Citation NR: 9725650 Decision Date: 07/24/97 Archive Date: 08/04/97 DOCKET NO. 94-49 275 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUE Entitlement to secondary service connection for impotence. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD C. W. Chambers, Associate Counsel INTRODUCTION The veteran served on active duty from August 1978 to July 1981, and from October 1982 to November 1982. This matter came before the Board of Veterans’ Appeals (Board) from a December 1992 decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia which denied the veteran's claim for service connection for impotence secondary to medication used to treat his service-connected hypertension. In February 1997, the Board remanded the veteran's claim for issuance of a statement of the case which cited the applicable law and regulations. CONTENTIONS OF APPELLANT ON APPEAL The veteran asserts that he suffers from impotence as a result of the medication that he must take to control his service-connected hypertension. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1997), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence supports secondary service connection for impotence. FINDING OF FACT The veteran has impotence which is caused or worsened by medication taken for service-connected hypertension. CONCLUSION OF LAW Impotence is proximately due to or the result of service- connected hypertension. 38 C.F.R. § 3.310 (1996). REASONS AND BASES FOR FINDING AND CONCLUSION I. Factual Background The veteran's established service-connected disabilities include hypertension and a gonococcal urethral stricture. Records show that for many years he has taken various medications to control the hypertension. He has a number of non-service-connected conditions, such as a psychiatric disorder which has also been treated with medication. A June 1984 VA medical record shows a complaint of impotency. The examiner noted that the problem was possibly related to the dosage of Inderal which the veteran took for hypertension, and the dosage was reduced. On VA examination in November 1990, the examiner noted that the veteran was impotent at times and that this was associated with medication. In a VA outpatient treatment record dated in February 1991, it was related that the veteran complained of impotence, and the examiner noted that this was probably secondary to Aldomet (an antihypertensive medication) use. The treatment records indicate that at times the veteran was able to maintain an erection; in April 1992 he was seen for a possible infection after having sexual relations with his wife. In July 1992 he complained of a decreased sex life. A September 1992 psychiatric record indicates that the role of psychiatric factors and medications, in producing sexual dysfunction, was being explored. An October 1992 VA outpatient treatment record indicates that the veteran reported that another physician had linked his sexual dysfunction to the effects of HCTZ (hydrochlorothiazide, an antihypertensive drug), the effects of Moban (a medication used to treat schizophrenia), and to his current marital problems. Records from December 1992 indicate the veteran complained of sexual dysfunction for the past year. The doctor commented that it was doubtful that Moban was the cause of the problem, and it was most likely Aldomet contributed to the problem, although psychiatric factors might be important. Records from February and March 1993 refer to complaints of diminished libido and potency. On genitourinary consultation in April 1993, the examiner noted the veteran's complaints of impotence but did not discuss the etiology of this disorder. He prescribed a mechanical device to the veteran. The order form for this device is associated with the file, and indicates that the principal diagnosis is organic impotence, with hypertension medication as a condition which may have caused or contributed to the veteran's impotence. In a May 1993 VA outpatient treatment record, a psychologist noted that the veteran's erectile dysfunction, for which the mechanical device had been given, was reportedly secondary to blood pressure medications. In September 1993, a VA physician reviewed the veteran's medical records, without examining the veteran, and related that another doctor had noted that the cause of sexual dysfunction was organic impotence due to antihypertensive medication. It was further noted that the chart indicated a significant psychological component which may aggravate the condition. The doctor commented that it is unusual that impotence would persist if secondary to blood pressure medications as these had been changed several times, and that the veteran's impotence was probably of multifactorial origin. He added that he was unable to determine a primary cause and effect relationship. II. Analysis The veteran's claim for secondary service connection for impotence is well grounded, meaning plausible; the file shows the evidence has been properly developed and there is no further VA duty to assist the veteran with his claim. 38 U.S.C.A. § 5107(a). Service connection may be granted for a disability which is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310. This includes situations in which a service-connected disorder aggravates a non-service- connected condition, in which case the veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). The veteran maintains that medication taken for service- connected hypertension has caused impotency. Medical records show he has had erectile dysfunction which has been variously attributed to medication for service-connected hypertension, non-service-connected causes including psychiatric symptoms and psychiatric medication, or a combination of service- connected and non-service-connected factors. The veteran has been prescribed a mechanical device to assist in erections, and this was based on a finding that he had organic impotence due to hypertension medication. The VA doctor who reviewed the records in September 1993 commented that it was unusual that impotence would persist from hypertensive medications, given that the medications had been changed several times. However, the doctor did not rule out such possibility; it was noted that another doctor had attributed impotency to hypertensive medication; and it was opined that the veteran's impotence was probably due to multiple factors. The evidence does not demonstrate with a certainty that the veteran's impotence is due to medication taken for service- connected hypertension. However, the evidence appears approximately balanced on the question of whether the hypertension medication has caused, or at least aggravated (Allen, supra) impotency. In such circumstances, the issue is to be resolved in favor of the veteran, pursuant to the benefit-of-the-doubt doctrine. 38 U.S.C.A. § 5107(b). Thus, the Board finds that impotency was caused or worsened by a service-connected disability, and secondary service connection for impotency is warranted. ORDER Secondary service connection for impotency is granted. (CONTINUED ON NEXT PAGE) L. W. TOBIN Member, Board of Veterans' Appeals 38 U.S.C.A. § 7102 (West Supp. 1996) permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1997), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. - 2 -