Citation Nr: 21029431 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 16-35 155A DATE: May 13, 2021 REMANDED Entitlement to service connection for erectile dysfunction is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from July 1974 to January 1995. This matter originally came before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this case in February 2019 and December 2020 for further development. Entitlement to service connection for erectile dysfunction is remanded. While the Board sincerely regrets further delay, a fully-informed decision on the issue of entitlement to service connection for erectile dysfunction can not be made because there has not been substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). In December 2020, the Board remanded this case to obtain a VA examination to specifically address whether the Veteran's erectile dysfunction was related to a service-connected disability to include any medications, his in-service complaint of a sore penis with swelling, or his military occupational specialty (MOS) as a demolition diver for over 20 years. The Veteran was afforded a VA examination for his erectile dysfunction in January 2021. Although the examiner opined the Veteran's erectile dysfunction is not related to a service-connected disability, his in-service complaint of a sore penis with swelling, or his MOS, he did not provide a complete rationale for this opinion. The examiner stated the Veteran's in-service complaint of a sore penis with swelling was not related to his current erectile dysfunction because it resolved without residuals. He also determined the Veteran's erectile dysfunction's cause is multifactorial, concluding that his service-connected back disability was not the sole cause of his erectile dysfunction. However, the examiner failed to discuss the Veteran's medications for his service-connected disabilities and whether they were related to his erectile dysfunction. Additionally, although the examiner mentioned sleep apnea, which the Veteran is service-connected for, as one of the many risk factors for the Veteran's erectile dysfunction, he did not address whether it specifically is related to his erectile dysfunction. Lastly, the examiner did not provide any rationale as to why he opined the Veteran's MOS was not related to his erectile dysfunction. Thus, a remand is necessary to obtain an addendum opinion to specifically address the Veteran's MOS, medications for service-connected disabilities, and his service-connected sleep apnea. The matters are REMANDED for the following action: 1. Obtain all VA treatment records not currently associated with the claims file. 2. Obtain an addendum opinion for the Veteran's erectile dysfunction. The entire file should be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's erectile dysfunction: A) had its clinical onset during active service or is related to any in-service disease, event, or injury, to include his 20 years as a demolition diver. B) is proximately due to a service-connected disability and any medication for it, to include sleep apnea. C) has been aggravated (worsened beyond natural progression) by a service-connected disability and any medication for it, to include sleep apnea. In addressing the questions (b) and (c), please note that there is no temporal requirement that the primary condition (service-connected disability) be service-connected, or even diagnosed, at the time the secondary condition (erectile dysfunction) is incurred, and reliance on this fact will render any opinion inadequate The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Papacalos, 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.