Citation Nr: 21041223 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 08-11 028 DATE: July 8, 2021 REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected acquired psychiatric condition and/or medication, is remanded. Entitlement to service connection for sleep apnea, to include as secondary to an acquired psychiatric disorder, is remanded. Entitlement to service connection for yeast infection, claimed as secondary to sleep apnea, is remanded. REASONS FOR REMAND The appellant is a Veteran who had active service from July 1986 to January 1990; and from January 1991 to April 1991. These matters are before the Board of Veterans' Appeals (Board) on appeal from the February 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). These matters were before the Board in June 2012, August 2017, and July 2020, with the latter remand to obtain etiology opinions. In Stegall v. West, 11 Vet. App. 268, 271 (1998), the United States Court of Appeals for Veterans Claims (Court) held that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the Board's remand order. Moreover, the Court held that the Board itself errs when it fails to ensure compliance with the terms of its remand. Id. The Board finds that the AOJ did not substantially comply with the remand directives because the an no opinion has been obtained. See Stegall v. West, 11 Vet. App. 268, 271 (1998). While additional delay is regrettable, the Board finds that another remand is required to fairly decide the Veteran's claim. The appeal is REMANDED to the AOJ. VA will notify the appellant if further action is required. The AOJ is advised that this case has been remanded by the Board multiple times, with this remand caused by Stegall violations. See Stegall, 11 Vet. App. at 271. Expeditious treatment and substantial compliance with remand directives are required. 1. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected acquired psychiatric condition and/or medication The Veteran asserts that service connection is warranted for his erectile dysfunction. A review of the evidence of his service treatment records (STRs) reflects that, in September 1987, the Veteran reported pain in his left testicle on movement. In April 1991, he reported right lower extremity pain with radiation into right groin. Examination revealed right testicular swelling with pain. In January 1995, the Veteran reported that his psychiatric medication was causing sexual problems. An August 1995 consultation report notes that his medication was causing erectile dysfunction and was discontinued. A December 2012 VA examiner indicated that the Veteran did not have a diagnosed condition of the male reproductive system; however, later indicated that they Veteran had erectile dysfunction. The Veteran reported that in 1993/1994 he was given medication for depression and anxiety which caused him to lose ejaculation, but maintained erections. He reported that over time his erections have gotten softer. The examiner attributed the Veteran's erectile dysfunction to lack of sexual activity since the 1990's. The examiner opined that it was less likely that the Veteran has organic erectile dysfunction caused by medications given to him for his depression in the 1990's. In response to the July 2020 remand directives, a VA erectile dysfunction examination was scheduled for February 2021. The Veteran canceled the appointment, and there is no evidence to suggest that the he has rescheduled. However, the remand directives were to obtain a medical opinion. As no opinion has been obtained, the Board finds that a remand is necessary. See Stegall, 11 Vet. App. at 271. 2. Entitlement to service connection for sleep apnea, to include as secondary to an acquired psychiatric disorder The Veteran asserts that service connection is warranted for his sleep apnea. The Veteran was diagnosed with sleep apnea in June 2006. In December 2005, the Veteran reported that he has snored loudly for years. The examiner noted that the Veteran had probable obstructive sleep apnea, snores loudly, sleeps poorly, has difficulty focusing and concentrating which may be more due to sleep apnea than to possible attention deficit disorder, hyperactivity disorder. In response to the July 2020 remand directives, a VA erectile dysfunction examination was scheduled for February 2021. The Veteran canceled the appointment, and there is no evidence to suggest that the he has rescheduled. However, the remand directives were to obtain a medical opinion. As no opinion has been obtained, the Board finds that a remand is necessary. See Stegall, 11 Vet. App. at 271. 3. Entitlement to service connection for yeast infection due to CPAP use for sleep apnea The Veteran asserts that service connection for yeast infection caused by use of CPAP is warranted. A July 2008 private treatment record reflects that the Veteran could not tolerate CPAP due to tendency for yeast infection. Because a decision on the remanded issue of service connection for sleep apnea could significantly impact a decision on the issue of service connection for yeast infection due to CPAP use for sleep apnea, the issues are inextricably intertwined. A remand of the claim for service connection for yeast infection due to CPAP use for sleep apnea is required. The matters are REMANDED for the following action: 1. Forward the Veteran's claims file to an appropriate medical professional for an opinion regarding the nature and etiology of the Veteran's sleep apnea. All pertinent evidence of record, to include a copy of this REMAND, must be made available to and reviewed by the examiner. If the examiner determines an examination is necessary, schedule the examination. Following a review of the relevant records and lay statements, and an additional examination if necessary, the examiner should state whether it is at least as likely as not (50 percent probability or greater) that the Veteran's sleep apnea had its onset during or is otherwise etiologically related to his military service. In providing an opinion, the examiner must address the Veteran's December 2005 statement that he had been snoring loudly for many years. The examiner should also identify any condition manifesting as chronic yeast infections during the period of the claim. If present, the examiner should state whether such condition is proximately due to or aggravated by the Veteran's sleep apnea, to include CPAP therapy. The examiner must provide a rationale for any opinion proffered. 2. Forward the Veteran's claims file to an appropriate medical professional for an opinion regarding the nature and etiology of the Veteran's erectile dysfunction. All pertinent evidence of record, to include a copy of this REMAND, must be made available to and reviewed by the examiner. If the examiner determines an examination is necessary, schedule the examination. Following a review of the relevant records and lay statements, and an additional examination if necessary, the examiner should identify all conditions manifesting as erectile dysfunction during the period of the claim. Then, with respect to each identified condition, the examiner should state whether it is at least as likely as not (50 percent probability or greater) that the condition had its onset during or is otherwise etiologically related to the Veteran's military service. If not, then with respect to each identified condition, the examiner should state whether it is at least as likely as not (50 percent probability or greater) that the condition is proximately due to or has been aggravated (worsened beyond its natural progression) by the Veteran's service-connected acquired psychiatric disorders, to include any medication taken for these conditions. The examiner must provide a rationale for any opinion proffered. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Camille NeSmith, 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.