Citation Nr: 21023509 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 16-21 264 DATE: April 20, 2021 REMANDED Entitlement to a rating in excess of 20 percent for penile chancroid, to include scarring, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to penile chancroid with scarring, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1977 to May 1979. These matters come before the Board of Veterans’ Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA). During the pendency of these matters, the agency of original jurisdiction (AOJ) granted service connection for erectile dysfunction secondary to penile chancroid and entitlement to special monthly compensation for loss of use of a creative organ. See Rating Decision – Narrative, April 2020. As this is considered a partial grant of the appeal for higher ratings for penile chancroid, the matter remains within the Board’s jurisdiction. AB v. Brown, 6 Vet. App. 35 (1993). In October 2018, the Board remanded these matters for further development. The AOJ was asked to “obtain any outstanding, relevant VA treatment records” and to procure VA examinations and a medical opinion for the disorders on appeal. After review of the record, the Board finds that substantial compliance is not achieved with the prior remand directives, and further development is necessary. Stegall v. West, 11 Vet. App. 268, 271 (2011) (holding that the Board errs, as a matter of law, when it fails to ensure substantial compliance with its own remand directives). Initially, the Board observes that there appear to be outstanding relevant medical records from the San Francisco VA Medical Center (VAMC) that have not been associated with the claims file. In February 2019, a VA clinician noted that the Veteran had been evaluated by the urology department for penile pain in March 2017. After an exhaustive review of the claims file, the Board is unable to locate records of the urology consultation, or indeed, any VA medical records from the year 2017. As the Veteran’s urology consultation is relevant to both of the claims at issue, the Board is obligated to procure the records relating to it before reaching a decision on the merits. 38 U.S.C. § 5103A(c)(1)(B). Moreover, records from the Social Security Administration (SSA) show that the Veteran received VA mental health care in early February 2012 through April 2012. However, complete copies of VA treatment records from this period have not been associated with the claims file. Thus, the AOJ must acquire these relevant records before the Board may adjudicate the claim. Id. Lastly, the Board notes that the August 2019 VA examiner diagnosed unspecified depressive disorder and issued a negative nexus opinion, finding in part that “in the documents reviewed, claimant did not indicate at any time that the penile scarring was causing symptoms or distress.” Nevertheless, the Board notes that the Veteran has reported pain related to his penile chancroid scar. For example, in February 2016, the Veteran reported “daily shooting pains” in his penis. As such, this raises doubt as to whether the examiner’s opinion was fully informed and consistent with the record, and the Board finds that further clarification is needed. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Moreover, the Veteran became service-connected for erectile dysfunction during the pendency of this appeal. He has asserted that his sexual dysfunction is a causal factor in his acquired psychiatric disorder. See VA Form 21-0781a, December 2012. Therefore, the Board finds that another VA examination is necessary to consider this theory of entitlement. See 38 C.F.R. § 3.310; Robinson v. Mansfield, 21 Vet. App. 545 (2008) (holding that VA has an obligation to consider all claims reasonably raised by the record). The matters are REMANDED for the following actions: 1. Obtain complete copies of all VA treatment the Veteran has received for the disorders on appeal, to include from the San Francisco VAMC, Oakland VAMC, Martinez VAMC, and Palo Alto VA system. Specifically, the AOJ must obtain the following: • Medical records from the San Francisco VAMC from the year 2017, including the urology consultation in March 2017 • Medical records from the San Francisco VAMC for the period between January 2012 and December 2012, including complete records of mental health treatment in February through April 2012 2. After completion of the above, schedule the Veteran for a VA examination to determine the nature and etiology of his acquired psychiatric disorder(s). The examiner is asked to carefully review the claims file, and to opine on the following: (a) Is it at least as likely as not that any of the Veteran’s acquired psychiatric disorder(s) had onset during or is causally related to military service? (b) Is it at least as likely as not that any of the Veteran’s acquired psychiatric disorder(s) is proximately due to, a result of, or aggravated by a service-connected disorder, to include penile chancroid with scarring and erectile dysfunction? A complete rationale should be provided for all opinions. The examiner is asked to consider and discuss relevant lay and medical evidence, to specifically include: • Service medical records, including a mental health evaluation finding “no significant mental illness” in March 1979, and military medical examinations and reports of medical history in March 1979 and June 1980 • VA general medicine clinic appointment in October 2001, where the Veteran complained of feeling depressed due to back pain • Negative VA depression screenings in December 2006, January 2008, April 2018, November 2018, October 2019, and October 2020 • The VA discharge summary from the Veteran’s psychiatric hospitalization in February 2012, in which the clinician noted “ongoing psychosocial stressors, including loss of job, homeless, falling out with family, pervasive sense of rejection by people and institutions (VA, Army, family, ex-wives etc.) and with utox +MJ.” • Veteran’s complaints of penile pain due to his chancroid scar, as documented by VA medical records including in May 2014, February 2016, and February 2019 • VA penile examination in August 2019, which found a single non-painful or unstable chancroid scar measuring 0.3 centimeters in length and 0.2 centimeters in width, and in which the examiner commented that “the Veteran has had chancroid, leaving a small scar on the penis. I can only speculate that the scar causing pain prohibit [sic] him from getting an erection.” • Private medical opinions from Dr. H.H.-G. dated May 2014, and from Dr. K.B. dated July 2020 • Prior VA psychiatric examination reports in December 2012, August 2016, and August 2019 The examiner is reminded that the term “at least as likely as not,” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against. Jenna Brant Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Reed, 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.