Citation Nr: 0732329 Decision Date: 10/12/07 Archive Date: 10/23/07 DOCKET NO. 96-35 572 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for erectile dysfunction as secondary to service-connected disabilities. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD D. Vella Camilleri, Associate Counsel INTRODUCTION The veteran served on active duty from October 1966 to October 1968. This matter is now before the Board of Veterans' Appeals (Board) pursuant to a September 1995 rating decision by the St. Petersburg, Florida, Regional Office (RO) of the Department of Veterans Affairs (VA). Appeal to the Board was perfected. FINDING OF FACT The weight of the competent medical evidence is at least in relative equipoise on the question of whether the veteran's diagnosed erectile dysfunction is proximately due to or the result of service-connected lumbar strain with degenerative disc disease. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction as secondary to service-connected lumbar strain with degenerative disc disease have been met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310(a) (2007). REASONS AND BASES FOR FINDING AND CONCLUSION In this decision, the Board grants service connection for erectile dysfunction on a secondary basis, which represents a complete grants of the benefit sought on appeal. See Barrera v. Gober, 122 F.3d 1030 (Fed. Cir. 1997); Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Thus, there is no need to discuss whether VA has complied with its duties to notify and assist found at 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. § 3.159. To establish service connection for a claimed disability, the evidence must demonstrate that a disease or injury resulting in current disability was incurred during active service or, if pre-existing, was aggravated therein. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2007). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service- connected disease or injury. See 38 C.F.R. § 3.310(a) (2007). In a November 2003 Board decision, the claim was subsequently recharacterized as entitlement to service connection for impotence secondary to service-connected disabilities. In light of the more recent diagnosis of erectile dysfunction, the issue has been recharacterized. The veteran generally contends that his currently diagnosed erectile dysfunction is proximately due to or the result of service-connected disabilities, including lumbar strain with degenerative disc disease, and including medications taken for service-connected disabilities. On an October 1993 Statement in Support of Claim (VA Form 21-4138), the veteran initially contended that he was impotent as a result of service-connected chronic prostatitis with urethritis. The veteran's service-connected disabilities are post- traumatic stress disorder (PTSD), lumbar strain with degenerative disc disease, chronic prostatitis with urethritis, chorioretinitis, and hypertension. The medical evidence of record reveals that the veteran has had complaints regarding loss of erection for decades. VA compensation and pension (C&P) examination reports dated September 1982, May 1984, August 1985, October 1986, and September 1987. He was diagnosed with impotency during an August 1994 VA C&P genitourinary examination, but no opinion on etiology was provided. The veteran underwent a VA compensation examination in April 2005. The examiner noted that a February 1998 urology note related to benign prostatic hypertrophy and impotence and with a plan to refer the veteran to the clinic for a vacuum erection device. The veteran reported that he had a penile pump for 15 years and that he had used Viagra about five years prior. The veteran also reported that he has fathered two children and that he currently has decreased sexual desire, which he attributed to many factors (emotional, situations, blood pressure medication). No diagnosis related to his genitourinary system was provided during this examination. Nor was a diagnosis provided in a May 2005 addendum after the examiner was able to review the veteran's claims folder. The veteran underwent a VA genitourinary examination in October 2006, at which time his claims folder and medical records were reviewed. He reported a problem with impotence with an approximate date of onset in 1986. The veteran further indicated that it had been about 20 years or so that he had a gradual onset of erectile dysfunction and that he had been unable to attain vaginal penetration for 18 years. He reported taking 20mg of Verdenafil, which he indicated was not effective (weak erection of 25 percent but not able to perform sexually). The veteran indicated that he had undergone two surgeries to remove a hydrocoele, both during the 1990s. He denied a history of trauma to the genitourinary system, history of neoplasm, and systemic symptoms due to genitourinary disease. The veteran did reported urinary symptoms, to include urgency, dribbling, and weak or intermittent stream. He also indicated an absence of ejaculation, the etiology of which the examiner attributed to his failure to achieve erection. An examination of the veteran's penis was normal, but examination of his testicles was not, as both were one-half the size of a normal testicle and were tender with soft consistency. An examination of the veteran's prostate was also abnormal, as it was tender and very small. The veteran was diagnosed with erectile dysfunction and the examiner reported that impotence was a problem associated with the diagnosis. The examiner also opined that the erectile dysfunction is more likely than not due to multiple causes, to include as a side effect of the veteran's blood pressure medications, loss of interest (hypoactive sexual desire), a lumbar disc condition causing constant back pain, the effect of drugs (cocaine), past use of alcohol, and diabetes mellitus. In pertinent part, the veteran is service-connected for lumbar strain with degenerative disc disease, with a 60 percent disability evaluation assigned effective June 7, 1993. The Board notes that the October 2006 VA examiner attributed the veteran's erectile dysfunction in part to this service-connected lumbar strain with degenerative disc disease. The Board also notes that when it is impossible to separate the effects of a service-connected disability and a non-service-connected disability, reasonable doubt must be resolved in the veteran's favor and the symptoms in question attributed to the service-connected disability. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). In light of the Mittleider decision and the VA examiner's opinion that the veteran's erectile dysfunction is more likely than not due to multiple causes, to include his service-connected back disability, the Board finds that the weight of the competent medical evidence is at least in relative equipoise on the question of whether the veteran's diagnosed erectile dysfunction is proximately due to or the result of service- connected lumbar strain with degenerative disc disease. Resolving such reasonable doubt in the veteran's favor, the Board finds that the criteria for service connection for erectile dysfunction as secondary to service-connected lumbar strain with degenerative disc disease have been met. See 38 C.F.R. § 3.310(a). ORDER Service connection for impotence, as secondary to service- connected disabilities, is granted. ____________________________________________ JEFFREY PARKER Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs