Citation Nr: A25041298
Decision Date: 05/07/25	Archive Date: 05/07/25

DOCKET NO. 240925-476979
DATE: May 7, 2025

REMANDED

The claim of entitlement to service connection for erectile dysfunction (ED) secondary to a service-connected anxiety disorder is remanded.

The claim of entitlement to service connection for hypertension secondary to a service-connected anxiety disorder is remanded.

The claim of entitlement to service connection for obstructive sleep apnea (OSA) secondary to a service-connected anxiety disorder is remanded.

REASONS FOR REMAND

The Veteran served on active duty from March 1984 until February 1987.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal of an April 2024 rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO).

In September 2024, the Veteran filed a VA Form 10182, notice of disagreement, against the decision.  He elected direct Board review.  See 38 C.F.R. § 20.301.   

A remand is warranted based on a duty to assist error.  See 38 C.F.R. § 3.159 (c) (4).  

The Veteran claims that ED, OSA, and hypertension are secondary to service-connected anxiety.  He underwent VA examination in October 2023.  The record contains two VA medical opinions, dated in October 2023 and April 2024.  Each addresses the question of whether anxiety caused OSA, ED, and/or hypertension.  But neither addresses whether anxiety aggravates any of these disorders.            See 38 C.F.R. § 3.310.

As such, the matters are REMANDED for the following action:

Return the case to the VA examiner who conducted the October 2023 examination, or to a suitable substitute, for issuance of an addendum opinion.  

After reviewing the electronic claims file, the examiner should answer the following question:

Is it approximately at least as likely as not (probability of approximately 50 percent or more) that ED, OSA, and/or hypertension has been aggravated (i.e., permanently or temporarily worsened) by anxiety?

The evidentiary standard "at least as likely as not" is defined as the "likelihood is at least approximately balanced or nearly equal, if not higher."  Conversely, "less likely than not" is defined as the "likelihood is less than approximately balanced or nearly equal."

If aggravation is found, the examiner should address the following medical issues: (1) the baseline manifestations of the disorder found prior to aggravation; and (2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder(s).

In answering this question, note the April 2023 private opinions addressing the claims.  

In rendering the requested report, the examiner should note that a lay person can be competent to attest to matters of which he or she has first-hand knowledge, including observable matters.

In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture.

Please explain in detail any opinion provided and the supporting rationale.

If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered.  In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s).

 

 

G. A. WASIK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Christopher McEntee

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.