Citation Nr: 18140542 Decision Date: 10/03/18 Archive Date: 10/03/18 DOCKET NO. 11-28 335 DATE: October 3, 2018 ORDER Entitlement to service connection for erectile dysfunction is granted. FINDING OF FACT The medical evidence of record supports a finding that the Veteran’s erectile dysfunction is more likely than not proximately due to the noted side effects of the medication he is prescribed to treat his service-connected disabilities. CONCLUSION OF LAW The criteria for entitlement to service connection for erectile dysfunction have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.310 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from May 1987 to September 1991. 1. Entitlement to service connection for erectile dysfunction The Veteran is seeking entitlement to service connection for erectile dysfunction claimed primarily as due to the medications associated with his service-connected psychiatric disability, posttraumatic stress disorder (PTSD), and low back disability. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996). Service connection may be granted, on a secondary basis, for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995) (holding that service connection on a secondary basis requires evidence sufficient to show that the current disability was caused or aggravated by a service-connected disability). In order to prevail under a theory of secondary service connection, there must be: (1) evidence of a current disorder; (2) evidence of a service-connected disability; and, (3) medical nexus evidence establishing a connection between the service-connected disability and the current disorder. See Wallin v. West, 11 Vet. App. 509, 512 (1998). At the Veteran’s February 2018 Board hearing he testified to experiencing the onset of erectile dysfunction after taking medications prescribed for his service-connected back disability and PTSD. He reported significant decreases in his libido over the last several years, and is presently prescribed Viagra. Thus, the Board finds that the evidence of record supports a finding that the Veteran has a current diagnosis and prescribed treatment to treat his erectile dysfunction. The remaining question before the Board is whether his erectile dysfunction is proximately due to or aggravated by his service-connected disabilities. In connection with the claim, the Veteran underwent VA examination where the examiner stated that he was unable to determine the etiology of the Veteran’s erectile dysfunction as it is multi-factorial; including hypogonadism and poly-pharmacy related to PTSD and his lumbar spine condition. Simultaneously, the examiner concluded that the Veteran’s erectile dysfunction was less likely attributable to his service-connected conditions. The claims file also includes a January 2017 statement from the Veteran’s primary care physician who alleged that the Veteran’s non-service-connected hypertension and low back condition are likely contributors to his erectile dysfunction. The Board sought an advisory medical opinion to clarify the etiology of the Veteran’s condition and to have an examiner address the treatise information he submitted. The July 2018 medical opinion found that the Veteran’s erectile dysfunction is at least as likely as not caused by PTSD treatment, low back pain, and related to certain medications that were prescribed to the Veteran, i.e. Dibalproem and Cyclobenzaprin which are known to have the side effect of erectile dysfunction. The Board finds this opinion to be probative evidence, weighing positively on the claim particularly as the examiner specifically addressed the medications the Veteran was prescribed to treat his service-connected disabilities. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Accordingly, the Board finds that entitlement to service connection for erectile dysfunction is warranted. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.310 (2017). T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.L. Reid, Associate Counsel