Citation Nr: 21024053 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 13-13 107 DATE: April 22, 2021 REMANDED Entitlement to service connection for a hypertension disability, to include as secondary to service-connected post-traumatic stress disorder (PTSD) and/or medications used to treat PTSD is remanded. Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for an erectile dysfunction disability, to include as secondary to hypertension or his service-connected PTSD and/or medications for PTSD is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1988 to January 1992. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a July 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2017, the Veteran testified before the undersigned Veterans Law Judge during a Board video conference hearing. These matters were previously before the Board in September 2017 and October 2018 but were remanded for additional development of the records and to obtain VA medical opinions for the disabilities. In an August 2020 supplemental statement of the case (SSOC), his claims for service connection were denied. These matters are again before the Board for adjudication. 1. Hypertension, to include as secondary to a service-connected PTSD or medications for PTSD 2. Lumbar spine disability 3. Erectile dysfunction, to include as secondary to hypertension or his service-connected PTSD and/or medications for PTSD Unfortunately, additional remand is warranted before the Board can adjudicate the merits of the claims. Once VA undertakes to provide a medical examination, VA must provide an adequate examination or, at a minimum, notify the claimant why one will not or cannot be provided. 38 C.F.R. § 4.2; Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). An examination “is adequate where it is based upon consideration of the veteran’s prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board’s ‘evaluation of the claimed disability will be a fully informed one.’” Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) (quoting Ardison v. Brown, 6 Vet. App. 405, 407-08 (1994)); Green v. Derwinski, 1 Vet. App. 121, 124 (1991); D’Aries v. Peake, 22 Vet. App. 97, 104 (2008); NievesRodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (“[A] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two.”). Pursuant to the Board’s October 2018 remand, the Veteran underwent VA examinations for his hypertension, lumbar strain, and erectile dysfunction disabilities. Pertaining to the Veteran’s hypertension disability, the Board finds that the November 2019 VA examiner’s opinion addressing secondary service connection is inadequate. The Board further finds that a remand is warranted to obtain an adequate and complete VA medical opinion for the Veteran’s lumbar spine disability. The November 2019 VA examiner was directed by the Board to opine as to whether the Veteran’s lumbar spine disability was related to any in-service event, injury, or disease to include his in-service boxing experiences. However, the medical opinion is based solely on the absence of any in-service treatment for a low back condition. The VA examiner also did not address whether his lumbar spine disability is related to the Veteran’s in-service boxing experience. Based on these deficiencies, a new VA medical opinion for the Veteran’s lumbar spine disability must be obtained on remand. Lastly, the Board finds that the November 2019 VA medical opinion for the Veteran’s erectile dysfunction is also inadequate. The examiner identified potentially secondary caused for the erectile dysfunction, including medications used to treat PTSD and TBI. As these statements are inconsistent, the Board cannot rely on them in adjudicating the Veteran’s claim. Upon remand, additional medical opinion is warranted to adequately address whether the Veteran’s erectile dysfunction is proximately caused or aggravated by his service-connected PTSD and TBI and/or medications prescribed for PTSD and TBI symptoms. Based on the foregoing reasons, the Board finds that a remand is warranted to obtain adequate VA medical opinions to address the Veteran’s hypertension, lumbar strain, and erectile dysfunction disability. The matters are REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records related to the Veteran’s hypertension, lumbar strain, and erectile dysfunction disability and associate them with the claims file. 2. Thereafter, obtain supplemental opinion from the examiner(s) who conducted the November 2019 The VA examiner is requested to provide an opinion to the following questions: (If the examiners are unavailable, then schedule the Veteran for a VA examination to obtain medical opinions for the Veteran’s hypertension, lumbar strain, and erectile dysfunction disability.) The Veteran’s claims file, including a copy of this remand, should be made available to the examiner, who should review it in conjunction with the prior examination and should note that review in the report. (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension disability is (1) proximately caused by or (2) aggravated beyond its natural progression due to a service-connected PTSD disability and/or medications prescribed for PTSD? (b) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s lumbar spine disability is related to an in-service injury, event, or illness, to include his documented in-service boxing experiences? The examiner is requested to also consider the Veteran’s and his boxing coach’s lay statements regarding his complaint of low back pain during service. (c) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s erectile dysfunction disability is (1) proximately due to or (2) aggravated beyond its natural progression due to the Veteran’s service-connected PTSD or a TBI and/or medications prescribed for PTSD or a TBI? A complete and detailed rationale for these opinions should be provided for every opinion requested by the examiner. 3. After, readjudicate the claim. If the benefit sought on appeal remains denied, furnish the Veteran with a supplemental statement of the case (SSOC) and provide him with an appropriate opportunity to respond. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Xiong, 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.