Citation Nr: 1043163 Decision Date: 11/17/10 Archive Date: 11/24/10 DOCKET NO. 07-03 871 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas THE ISSUES 1. Entitlement to service connection for epididymitis status post orchiectomy. 2. Entitlement to service connection for erectile dysfunction as secondary to epididymitis status post orchiectomy. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD M. C. Graham, Counsel INTRODUCTION The appellant is a Veteran who served on active duty from July 1950 to March 1951. These matters are before the Board of Veterans' Appeal (Board) on appeal from a July 2005 rating decision by the Houston, Texas, RO. In February 2009, a hearing was held before RO personnel, and in April 2010 a videoconference hearing was held before the undersigned. Transcripts of both hearings are associated with the claims files. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c)(2010). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. Epididymitis was not manifested in service, and the preponderance of the evidence is against a finding that the Veteran's status post orchiectomy is due to epididymitis that was incurred or aggravated in service, or is otherwise related to service. 2. The Veteran's erectile dysfunction was not manifested in service, and the preponderance of the evidence is against a finding that it is related to his service; epididymitis is not service-connected. CONCLUSIONS OF LAW 1. Service connection for epididymitis status post orchiectomy is not warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. § 3.303 (2010). 2. Service connection for erectile dysfunction is not warranted; the claim of service connection for erectile dysfunction as secondary to service-connected epididymitis lacks legal merit. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Veterans Claims Assistance Act (VCAA) The VCAA, in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative of any information, and any medical or lay evidence, not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). VCAA notice requirements apply to all five elements of a service connection claim: 1) veteran status; 2) existence of a disability; 3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 484-86 (2006), aff'd, 483 F.3d 1311 (Fed. Cir. 2007). VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction decision on a claim. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). When VCAA notice is delinquent or erroneous, the "rule of prejudicial error" applies. See 38 U.S.C.A. § 7261(b)(2). In the event that a VA notice error occurs regarding the information or evidence necessary to substantiate a claim, VA bears the burden to show that the error was harmless. However, the appellant bears the burden of showing harm when not notified whether the necessary information or evidence is expected to be obtained by VA or provided by the appellant. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009). The Veteran was advised of VA's duties to notify and assist in the development of his claims. Mayfield, 444 F.3d at 1333. An August 2004 letter explained the evidence necessary to substantiate the claims, the evidence VA was responsible for providing, and the evidence he was responsible for providing. In compliance with Dingess/Hartman, 19 Vet. App. at 473, a March 2006 letter informed the Veteran of disability rating and effective date criteria. The case was thereafter readjudicated in a June 2009 supplemental statement of the case. Regarding VA's duty to assist, all appropriate development to obtain the Veteran's service treatment records (STRs) and service personnel records has been completed, and the record contains VA and private treatment records (and the Veteran has submitted a private medical opinion in support of his claim). The Veteran has provided testimony as well as numerous written statements. Furthermore, a VA examination was performed in connection with this claim in July 2008, and in July 2010 the Board secured a Veterans Health Administration (VHA) medical advisory opinion in the matter. Taken together, the examination and the two medical opinions are adequate for adjudication purposes as the 2008 examiner had the claims files for review, obtained a reported history from the Veteran, and conducted a thorough examination. Any deficiencies in the 2008 examination were remedied by the 2010 VHA opinion which was by a Board-certified urologist and Chief of Urology at a VA medical center who had the claims files for review and referred to the evidence of record in his opinion. The VA examiner and the VA urologist also provided rationales for their conclusions. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (VA must provide an examination that is adequate for rating purposes). The Veteran was advised of the opinions, and had opportunity to respond. In a written statement received in September 2010, the Veteran presented argument and requested that these matters be returned to the RO for their initial consideration of his submission. On review of the submission, the Board finds that remand is not warranted, as the statement is cumulative. It amounts to no more than reiteration of previous statements that: (1) he had no urology problems for many years after service and (2) that his present health condition is related to his 1950 episode of gonorrhea in service. Therefore, the additional submission does not have a material bearing on the issues on appeal. 38 C.F.R. § 20.1304. The Board is satisfied that evidentiary development is complete; VA's duties to notify and assist are met. The Veteran is not prejudiced by the process in this matter. Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). II. Factual Background The Veteran contends as a result of contracting gonorrhea while in service in 1950 that he developed epididymitis which resulted in the removal of his left testicle in the 1970s, and that he now has erectile dysfunction secondary to the epididymitis. The Veteran's STRs document he had acute urethritis due to gonorrhea in October 1950. He was treated with penicillin and was asymptomatic 2 days later. It was noted that "urethral dilated to 26F and no evidence of stricture". He was released to duty several days later. He was examined and found physically qualified for discharge in March 1951 with no need for treatment or hospitalization. The Veteran has variously reported that (1) he had no urology problems between the resolution of his gonorrhea in 1950 and the mid-1960s (see July 2008 VA examination report and his February 2009 hearing testimony); and (2) that he had treatment for swelling of the testicles in the 1950s and 1960s (see his April 2010 hearing testimony). He fathered several children during this time. The next available medical treatment record is dated over 20 years later, in July 1971, and relates to burns on the face, arms, and neck. Past medical history noted only a broken leg in 1953 and tularemia three years ago. A review of genitalia noted "no burn areas over genital organs." The genitourinary system was noted to be noncontributory. A November 1976 record of treatment for low back pain notes a history of vasectomy 4 years prior. The Veteran has reported that his left testicle was surgically removed in 1971 due to epididymitis. The first medical record noting an orchiectomy is a May 1977 treatment record for leg pain which noted a past history of left orchiectomy for an unspecified infection. A January 1985 private treatment record notes a 6-month history of hesitancy and incomplete voiding with an abnormal prostate exam and a history of low testosterone and erectile impotence. The right testis was noted to be small and the left testis was absent with a history of orchiectomy. The Veteran underwent cystoscopy with needle biopsy of the prostate; the postoperative diagnosis was bladder outlet obstruction and abnormal prostate examination. During the 1985 procedure, it was noted that the urethra was of normal caliber and the ureteral orifices were in a normal position and of normal appearance. The next medical treatment records are dated 14 years later, in 1998, and reveal a 4 year history of diabetes mellitus and complaints of impotence. A March 2004 private treatment record notes a 4 year history of erectile dysfunction symptoms. A March 2005 private treatment record, after noting that the Veteran "wants to know if epididymitis could be caused by GC [gonorrhea] and could low testosterone be caused by epididymitis", advised that "hypogonadism could be caused by epididymitis [secondary] to GC." VA treatment records dated in May 2003 note that it was concluded that impotence was likely not related to the spine as an MRI did not reveal a spinal lesion which would explain the impotence. A November 2005 VA treatment record notes "[i]mpotence d/t hypogonadism s/p testicle removal." A July 2008 VA examiner, a physician's assistant, noted that the Veteran reported that he first had problems with erectile dysfunction in 1971 after his orchiectomy. The examiner concluded that it is less likely than not that the Veteran's epididymitis was related to his prior occurrence of acute gonococcal urethritis. With respect to the Veteran's assertions that he "required removal of the left testicle due to severity of the epididymitis in approximately 1971", the 2008 examiner noted that "NO MD OR HOSPITAL RECORDS ARE AVAILABLE FOR FURTHER DOCUMENTATION OF THE NEED TO REMOVE THE TESTICLE OR ACTUAL DIAGNOSIS AT THIS TIME [1971]." (emphasis in original). The examiner explained that a review of the literature showed that epididymitis from infection sources generally causes the onset of symptoms within 24-48 hours and that it would be "highly unlikely" to cause epididymitis 10-20 years after the patient was successfully treated for the urethritis. The examiner stated that it was more likely that the Veteran's epididymitis was caused by "a different causative organism based on his age, or noninfectious causes, such as abnormal genitourinary anatomy, excessive exercise or lifting", or other etiologies. The examiner opined that the Veteran's erectile dysfunction is at least as likely as not due to hypogonadism. The examiner concluded that it is less likely than not that the Veteran's orchiectomy was related to the acute gonococcal urethritis [in service] because there was no supporting documentation in the chart regarding the orchiectomy. The examiner noted that epididymitis did not usually result in an orchiectomy. August 2008 private medical records show that the Veteran underwent cystourethroscopy with complicated removal of left indwelling ureteral stent; cystourethroscopy with catheterization of left ureteral orifice and left retrograde pyelogram; left- sided ureteroscopy with biopsy/resection of tumor; left ureteral washings; and cystourethroscopy with insertion of left indwelling ureteral stent. These procedures were performed in order to treat diagnoses of left hydronephrosis, left ureteral stricture, kidney stones, and left ureteral mass. Pathology reports reveal no malignancies were found. In November 2009 a bladder tumor and left distal ureteral stricture with left hydroureteronephrosis were diagnosed. Left ureteral stent placement was performed. The Veteran testified at his April 2010 hearing that he was undergoing treatment for bladder cancer. A November 2009 medical opinion by Dr. C. N. Bash (a neuro- radiologist) concludes that the Veteran's loss of testicle, urethra strictures, scrotal pain, erectile dysfunction, and kidney problems are all due to his gonorrhea in service. Dr. Bash supported his findings by noting that the Veteran "likely had a serious gonorrhea infection, which required several urethral dilations"; "he has had chronic problems with urination ever since"; he had a "serious urethral injury in service"; his urethral injury in service "caused intermittent urethral obstruction and has likely caused . . . his erectile dysfunction by way of urethral scarring"; his loss of the left testicle is likely due to scarring and "torsion from scarring"; and the time lag between service and his "development of signs and symptoms" is consistent with known medical principles. At the April 2010 videoconference hearing before the undersigned, the Veteran testified that he had an episode of gonorrhea in service, and "several more outbreaks of gonorrhea" in the 1960's; that he began having urinary problems in the 1960's when his treating physician noted scarring in his urethra; that he also had scrotum pain and underwent left testicle removal in 1971, and thereafter developed erectile dysfunction; and that he had fathered children postservice, but not after his testicle removal. In an August 2010 written statement, the Veteran denied contracting gonorrhea after 1950. The July 2010 VHA opinion by P. R. Auriemma, M.D., noted that he "could not find any evidence that the veteran ever required urethral dilations" and that "[t]he only evidence of a urethral dilation that I could find was done following the treatment for the acute GC urethritis in October 1950." Dr. Auriemma noted that the dilation "was done to rule out the presence of a urethral stricture from the acute GC urethritis" and that "there was no evidence of a stricture" when the urethra was dilated. Dr. Auriemma also noted as significant the fact that the Veteran did not complain of testicular pain or swelling and that he was described as "[w]ell otherwise" at the time of his acute infection in service. The Veteran's only complaints were of urethral discharge for 2 days and burning with urination. Dr. Auriemma also found that it was "less likely than not" that the Veteran's GC urethritis led to a "'serious urethral injury', including urethral scarring." Dr. Auriemma supported this conclusion by noting that he could find "no evidence to show urethral strictures or scarring in the Veteran's records" and, furthermore, "the anterior urethra was reported as normal on a Cystoscopy done on 11/10/09." Dr. Auriemma did note that the Veteran had a left distal urethral stricture which was stented, "the cause of which appears to be from a urothetial cancer, and the patient is being treated for bladder cancer." See November 10, 2009 surgical report. Dr. Auriemma concluded that "[i]t is less likely than not that the Veteran's GC infection in 1950 led to the development of epididymitis" because the available records showed that the acute episode of urethritis was "successfully treated"; he presented with urethritis in service with no other symptoms or signs; he was treated with "the appropriate antibiotic"; and he was reported as "asymptomatic" after two days. Dr. Auriemma also concluded that it was "less likely than not that the Veteran's acute GC urethritis led to the loss of the left testicle in the 1970's and to his erectile dysfunction." Dr. Auriemma supported this finding by noting that (1) "[t]here were no signs or symptoms of an epididymitis at the acute presentation of the GC urethritis;" (2) that "while N. gonorrhea can cause epididymitis, it usually presents as an acute infection which was not the case with this Veteran"; and (3) that he "could not find any reports in the literature for a chronic or indolent GC infection of the epididymis lasting 20 years or longer." In addition, Dr. Auriemma provided an alternate etiology for the Veteran's hypogonadism and erectile dysfunction-the removal of the left testis in 1971 and an August 2008 finding that the right testis was atrophic. Dr. Auriemma also stated that he was "in agreement with the medical opinion done by the VA examiner in July 2008." He stated that it was "highly unlikely" that a patient would present with epididymitis 10 to 20 years following successful treatment of a urethritis infection in 1950. He thought that the urethritis which reportedly led to the orchiectomy "must have been caused by a subsequent exposure to a new organism(s) years later." He explained that "[w]hile erectile dysfunction is usually multi-factorial, I also agree that the Veteran's erectile dysfunction could be caused by hypogonadism since, as stated above, the patient's remaining right testicle is atrophic, and with the absence of a left testis, his atrophic right testis cannot provide adequate testosterone." With respect to the opinion of Dr. Bash, Dr. Auriemma stated, "I do not agree with the medical opinion from Dr. Bash." He noted that Dr. Bash reported that the Veteran has a "URETHRAL stent placed in July 2009 due to scarring of his urethra"; however, Dr. Auriemma noted that "[t]he Veteran actually had a URETERAL stent placed in the LEFT URETER, not the URETHRA and the reason for the stent appears to be from URETERAL stricture caused by a urothelial carcinoma." (emphasis in original) Dr. Auriemma also noted that the cystoscopy record clearly showed that the anterior urethra was normal and that "[i]f there was a stricture or evidence of chronic scarring, it would have been seen." Dr. Auriemma stated that "I have never heard of the entity of 'scarring and a delayed-association torsion' as reported by Dr. Bash, and it is not plausible that the Veteran would develop any 'reflux nephropathy' without a serious urethral stricture." Dr. Auriemma concluded that "[i]f the Veteran went on to develop other episodes of epididymitis which eventually led to an orchiectomy in 1971, the infections must have been due to new exposure to GU pathogens, not from the acute episode of GC urethritis which was successfully treated in 1950." III. Pertinent Law and Analysis Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110. If a chronic disease is shown in service, subsequent manifestations of the same chronic disease at any later date, however remote, may be service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). However, continuity of symptoms is required where a condition in service is noted but is not, in fact, chronic or where a diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Secondary service connection is available where a service- connected disability directly caused another disability and where a service-connected disability has aggravated a non- service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The record includes both evidence that tends to support the Veteran's claims for service connection and medical evidence that is against his claims. When evaluating this evidence, the Board must analyze its credibility and probative value, account for evidence which it finds to be persuasive or unpersuasive, and provide reasons for rejecting any evidence favorable to the appellant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991). The Board finds the "negative" opinions of the 2008 VA examiner and, in particular, the 2010 VA urologist, Dr. Auriemma, to be more persuasive and probative than the "positive" opinion provided by the private physician, Dr. Bash. While it is true that (as Dr. Bash notes) the 2008 VA examiner was a physician's assistant, not a physician, the findings of that examiner were subsequently endorsed, in the 2010 VHA opinion, by a physician, a board-certified urologist. Both Dr. Bash and Dr. Auriemma reviewed the information contained in the claims folders, the medical literature, and the Veteran's statements. However, the Board finds that the 2010 opinion of Dr. Auriemma is more probative and persuasive because it provided more detailed, and better explained, findings than Dr. Bash. Dr. Auriemma supports his findings with evidence in the record; however, Dr. Bash does not identify with specificity the evidence in the record which supports his conclusions. For example, Dr. Bash's opinion, in essence, is that the Veteran had a "serious urethral injury" in service that led to urethral scarring, loss of his testicle, and erectile dysfunction. He does identify with specificity the clinical evidence in the record that supports this conclusion. Dr. Auriemma, on the other hand, concludes that the Veteran did not have a "serious urethral injury" in service, but instead had an acute infection that was treated appropriately and resolved without further symptoms. As a result, Dr. Auriemma finds that the in-service infection is unrelated to any infection many (20) years later which led to the orchiectomy. He supports this conclusions with evidence, identified by date, from the STRs. This in-depth rationale that Dr. Auriemma provided for all his medical opinions makes his opinion more probative than that of Dr. Bash. Dr. Auriemma's medical opinion is more persuasive and probative because it addressed the opinions of Dr. Bash. Where Dr. Bash's opinion's differed, Dr. Auriemma explained, with specific evidence in the record, the reasons for he reached a different conclusion. For example, addressing Dr. Bash's notation that in service the Veteran "likely had a serious gonorrhea infection, which required [emphasis added] several urethral dilations", Dr. Auriemma notes that he could find no evidence in the record that the Veteran ever required [emphasis added] urethral dilation. He explains that the one instance of dilation in the record was following the Veteran's treatment for acute GC urethritis, to rule out urethral stricture (and dilation found no evidence of stricture). Dr. Auriemma's opinion also identifies an error in the findings of Dr. Bash in that Dr. Bash incorrectly identified a ureteral stricture in 2009 as a urethral stricture. Regarding the Dr. Bash's proposed theory that the Veteran's GC urethritis led to a "serious urethral injury", including scarring, Dr. Auriemma noted there was no evidence in the record that the Veteran had urethral stricture or scarring, and in support cited to normal anterior urethra found on cystoscopy in November 2009. Dr. Auriemma addresses Dr. Bash's suggestion that the Veteran's GC infection in service resulted in his development of a chronic epididymitis by pointing to the absence of any signs or symptoms of epididymitis when the Veteran was seen for his acute GC infection in service. and noting that he could find no report in medical literature for "a chronic or indolent GC infection of the epididymis lasting 20 years or longer"; Dr. Bash does not cite any medical literature indicating otherwise/supporting his theory. Finally, Dr. Auriemma (who is, as noted above, a Board-certified urologist) notes that he has never heard of the entity of "scarring and delayed association torsion"; Dr. Bash does not cite to any medical literature that identifies such entity. In summary, Dr. Auriemma's opinion is more probative than Dr. Bash's because he supports his conclusions with citation to clinical data in the factual record, whereas Dr. Bash's opinion is conclusory (without citation to supporting clinical data) and he premises his theory regarding the etiology of the claimed disabilities on factual assumptions that (as Dr. Auriemma explains) are unsupported by or inconsistent with the clinical data. Furthermore, Dr. Auriemma provides a more plausible etiology for the Veteran's epididymitis leading to left testicle removal, i.e., intercurrent, postservice infections noted in the record, and for his erectile dysfunction, namely, that with the removal of his left testicle the Veteran is not producing adequate testosterone, in part, because of an atrophic right testis which is unrelated to service. The preponderance of the evidence is thus against the claim of service connection for epididymitis and the related left orchiectomy. The Veteran's claim of service connection for erectile dysfunction is strictly one of secondary service connection ; it is neither alleged, nor suggested by the record (notably, the Veteran fathered children postservice, then had a vasectomy, apparently in approximately 1972), that the Veteran developed erectile dysfunction in service. He alleges his erectile dysfunction is secondary to a service-connected epididymitis. As noted above, a threshold legal requirement for establishing secondary service connection is that the disability which is alleged to have caused or aggravated the disability for which service connection is sought must itself be service-connected. See 38 C.F.R. § 3.310. Inasmuch as this decision denies service connection for epididymitis, the claim of secondary service connection lacks legal merit, and must be denied. See Sabonis v. Brown, 6 Vet. App. 426 (1994). The Board has also considered the Veteran's statements and sworn testimony asserting a nexus between epididymitis and erectile dysfunction and his service or a service-connected disability. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). The Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470. However, whether he has internal scarring as a result of one episode of gonorrhea in service; whether he developed epididymitis as a result of gonorrhea in service; and whether he has erectile dysfunction as a result of service or a service-connected disability are not questions for which a layperson can provide competent opinion evidence. Competent evidence has been provided by the VA examiner and urologist who reviewed the Veteran's file and by the medical records which are associated with the claims file. Further, the Veteran's statements with regard to having "reoccurrences" of his infection in service continuously post service until the orchiectomy (see January 2008 written statement from the Veteran); his testimony that he was treated as an inpatient for "two to three weeks" in service for gonorrhea (see transcript of April 2010 hearing); and his testimony that he underwent orchiectomy due to epididymitis continuing since service are not credible. See Caluza v. Brown, 7 Vet. App. 498, 510-511 (1995). ("Credibility can be genuinely evaluated by a showing of interest, bias, or inconsistent statements, and the demeanor of the witness, official plausibility of the testimony, and the consistency of the witness' testimony"). These accounts are self-serving. See Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration the Veteran's statements, it may consider whether self-interest may be a factor in making such statements). Furthermore, his STRs clearly contradict his statements with respect to the length of his treatment for gonorrhea in service. His STRs show that he was not treated as an inpatient for two to three weeks in service; at most, he was treated for less than a week. Finally, his accounts are inconsistent with known medical principles; specifically Dr. Auriemma has indicated that there is no reported instance in medical literature of a chronic or indolent GC infection of the epididymis lasting 20 years or longer. The accounts to the contrary are simply implausible. Furthermore, the Veteran's statements lack credibility because they lack consistency. For example, he has variously reported that (1) he had no urology problems between the resolution of his gonorrhea in 1950 and the mid-1960s (see July 2008 VA examination report, transcript of his February 2009 hearing testimony, and his September 2010 written statement); and (2) that he had treatment for swelling of the testicles in the 1950s and 1960s (see his April 2010 hearing testimony). There are no post-service treatment records prior to 1971, and there are no treatment records pertaining to the diagnosis surrounding the removal of his left testicle. The Veteran has reported that his left testicle was surgically removed in 1971 due to epididymitis. The first medical record referencing an orchiectomy is a May 1977 treatment record for leg pain which noted a past history of left orchiectomy for an unspecified infection. [Notably, there is also a clinical notation of an interim vasectomy (in apparently 1972).] In the absence of a more contemporaneous notation with respect to the circumstances surrounding his genitourinary history in the 1950s through the 1970s, the Veteran's statements are considered not credible. See Swann v. Brown, 5 Vet. App. 229, 233 (1993) (Board is not bound to accept uncorroborated account of veteran's medical history but must assess the credibility and weight of the evidence provided by the veteran before rejecting it). This is particularly true when the medical evidence of record, namely the opinion of a board-certified urologist who has reviewed the relevant treatise evidence, concludes that if the Veteran went on to develop other, post-service episodes of epididymitis, they were unrelated to his one-time acute gonorrhea infection in service. In summary, to the extent that there is contemporaneous evidence of a clinical nature that can either support or contradict the Veteran's accounts relating his genitourinary disability, in each instance such evidence either contradicts, or at the least fails to support the accounts. Consequently, the Board finds that the Veteran's accounts relating his orchiectomy and erectile dysfunction to an episode of gonorrhea in service are totally lacking in credibility. The Board concludes that the preponderance of the evidence is against the claims of service connection, and that there is no doubt to be resolved. Hence, the claims must be denied. ORDER Service connection for epididymitis status post orchiectomy is denied. Service connection for erectile dysfunction as secondary to epididymitis status post orchiectomy is denied. ____________________________________________ GEORGE R. SENYK Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs