Citation Nr: 22013463 Decision Date: 03/09/22 Archive Date: 03/09/22 DOCKET NO. 17-25 886 DATE: March 9, 2022 REMANDED Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1959 to January 1964. This matter comes before the Board of Veterans' Appeals (Board) on appeal from June 2017 and August 2018 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board most recently remanded the case in October 2021 for further development. The matters are now back before the Board. 1. Entitlement to service connection for a cervical spine disability is remanded. 2. Entitlement to service connection for a lumbar spine disability is remanded. 3. Entitlement to service connection for erectile dysfunction is remanded. 4. Entitlement to TDIU is remanded. The Board remanded the Veteran's claim in October 2021 for further development. Unfortunately, for the reasons discussed below, that development was not satisfactorily completed and further development is required. Stegall v. West, 11 Vet. App. 268 (1998). In October 2021, the Board determined that new VA examinations and opinions were required prior to adjudication of the Veteran's claims. Specifically, the Board noted that the Veteran's erectile dysfunction had been linked to his cardiovascular or metabolic disabilities in previous VA examinations and therefore, a VA opinion was needed to determine whether obesity associated with the Veteran's service-connected PTSD caused or aggravated his erectile dysfunction. Regarding the Veteran's cervical and lumbar spine disabilities, the Board found there was not sufficient compliance with its April 2021 remand directives which called for VA medical opinions that addressed whether the Veteran's service-connected PTSD aggravated his obesity, and in turn caused or aggravated his claimed musculoskeletal disabilities. Pursuant to the October 2021 remand, new VA opinions were rendered in December 2021. The opinions failed to adequately address obesity as an intermediate factor in causing or aggravating the Veteran's claimed disabilities. Once VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Accordingly, remand for new VA opinions is warranted. As the Veteran's claims of service connection for a cervical spine disability, lumbar spine disability, and erectile dysfunction may impact the Veteran's claim for TDIU, the Board must defer the TDIU claim. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Obtain new medical opinions regarding the Veteran's (i) cervical spine disability, (ii) lumbar spine disability, and (iii) erectile dysfunction from a qualified VA clinician. All pertinent evidence of record, including a copy of this remand order, must be made available to and reviewed by the examiner. Any required studies should be performed, and all clinical findings should be reported in detail. a) The examiner should opine whether it is at least as likely as not that the Veteran's (i) cervical spine disability, (ii) lumbar spine disability, and (iii) erectile dysfunction are proximately due to service-connected disabilities, including alcohol abuse and obesity linked to his service-connected PTSD. b) The examiner should opine whether it is at least as likely as not that the Veteran's (i) cervical spine disability, (ii) lumbar spine disability, and (iii) erectile dysfunction are aggravated beyond their natural progression by service-connected disabilities, including alcohol abuse and obesity linked to his service-connected PTSD. Aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. The examiner should note that the permanence of the aggravation is not required. The examiner should address the Veteran's contentions that his claimed disabilities are due to obesity linked to his service-connected PTSD or have been aggravated by obesity linked to his service-connected PTSD. The examiner should be advised that aggravation and causation are distinct theories and must be addressed separately and independently of each other. Medical opinions which combine or conflate aggravation and causation rationales will be deemed inadequate for adjudicative purposes. The examiner must provide a complete rationale for all proffered opinions. If the examiner cannot provide the required opinions without resorting to speculation, he or she shall provide a complete explanation as to why that is the case. Further, the examiner must state whether the inability to provide the required opinions is based on a personal limitation or on a lack of knowledge among the medical community at large. (Continued on the next page) 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 Veteran's claims should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, furnish the Veteran and his representative a supplemental statement of the case (SSOC) and return the case to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Silverblatt, 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.