Citation Nr: 22014649 Decision Date: 03/14/22 Archive Date: 03/14/22 DOCKET NO. 14-23 896 DATE: March 14, 2022 REMANDED The claim for service connection for residuals of a head injury, to include traumatic brain injury (TBI) is remanded. The claim for service connection for erectile dysfunction (ED) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1985 to December 1994. In April 2018 and February 2020, the Board remanded the case for further development. 1. Service connection for residuals of a head injury, to include TBI The Veteran seeks service connection for residuals of a head injury, to include TBI. In July 2019, he was afforded a VA examination where a diagnosis of TBI was not found. The VA examiner further indicated that the Veteran had no complaints of impairment of memory, attention, concentration, or executive functions. The Veteran's judgement was also normal, social interaction was routinely appropriate, and without subjective symptoms. The VA examiner indicated there were also no neurobehavioral effects. However, contrary to this finding, the Veteran and his ex-wives submitted statements in August 2019 that shortly after his head injury during his military service, the Veteran began exhibiting symptoms such as inability to sleep, nighttime incontinence, a change in his temper and character, lapses in his memory, and severe headaches, among others. The Veteran and his ex-wife, B.D., also testified at the October 2021 Board hearing about the neurobehavioral concerns resulting from his claimed in-service head injury. The Board finds that there is thus some question as to whether the Veteran does, in fact, have residuals, specifically neurobehavioral, are related to his claim in-service head injury and another examination addressing concerns is necessary. Additionally, the Board notes that the VA examiner indicated "[t]here are no findings in the [service treatment records] of a head injury and based on history and physical examination, his claimed residuals are not due to a head injury." However, the Veteran's service treatment records show various notations whereby the Veteran presented with complaints of headaches to include in June 1990 when he presented with a headache and back pain. Additionally, the service treatment record shows he reported sustaining a head injury during a parachute jump in July 1990 on his August 1994 Expiration of Term of Service (ETS) Report of Medical History. A July 1993 report shows he was treated for "low back pain with headache" after a hard hit to the head in July 1993. As such, the July 2019 VA examination opinion is inadequate. 2. Service connection for ED The Veteran was afforded a VA examination in July 2019 where the VA examiner provided a negative etiological opinion. The VA examiner's rationale for each of the Board's question was that the Veteran's ED was "multifactorial in origin" and that it was related to an enlarged prostate and medications to treat this and his hypertension. However, the question of whether it was aggravated by his service-connected disabilities such as his cervical spine disability, headaches, and sleep apnea was not discussed. The VA examiner did not consider the Veteran's lay statements regarding the impact of these disabilities, to include its treatment, on his ED. As such, a new VA opinion is needed. The matters are REMANDED for the following action: 1. Schedule the Veteran for a TBI examination. The VA examiner is asked the following: (a.) Does the Veteran have any current residuals of TBI, to include chronic mild memory problems, incontinence, and behavioral problems? Why or why not? In discussing this, the examiner is asked to distinguish between symptomatology that is attributable to other disabilities (e.g. depression, posttraumatic stress disorder, etc.) and symptomatology attributable to potential TBI residuals. If certain symptoms cannot be ascribed to a specific diagnosis or disability, this should be indicated. If cognitive residuals are found to be present but unrelated to TBI, the basis for this opinion should be clearly stated. It is noted that the Veteran is already service connected for headaches. (b.) It is at least as likely as not (a 50/50 probability or greater) that the Veteran developed a head injury or any residuals thereof, as a result of his active service? Why or why not? Please address the Veteran's contentions that his residuals of a head injury began after sustaining a head injury during a parachute jump which is documented in his service treatment records. (c.) Is at least as likely as not (a 50/50 probability or greater) that the Veteran's residuals of a head injury, to include neurobehavioral effects, are due to or aggravated (made worse) by his service-connected disabilities? Why or why not? The VA examiner is asked to consider and address the Veteran's lay statements and the statements from his two ex-wives, as documented in submitted statements within claims file and at the October 2021 Board hearing, as well as the relevant service treatment record of an in-service head injury. 2. Obtain a VA opinion to determine the etiology of his ED. If a physical examination is necessary to answer the Board's questions, one should be scheduled. The VA examiner is asked to respond to the following opinions: a) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's ED originated in active service or is etiologically related to an in-service injury, event, or disease? Why or why not? b) Is it at least as likely as not that the Veteran's ED was aggravated (made worse) by a service-connected disability, to specifically include as a result of medications prescribed for the treatment of any service-connected disability? Why or why not? The VA examiner is asked to consider and address the Veteran's lay statement regarding his symptomatology and contentions that his ED is secondary to (including aggravated by) his service-connected disabilities, i.e., cervical and lumbar spine disability, headaches, and sleep apnea. In addressing this, the VA examiner is also asked to consider the impact of the treatment for his service-connected disabilities on his ED. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Yoo, 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.