Citation Nr: 21023785 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 18-09 280 DATE: April 21, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected diabetes mellitus, is remanded. Entitlement to service connection for a heart disability including atrial fibrillation, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1969 to August 1971, including service in the Republic of Vietnam. The Veteran testified at a hearing before the undersigned in February 2021. A transcript of the hearing has been associated with the claims file. 1. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected diabetes mellitus. The claim is remanded because the May 2015 VA examination is inadequate. The examiner diagnosed erectile dysfunction and offered a negative nexus opinion, but did not adequately address aggravation. 2. Entitlement to service connection for a heart disability including atrial fibrillation, to include as due to herbicide exposure. The Veteran has been diagnosed with atrial fibrillation. See, e.g., VA Treatment,June 2016. His representative has submitted documentation that indicated that a risk factor for atrial fibrillation is diabetes mellitus. The claim is remanded to obtain a medical opinion. See 38 C.F.R. § 3.159; McLendon v. Nicholson, 20 Vet. App. 79 (2006). On remand attempts must be made to obtain and associate with the claims file VA treatment records regarding the Veteran dated since May 2019. See 38 C.F.R. § 3.159. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file complete VA treatment records regarding the Veteran dated since May 2019. Any additional pertinent records identified by the Veteran during the course of the remand should also be obtained, following the receipt of any necessary authorizations from the Veteran, and associated with the claims file. 2. After completion of the above, obtain an opinion from an appropriate VA medical examiner on the likely etiology of the Veteran's erectile dysfunction. Copies of all pertinent records should be made available to the examiner for review. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). Based on a review of the record, the examiner should address the following: (i) Is it at least as likely as not that the Veteran's erectile dysfunction was incurred in or related to service? (ii) Is it at least as likely as not that the Veteran's erectile dysfunction is due to or aggravated by his service-connected diabetes mellitus disability? The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. The examiner is also informed that whether erectile dysfunction predated the diagnosis of diabetes is not determinative when addressing the aggravation question. (iii) In answering the questions, the examiner must consider, and discuss as necessary, the articles submitted by the Veteran’s representative and the prior examination. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 3. Thereafter, afford the Veteran a VA medical examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) regarding the etiology of the Veteran’s heart disability including atrial fibrillation. Copies of all pertinent records should be made available to the examiner for review. Based on a review of the record and examination, the examiner should address the following: (i) Identify all heart disabilities. (ii) Is it at least as likely as not that any identified heart disability, including atrial fibrillation, was incurred in or related to service, including any exposure to herbicides? (iii) Is it at least as likely as not that any identified heart disability, including atrial fibrillation, is due to or aggravated by his service-connected diabetes mellitus disability? The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. The examiner is also informed that whether any identified heart disability, including atrial fibrillation, predated the diagnosis of diabetes is not determinative when addressing the aggravation question. (iv) In answering the questions, the examiner must consider, and discuss as necessary, the articles submitted by the Veteran’s representative. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 4. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. LARKIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Robert J. Burriesci, 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.