disease or injury in service. Because the Veteran did not perfect an appeal within one year of date the rating decision was mailed or within 60 days of the SOC, the rating decision became final. 38 U.S.C. § 7105 (2018); 38 C.F.R. §§ 20.302, 20.1103 (2018). Since the November 2014 rating decision became final, the Veteran has stated that during his service in Vietnam, he was exposed to hazardous noise including exploding grenades and “constant bombing.” The Board finds that this evidence is new, in that it has not been previously submitted to either the regional office or the Board. The Board finds that it is material, as it directly supports the Veteran’s claim of service connection for hearing loss by providing evidence of an in-service injury to his ears. Because the Veteran has submitted new and material evidence supporting his claim of service connection for bilateral hearing loss, reopening this claim is warranted. The claim itself will be addressed in the remand section below. 3. The application to reopen a previously denied claim for service connection for tinnitus A rating decision of November 2014 denied service connection for tinnitus. One of the reasons given for the denial was that the evidence did not show an event, disease or injury in service. Because the Veteran did not perfect an appeal within one year of date the rating decision was mailed or within 60 days of the SOC, the rating decision became final. 38 U.S.C. § 7105 (2018); 38 C.F.R. §§ 20.302, 20.1103 (2018). Since the November 2014 rating decision became final, the Veteran has stated that during his service in Vietnam, he was exposed to hazardous noise including exploding grenades and “constant bombing.” The Board finds that this evidence is new, in that it has not been previously submitted to either the regional office or the Board. The Board finds that it is material, as it directly supports the Veteran’s claim of service connection for hearing loss by providing evidence of an in-service injury to his ears. Because the Veteran has submitted new and material evidence supporting his claim of service connection for tinnitus, reopening this claim is warranted. The claim itself will be addressed in the remand section below. 4. The application to reopen a previously denied claim for service connection for sleep disturbance A rating decision of November 2014 denied service connection for sleep disturbance. One of the reasons given for the denial was that the evidence did not show a current diagnosed disability. Because the Veteran did not perfect an appeal within one year of date the rating decision was mailed or within 60 days of the SOC, the rating decision became final. 38 U.S.C. § 7105 (2018); 38 C.F.R. §§ 20.302, 20.1103 (2018). Since the November 2014 rating decision became final, the Veteran has submitted sleep studies of April 2017 and November 2017, as well as medical records from that period onward showing diagnosis of sleep apnea and treatment with a CPAP. The Board finds that this evidence is new, in that it has not been previously submitted to either the regional office or the Board. The Board finds that it is material, as it directly supports the Veteran’s claim of service connection for sleep disturbance by providing evidence of a current diagnosis of sleep apnea. Because the Veteran has submitted new and material evidence supporting his claim of service connection for a sleep disorder, reopening this claim is warranted. The claim itself will be addressed in the remand section below. 5. The application to reopen a previously denied claim for service connection for hypertension A rating decision of November 2014 denied service connection for hypertension. The reasoning of the denial included the lack of an in-service injury, event, or disease, and the lack of manifestation to a compensable degree withing one year of separation from service. The November 2014 rating decision did not discuss the possibility that the Veteran’s hypertension could be secondary to a service-connected disability. Because the Veteran did not perfect an appeal within one year of date the rating decision was mailed or within 60 days of the SOC, the rating decision became final. 38 U.S.C. § 7105 (2018); 38 C.F.R. §§ 20.302, 20.1103 (2018). Since the November 2014 rating decision became final, the Veteran has claimed that his hypertension was caused or aggravated by his service-connected disabilities including PTSD, his claimed condition of sleep disturbance, or, in the alternative, by his exposure to herbicide agents in Vietnam. The Board finds that the Veteran’s statements including new reasoning in support of his claim are new, in that they have not been previously submitted to either the regional office or the Board. The Board finds that they are material, as they provide a new rationale in support of the Veteran’s claim for service connection for hypertension. Because the Veteran has submitted new and material evidence supporting his claim of service connection for hypertension, reopening this claim is warranted. The claim itself will be addressed in the remand section below. 6. The application to reopen a previously denied claim for service connection for glaucoma of the left eye A rating decision of November 2014 denied service connection for glaucoma of the left eye, claimed as left eye loss of vision. The reasoning of the denial included the lack of an in-service injury, event, or disease, and the lack of manifestation to a compensable degree withing one year of separation from service. The November 2014 rating decision did not discuss the possibility that the Veteran’s left eye glaucoma could be related to in-service exposure to an herbicide agent. Because the Veteran did not perfect an appeal within one year of date the rating decision was mailed or within 60 days of the SOC, the rating decision became final. 38 U.S.C. § 7105 (2018); 38 C.F.R. §§ 20.302, 20.1103 (2018). Since the November 2014 rating decision became final, the Veteran has claimed that his left eye glaucoma was caused or aggravated by his service-connected disabilities or, in the alternative, by his exposure to herbicide agents in Vietnam. The Board finds that the Veteran’s statements including new reasoning in support of his claim are new, in that they have not been previously submitted to either the regional office or the Board. The Board finds that they are material, as they provide a new rationale in support of the Veteran’s claim for service connection for glaucoma of the left eye. Because the Veteran has submitted new and material evidence supporting his claim of service connection for glaucoma of the left eye, reopening this claim is warranted. The claim itself will be addressed in the remand section below. 7. The application to reopen a previously denied claim for service connection for erectile dysfunction A rating decision of November 2014 denied service connection for erectile dysfunction. The reasoning of the denial included the lack of an in-service injury, event, or disease. The November 2014 rating decision did not discuss the possibility that the Veteran’s erectile dysfunction was caused or aggravated by any service-connected disability. Because the Veteran did not perfect an appeal within one year of date the rating decision was mailed or within 60 days of the SOC, the rating decision became final. 38 U.S.C. § 7105 (2018); 38 C.F.R. §§ 20.302, 20.1103 (2018). Since the November 2014 rating decision became final, the Veteran has been granted service connection for both PTSD and prostate cancer. The Veteran has stated that the onset of his erectile dysfunction was near in time to his diagnosis of prostate cancer and that he believes this may have caused or aggravated his condition. The Board finds that the Veteran’s statements including new reasoning in support of his claim are new, in that they have not been previously submitted to either the regional office or the Board. The Board finds that they are material, as they provide a new rationale in support of the Veteran’s claim for service connection for erectile dysfunction. Because the Veteran has submitted new and material evidence supporting his claim of service connection for erectile dysfunction, reopening this claim is warranted. The claim itself will be addressed in the remand section below. REASONS FOR REMAND 1. Entitlement to service connection for bilateral hearing loss and tinnitus The Board cannot make a fully-informed decision on the issue of servic e connection for bilateral hearing loss because no VA examiner has provided an adequate opinion as to whether the Veteran’s diagnosed hearing loss and tinnitus are related to his claimed in-service exposure to hazardous noise, including “constant bombing” in Vietnam and being near at least one exploding grenade. The Board notes that the record contains an August 2013 VA opinion indicating that it is unlikely that the Veteran’s hearing loss and tinnitus are related to service. The Board finds, however, that the opinion is inadequate, because it is based entirely on the lack of a significant threshhold shift between the Veteran’s enlistment and separation medical exams. The absence of a hearing loss disability in service does not preclude service connection if the evidence shows a current hearing loss disability was nevertheless incurred in or aggravated by in-service hazardous noise exposure. See Hensley v. Brown, 5 Vet. App. 155, 163-64 (1993). The examiner also opined that the Veteran’s tinnitus was at least as likely as not related to his hearing loss without addressing the Veteran’s statement that his tinnitus began in 1965. A new opinion—based on full review of the record and supported by stated rationale—is needed to fairly resolve the appellant’s claims. 2. Entitlement to service connection for sleep disturbance The Board cannot make a fully-informed decision on the issue of entitlement to service connection for sleep disturbance because no VA examiner has opined whether the Veteran’s condition, diagnosed as sleep apnea, is related to an in-service event, injury, or disease. A new opinion—based on full review of the record and supported by stated rationale—is needed to fairly resolve the appellant’s claim. 3. Entitlement to service connection for hypertension The Board cannot make a fully-informed decision on the issue of service connection for hypertension because no VA examiner has opined whether the Veteran’s hypertension was caused or aggravated by his conceded in-service exposure to an herbicide agent or by one or more service-connected disabilities. The Board notes that the record contains an April 2019 VA opinion indicating that it is unlikely that the Veteran’s hypertension was caused by his service-connected coronary artery disease and opining that it is most likely an idiopathic hypertension that has no identifiable cause. The Board finds, however, that the opinion is inadequate because it did not discuss whether the Veteran’s hypertension was aggravated beyond its natural progression by any service-connected disability. A new opinion—based on full review of the record and supported by stated rationale—is needed to fairly resolve the appellant’s claim. 4. Entitlement to service connection for glaucoma of the bilateral eyes The Board cannot make a fully-informed decision on the issue of service connection for glaucoma of the bilateral eyes because no VA examiner has opined whether the Veteran’s glaucoma was caused or aggravated by his conceded in-service exposure to an herbicide agent. A new opinion—based on full review of the record and supported by stated rationale—is needed to fairly resolve the appellant’s claim. 5. Entitlement to service connection for erectile dysfunction The Board cannot make a fully-informed decision on the issue of service connection for erectile dysfunction because no VA examiner has opined whether the Veteran’s erectile dysfunction was caused or aggravated by one or more service-connected disabilities. A new opinion—based on full review of the record and supported by stated rationale—is needed to fairly resolve the appellant’s claim. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate clinician regarding the etiology of the Veteran’s bilateral hearing loss and tinnitus. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinions below. For each claimed disability, the examiner is asked to provide a response to the following: Is the disability at least as likely as not related to service, including claimed in service exposure to hazardous noise such as constant bombing in Vietnam and being near an exploding grenade? Provide a rationale to support the opinions. In providing the requested opinions, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? Is the disability at least as likely as not proximately due to one or more service-connected disabilities? Is the disability at least as likely as not aggravated, i.e., worsened beyond its natural progression, by one or more service-connected disabilities? If sensorineural hearing loss is diagnosed, is it at least as likely as not that the it (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? Only if the required opinions cannot be provided based on the evidence of record, schedule the Veteran for an appropriate in-person examination. 2. Obtain an opinion from an appropriate clinician regarding the etiology of the Veteran’s sleep disturbance, diagnosed as sleep apnea. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Does the Veteran have, or has he had at any time during the period on appeal, a sleep disorder distinct from the “chronic sleep impairment” which is noted as a symptom of his PTSD? For any such sleep disturbance, including sleep apnea, is it at least as likely as not related to service? Provide a rationale to support the opinions. In providing the requested opinion, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? Is the Veteran’s sleep disturbance, including sleep apnea, at least as likely as not proximately due to PTSD? Is the Veteran’s sleep disturbance, including sleep apnea, at least as likely as not aggravated, i.e., worsened beyond its natural progression, by PTSD? Only if the required opinions cannot be provided based on the evidence of record, schedule the Veteran for an appropriate in-person examination. 3. Obtain an opinion from an appropriate clinician regarding the etiology of the Veteran’s hypertension. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is the Veteran’s hypertension at least as likely as not related to service, including conceded in-service exposure to an herbicide agent? Provide a rationale to support the opinions. In providing the requested opinions, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? Is the Veteran’s hypertension at least as likely as not proximately due to one or more service-connected disabilities, specifically PTSD? Is the Veteran’s hypertension at least as likely as not aggravated, i.e., worsened beyond its natural progression, by one or more service-connected disabilities, specifically PTSD and coronary artery disease? Is the Veteran’s hypertension at least as likely as not related to in-service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that hypertension is not on the list of diseases that are presumptively associated with exposure to herbicide agents. Only if the required opinions cannot be provided based on the evidence of record, schedule the Veteran for an appropriate in-person examination. 4. Obtain an opinion from an appropriate clinician regarding the etiology of the Veteran’s glaucoma of the bilateral eyes. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is the Veteran’s glaucoma at least as likely as not related to service? Provide a rationale to support the opinions. In providing the requested opinions, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? Is the Veteran’s glaucoma at least as likely as not related to conceded in-service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that glaucoma is not on the list of diseases that are presumptively associated with exposure to herbicide agents. Only if the required opinions cannot be provided based on the evidence of record, schedule the Veteran for an appropriate in-person examination. 5. Obtain an opinion from an appropriate clinician regarding whether the Veteran’s erectile dysfunction is at least as likely as not proximately due to, or aggravated beyond its natural progression by, one or more service-connected disabilities, specifically including prostate cancer. Only if the required opinion cannot be provided based on the evidence of record, schedule the Veteran for an appropriate in-person examination. 6. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If any benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zimmerman, Micah 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.