Citation Nr: 22012452 Decision Date: 03/03/22 Archive Date: 03/03/22 DOCKET NO. 17-11 899 DATE: March 3, 2022 REMANDED The claim for entitlement to service connection for erectile dysfunction to include as secondary to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served in the U.S. Army on active duty from March 1988 to June 1992. This matter comes to the Board of Veterans' Appeals (Board) from a June 2016 rating decision. This claim was before the Board in August 2021, when it was remanded for VA examination to determine the etiology of the Veteran's erectile dysfunction. Unfortunately, the Board determines that additional remand is required. The August 2021 remand directed the agency of original jurisdiction (AOJ) to obtain medical opinions that considered aggravation of the nonservice-connected erectile dysfunction by the service-connected disabilities, to include the medications prescribed for them. These examinations were conducted by records review in December 2021, in which the VA examiner found no causal nexus between the Veteran's service-connected disabilities or the medications prescribed to treat them and the Veteran's currently diagnosed erectile dysfunction. However, these examinations and opinions are inadequate for the following reasons. First, the VA examiner's rationale for finding no aggravation of the erectile dysfunction by service-connected disabilities other than depression, anxiety, and the lower back disorder with associated radiculopathies and bowel incontinence was that aggravation of erectile dysfunction is "not plausible." An individual "either has erectile dysfunction or doesn't". See, generally, December 2021 VA Examinations. Second, and more critically, the December 2021 VA examiner's rationale in finding erectile dysfunction not causally connected to the service-connected depressive and anxiety disorders is based on inaccurate data. Specifically, the examiner observed erectile dysfunction was diagnosed in 2014, at which time the Veteran was not diagnosed with depression or anxiety and had not been prescribed medications for psychiatric conditions. There are two factual inaccuracies here: (a) the Veteran reported in a 2016 VA examination that he first experienced weakening and less frequent erections beginning in about 2010; and (b) private treatment records show the onset of depression in 2005 and anxiety in 2008 with prescribed psychiatric medications including trazodone, clonazepam, and lorazepam. These records include a January 2017 Disability Benefits Questionnaire (DBQ) provided by the Veteran's private treating psychiatric doctors. Third, the VA examiner did not discuss the evidence the Veteran's attorney submitted in 2019 and 2020 which support the Veteran's assertions that his erectile dysfunction is caused or aggravated by his service-connected disabilities or the medications prescribed to treat them. This evidence includes medical articles and treatises addressing (a) erectile dysfunction in patients with lower back disorders, (b) sexual and sphincter dysfunction in patients with lower back disorders, (c) and depression and erectile dysfunction. Given the foregoing, the Board must find the December 2021 VA examinations provide an inadequate basis upon which to adjudicate the Veteran's claim. Regrettably, the Board must again remand this case for appropriate examination and opinion with thorough and accurate review of the evidence of record. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); Stegall v. West, 11 Vet. App. 268 (1998). Therefore, this matter must again be REMANDED for the following action: 1. Schedule the Veteran for VA examination with the appropriate neurology and urology specialists to conduct VA neurologic and urologic examinations to assess the nature and etiology of this erectile dysfunction. All erectile dysfunction and/or pathology of genitourinary system must be reported. The claims file must be reviewed in conjunction with the examinations. For all diagnosed erectile dysfunction and/or pathology of the genitourinary system the examiners must offer an opinion as to whether it is as likely as not (50 percent or more probability) that any diagnosed erectile dysfunction and/or genitourinary disability: (a.) is the result of any incident during active service, or (b.) is the result of service-connected depression and anxiety disorders, to include medications prescribed for these disabilities, or (c.) is the result of service-connected thoracolumbar spine disorder with bilateral lower extremity radiculopathies and bowel incontinence, to include medications prescribed for these disabilities, or (d.) is aggravated by service-connected disability or the medications prescribed to treat them. A complete rationale must be provided for each opinion provided is necessary. The VA examiners must discuss: (e.) the Veteran's lay statements dating the onset of weakening and less frequent erections to approximately 2010 (f.) private medical evidence showing the onset of service-connected depression in 2005 and anxiety in 2008 with medications prescribed to treat these psychiatric conditions including but not limited to trazodone, lorazepam, and clonazepam and their impact on erectile dysfunction (g.) service-connected thoracolumbar spine disorder with lower extremity radiculopathy and bowel incontinence and its impact on erectile dysfunction (h.) nonservice-connected hypertension and its impact on erectile dysfunction (i.) the prescription of tramadol and/or other medications that are known or suspected to cause sexual dysfunction (j.) the medical and internet articles including but not limited to those submitted in 2019, 2020 and 2021. If more than one condition or medication for more than one condition are found to impact the erectile dysfunction, and one or more are service-connected and one or more are not service-connected, the VA examiners are asked to determine what part of the erectile dysfunction is caused by the service-connected disability as opposed to what part is caused by the nonservice-connected disability. If the VA examiners cannot differentiate, they should so state. 2. The AOJ must ensure that all requested development has been completed. 3. After the above has been completed, readjudicate the claim. If the claim is again denied, the AOJ must send the Veteran and his representative a supplemental statement of the case with sufficient time to respond. The case should thereafter be returned to the Board as appropriate. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bakke, Lila J. 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.