Citation Nr: 21021662 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 15-23 884 DATE: April 13, 2021 REMANDED Entitlement to service connection for sexual problems, to include erectile dysfunction and infertility, due to herbicide agent exposure is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 1968 to December 1970, including service in the Republic of Vietnam. The issue comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The above issue was previously before the Board in July 2018, October 2019, and August 2020. The Board remanded each time for further development to include VA examinations. As an initial matter, the Veteran also appealed his claim to service connection for his skin condition. The Board remanded the Veteran’s skin condition claim for further development. In a February 2021 rating decision, the RO granted service connection for xerosis (claimed as skin problems) from November 8, 2010, evaluated as 10 percent disabling and 30 percent assigned from October 29, 2020. As the RO’s decision constitutes a grant in full, the claim of service connection for the Veteran’s skin disorder is not before the Board. Entitlement to service connection for sexual problems, to include erectile dysfunction and infertility, due to herbicide agent exposure is remanded. Although the Board regrets further delay, another remand is necessary to provide the Veteran with every possible consideration. Further development is necessary prior to appellate review to provide the Veteran with a VA medical opinion that adequately addresses the Veteran’s claim of service connection due to exposure to herbicide agents. Pursuant to the August 2020 Board remand, the RO provided the Veteran with a VA examination. In the October 2020 VA examination, the examiner provided the medical opinion that the Veteran’s chronic prostatitis and erectile dysfunction were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner rationalized that the Veteran’s sexual problems were not related to service, as his conditions developed after his service dates. Additionally, the VA examiner noted the Veteran’s claimed sexual problems were not conditions recognized by VA as presumptively linked to herbicide agent exposure. The RO requested a VA addendum opinion in February 2021 to address the contention that the Veteran’s sexual problems are directly due to exposure to Agent Orange or other chemical herbicides. The examiner provided the opinion that the Veteran’s erectile dysfunction and chronic prostatitis were less likely than not incurred during service including while in Vietnam. The examiner rationalized that the Veteran’s medical history and the dates of diagnoses supported such a finding. The examiner found no evidence of the Veteran’s infertility in the claims file and did not diagnose infertility based on the evidence of record. The Board must consider all theories of entitlement either expressly raised by the claimant or which are reasonably raised by the record. See Robinson v. Shinseki, 557 F.3d 1355, 1362 (Fed. Cir. 2009). Additionally, VA’s duty to assist includes obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claim. 38 U.S.C. § 5103A. Absent a reasoned medical explanation and without supporting data, a medical opinion is inadequate to adjudicate the Veteran’s claim. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). A mere conclusory medical opinion is insufficient. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Without a medical opinion that clearly addresses the relevant facts and medical science, the Board is left to rely on its own lay opinion, which it is forbidden from doing. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board finds a new medical opinion is required to address the Veteran’s explicit contention that his sexual problems, to include erectile dysfunction and infertility, are related to herbicide agent exposure from his service in the Republic of Vietnam. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination with an appropriate examiner to determine the etiology of the Veteran’s claimed sexual problems. The record and a copy of this Remand must be made available to the examiner. The examination may be conducted via telehealth or similar service during the social distancing restrictions of the COVID-19 pandemic. Following a review of the evidence of record, the examiner must opine as to whether it is at least as likely as not (50 percent probability or more) that the Veteran’s sexual disability, to include erectile dysfunction and infertility, is etiologically related to herbicide agent exposure during active duty service. For the purposes of the examination, the Veteran’s exposure to herbicide agents during his service in the Republic of Vietnam is established. The examiner must provide a comprehensive report including a clearly stated rationale for any opinions offered and conclusions reached, citing the objective medical findings leading to the conclusions, and must not be based solely on the lack of records. In this regard, the Board emphasizes that the Veteran is competent to report his symptoms and history, and such statements by the Veteran regarding symptomatology and medical history must be specifically acknowledged and considered in formulating any opinions concerning the onset and severity of his disability. If such reports are rejected by the examiner, a reason for doing so must be provided. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.V. Bona, 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.