Citation Nr: 1324017 Decision Date: 07/29/13 Archive Date: 08/07/13 DOCKET NO. 10-42 425 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Buffalo, New York THE ISSUE Entitlement to service connection for erectile dysfunction as secondary to medications prescribed to treat service-connected posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD A. G. Alderman, Counsel INTRODUCTION The Veteran served on active duty from January 1969 to January 1971. This case comes before the Board of Veterans' Appeals (Board) on appeal from a July 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York. The Veteran appeared and provided testimony before the Board in May 2011. A transcript of the hearing has been associated with the claims file. In May 2011, the Veteran provided additional evidence without a waiver of initial RO review; however, since the claim has been granted herein, a remand for RO review is not necessary. 38 C.F.R. § 20.1304 (2012). FINDING OF FACT The Veteran's erectile dysfunction is due to medications prescribed for his service-connected PTSD. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction have been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION The Duty to Notify and Assist VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). In this case, the Board is granting in full the benefit sought on appeal. Accordingly, assuming, without deciding, that any error was committed with respect to either the duty to notify or the duty to assist, such error was harmless and will not be further discussed. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310(a) (2012); Harder v. Brown, 5 Vet. App. 183, 187 (1993). To prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran claims that his erectile dysfunction (ED) is due to medications prescribed for his service-connected PTSD. Treatment records show that he has been taking medications for PTSD since August 2007 and that the type and dosage of medications has changed over the years. August 2007 Vet Center and VA treatment records indicate that the Veteran was in the process of divorcing his wife but had a good relationship with his girlfriend. He did not report problems with ED. In fact, treatment records do not show complaints or treatment of ED until November 2009. November 2009 treatment records suggest that his ED could be related to his SSRI, or selective serotonin reuptake inhibitor. The provider suggested reducing or changing his medication. The Veteran had a VA examination in February 2010. The examiner reviewed the claims file and interviewed and examined the Veteran. The Veteran said his condition had its onset three or four years prior to the examination. He said he had been on medication, Vardenafil, for about three years. The examiner opined that it is at least as likely as not that the Veteran's ED was caused by medication prescribed for PTSD. The RO requested clarification of the February 2010 opinion and pointed out that the Veteran was not prescribed Sertraline until October 2009 and that his ED had onset long before being prescribed Sertraline. In the March 2010 addendum, the examiner noted that the Veteran started taking Sertraline in October 2009 but that his ED started years before. Thus she found it not at least as likely as not that the ED is secondary to his PTSD medication. During his May 2011 hearing before the Board, the Veteran testified that he started having ED shortly after being prescribed medications for PTSD about three years ago. He said he did not have problems with ED before taking the medication. Subsequent to his Board hearing, the Veteran submitted a letter from his VA psychiatrist. This letter indicates that the psychiatrist consulted with the Veteran's VA primary care provider and that they concluded that the Veteran's medication for high blood pressure and two medications for mental health matters can cause ED. Thus, the psychiatrist opined that it is at least as likely as not that one or more of the mediations is the cause of ED. Notably, the Veteran is not service-connected for high blood pressure. After reviewing the evidence, the Board finds that service-connection for ED as secondary to medications prescribed for service-connected PTSD is warranted. The Veteran testified that ED had onset after he started taking medication for his service-connected PTSD. His statements are supported by the medical evidence which shows that he was prescribed medications for PTSD in 2007 and by the medical evidence showing a nexus between his medications and ED. ORDER Entitlement to service connection for erectile dysfunction is granted. ____________________________________________ L.M. BARNARD Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs