Citation Nr: 21024884 Decision Date: 04/26/21 Archive Date: 04/26/21 DOCKET NO. 15-37 543 DATE: April 26, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1965 to December 1967. This matter comes before the Board of Veterans’ Appeals (Board) from a February 2015 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran testified before the undersigned at a November 2018 Board hearing. A transcript of the hearing is of record. The Board previously remanded this matter in March 2019. 1. Service connection for erectile dysfunction is remanded. The Veteran’s chief contention is that his erectile dysfunction is related to his service-connected diabetes mellitus. A review of the medical records indicates that the Veteran was diagnosed with diabetes mellitus in 2012 and that his erectile dysfunction was diagnosed as early as February 2004. VA examiners in December 2018, October 2019, and January 2020 all found the Veteran’s erectile dysfunction is less likely than not caused or aggravated by his diabetes mellitus. The examiners consistently explained that the Veteran’s erectile dysfunction manifested prior to his diabetes mellitus diagnosis and therefore could not be caused by his diabetes. The examiners also note that the Veteran’s erectile dysfunction has not been aggravated because ED medication had been shown to be effective, thus showing no worsening of his condition. In January 2016, the Veteran’s primary care VA physician opined that there can be association with prediabetes or diabetes mellitus and erectile dysfunction. The VA physician noted that other risk factors include alcohol consumption and age. The private physician further stated that without doubt there can be a relationship between prediabetes or diabetes and erectile dysfunction. In a November 2018 statement, the Veteran’s primary care VA physician found the Veteran had diabetes type II with peripheral neuropathy. The physician noted that the Veteran had erectile dysfunction. The physician opined that the Veteran’s diabetes is contributing to his erectile dysfunction. The physician noted there were other health factors that contributed to the erectile dysfunction which include, but not limited to, hypertension, alcohol use, and potentially his posttraumatic stress disorder (PTSD). In March 2019, the Board remanded this matter in order to obtain a medical to address the Veteran’s contention that his diabetes mellitus predated his formal diagnosis of erectile dysfunction and that he had prediabetes that caused his erectile dysfunction. The Board specifically directed a VA examiner to address the January 2016 opinion that prediabetes had an association with erectile dysfunction. The October 2019 VA the examiner opined that the claimed condition is less likely than not proximity due to or a result of the Veteran’s service-connected condition. The examiner reasoned that the Veteran’s erectile dysfunction is less likely as not caused by or the result of his diabetes as the Veteran had erectile dysfunction prior to his diagnosis of diabetes. The examiner noted that it appeared the Veteran’s erectile dysfunction began after beginning a prescription for HCTZ, which is well-known to have erectile dysfunction as a side effect. The examiner noted that the Veteran’s primary care provider met the Veteran first in October 2015 and it appeared the provider did not look at prior VA treatment records to determine the date of the onset of this condition when he indicated diabetes contributed to the Veteran’s diabetes. The examiner noted that it is clear that the Veteran’s erectile dysfunction was present prior to the diagnosis of diabetes. The Board notes that the October 2019 and January 2020 examination failed address the contention that prediabetes caused the Veteran’s erectile dysfunction. Notably, the October 2019 examiner’s rationale relied on the fact that the VA provider appeared to not review previous VA medical records that indicate the timeline of the Veteran’s erectile dysfunction versus his diagnosis of diabetes mellitus. A review of the VA treatment records indicates that the Veteran was diagnosed with erectile dysfunction in February 2004. In that February 2004 VA treatment note the Veteran’s VA provider noted that the Veteran had a glucose level of 102. The VA examiners failed to discuss whether the Veteran had prediabetes when the Veteran was diagnosed with erectile dysfunction or address the glucose level 102. As such the Board finds an addendum medical opinion is required to address the Veteran’s contention concerning prediabetes and the February 2004 VA treatment note. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran’s erectile disfunction. The examiner should provide the following opinion: (a.) Whether the Veteran’s erectile dysfunction is at least as likely as not proximately due to or aggravated by the Veteran’s diabetes mellitus. i. The examiner must address the January 2016 statement that there can be a relationship between prediabetes or diabetes and erectile dysfunction. ii. The examiner must address February 2004 VA treatment record that includes a diagnosis of erectile dysfunction and notes a blood glucose level of 102 in relation to any purported prediabetes. (b.) The examiner most provide a complete medical rationale for all opinions. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Robert Batten 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.