Citation Nr: 21031619 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 16-39 743 DATE: May 24, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to prostate cancer, is remanded. REASONS FOR REMAND The Veteran had active service from July 1967 to April 1971. This case comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in October 2018, August 2020, and February 2021 when the Board remanded the case for additional development and adjudication on the merits. On each occasion, after taking further action, the agency of original jurisdiction (AOJ) confirmed and continued the prior denial and returned the case to the Board. Service Connection - Erectile Dysfunction The Veteran seeks a compensable rating for his erectile dysfunction. Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the Veteran's claim and to afford him every possible consideration. . A September 2019 VA examination indicated that the erectile dysfunction began as early as 2009. This is echoed in an August 2013 medical record which indicates that the Veteran has had trouble maintaining an erection for years. The official erectile dysfunction diagnosis occurred in August 2013. The Veteran underwent a VA examination in June 2018. A negative nexus was found between the Veteran's prostate cancer and the erectile dysfunction. However, there was no rationale provided. A January 2019 VA prostate cancer examination indicated that the Veteran did not have erectile dysfunction which conflicts with the Veteran's medical history. A September 2019 VA examination again found a negative nexus between the Veteran's prostate cancer and his erectile dysfunction. The rationale provided showed the Veteran stated he had erectile dysfunction as early as 2009 and that this predated his diagnosis of prostate cancer. In October 2020, VA obtained an opinion concerning, in relevant part, whether the Veteran's erectile dysfunction was at least as likely as not related to his claimed cardiovascular disability/bradycardia. In response the examiner noted that "Erectile Dysfunction is not related to direct military service, but it is a secondary connection as a common sequela of Coronary Artery Disease... Coronary Artery Disease [injures] the arterial walls in penis and leads to issues with veteran having erections." In November 2020, a VA examiner indicated that the Veteran's erectile dysfunction was not aggravated by his prostate cancer because it predated his prostate cancer diagnosis. In the February 2021 Board remand, the Board again remanded the claim to obtain an opinion concerning whether the Veteran's erectile dysfunction was caused or aggravated by his service-connected valvular heart disease with bradycardia. Pursuant to the remand, the Veteran was afforded a VA examination in March 2021. The VA examiner found no secondary connection between the Veteran's erectile dysfunction and his service-connected valvular heart disease with bradycardia. However, in a February 2021 VA prostate cancer examination, the examiner discussed the Veteran's prostate cancer and its relation to his erectile dysfunction. erectile dysfunction was found to be a symptom of the Veteran's prostate cancer. This examiner also found that the Veteran's erectile dysfunction was at least as likely as not attributable to the Veteran's prostate cancer. However, the examiner also indicated that the Veteran's erectile dysfunction predated his prostate cancer. It is unclear how the Veteran's erectile dysfunction could be attributable to the prostate cancer if the erectile dysfunction predates the same. Therefore, a remand is necessary to obtain a clarifying opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's the nature and etiology of the Veteran's erectile dysfunction. If the examiner finds that another examination of the Veteran is required, one should be undertaken. arrange for the claims file to be reviewed by the VA examiner who prepared the February 2021 prostate cancer disability benefits questionnaire for the purpose of preparing an addendum opinion. After reviewing the record, the examiner should discuss the onset of the Veteran's erectile dysfunction then offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran's erectile dysfunction was (a) caused or (b) aggravated (i.e., worsened beyond natural progression) by a Veteran's service-connected disability, including prostate cancer. If the February 2021 examiner is no longer employed by VA, or is otherwise unable to provide the opinion(s) requested, arrange to obtain the requested information from another qualified examiner. The need for another examination and/or telephonic or video interview of the Veteran is left to the discretion of the examiner(s) selected to offer the requested opinions. A complete medical rationale for all opinions expressed must be provided. 2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issue on appeal should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. Richard Kettler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Andrew Ledman II 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.