Citation Nr: 18144219 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 16-27 833 DATE: October 24, 2018 ORDER Entitlement to service connection for erectile dysfunction is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has erectile dysfunction that is attributable to his active service or to any incident of service, including as secondary to a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for erectile dysfunction, including as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1997 to October 2005. The claims file includes a Brief on Appeal from July 2018 concerning a clothing allowance claim. The Board has reviewed the claims file but finds no documentation indicating that such a claim has been perfected for appeal; it is possible that the representative may have been referring to another claimant’s appeal, as specific documents not located in the claims file were referenced. In any event, the Board refers this matter back to the Regional Office for appropriate action. 1. Entitlement to service connection for erectile dysfunction, to include as secondary to a service-connected disability The Board concedes that the Veteran has a current diagnosis of erectile dysfunction. The Veteran contends that his erectile dysfunction is attributable to his service. In the alternative, he contends that his erectile dysfunction is secondary to his service-connected disabilities. At the outset, the Board notes that service connection on a secondary basis is permitted based on aggravation, with compensation payable for the degree of aggravation of a nonservice-connected disability caused by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran’s service treatment records (STR) do not contain complaints, treatment, or diagnosis for erectile dysfunction. During the Veteran’s May 2015 VA examination, the examiner opined that the condition was less likely than not due to the Veteran’s service-connected PTSD. The examiner stated that the erectile dysfunction likely had a biological or biomechanical etiology rather than a psychological etiology based on the Veteran’s intact sexual drive. The examiner also opined that the condition is less likely than not due to the Veteran’s PTSD medication, as erectile dysfunction is not a common adverse side effect of bupropion or fluoxetine. In December 2015, a second VA examiner reviewed the available medical evidence, including lay statements and medical literature submitted by the Veteran. The examiner opined that the Veteran’s erectile dysfunction was less likely than not aggravated beyond its natural progression by the Veteran’s PTSD or PTSD medications. The examiner’s rationale stated that the Veteran’s erectile dysfunction was first diagnosed in March of 2014, but that his PTSD stems from events in 2002. The examiner concluded that because the Veteran’s PTSD pre-existed his erectile dysfunction, no baseline of erectile dysfunction in the absence of PTSD or PTSD medication could be established, and therefore, there was no evidence of aggravation. The Veteran also contends that his erectile dysfunction may be due to his service-connected low back condition and the associated pain and medication he takes for his low back. During the same December 2015 examination, the second VA examiner opined that the Veteran’s erectile dysfunction was less likely than not due to his service-connected lumbar strain or lumbar strain medication. The examiner stated that the Veteran’s specific mediations are not deemed causative of erectile dysfunction. Additionally, the same examiner opined that the Veteran’s erectile dysfunction was less likely than not aggravated beyond its natural progression by the Veteran’s thoracolumbar strain or thoracolumbar strain medications. The examiner’s rationale stated that the Veteran’s erectile dysfunction was first diagnosed in March of 2014, but that his thoracolumbar strain stems from an injury in service predating that diagnosis. The examiner concluded that since the thoracolumbar strain pre-existed the erectile dysfunction, no baseline of erectile dysfunction in the absence of the thoracolumbar strain or thoracolumbar strain medication could be established. Therefore, there was no evidence of aggravation. In August 2015, the Veteran submitted literature discussing the potential medical link between erectile dysfunction and PTSD, back conditions, and various medications. This evidence is outweighed by the competent medical evidence of record. The Board assigns this literature less probative weight than the VA examinations because the conclusions drawn by the literature are not based on the Veteran’s specific medical history. The Veteran submitted a December 2014 statement by his chiropractic physician. The physician opines that there may be a possible link between the Veteran’s physical conditions, including his lower back condition, and the Veteran’s decreased sexual performance. While the chiropractor is a medical professional, given the opinion’s limited rationale and its indefinite nature, the Board only assigns the statement minimal probative weight. Obert v. Brown, 5 Vet. App. 30, 33 (1993). Finally, the Veteran submitted his own lay statements. The Veteran’s August 2015 VA 21-4138 statement disputes the adequacy of his May VA examination and states that his erectile dysfunction causes stress to himself and his wife. In the Veteran’s May 2018 Appellate Brief, the Veteran’s representative asserts a link between his erectile dysfunction and his service-connected PTSD based on the medical literature he submitted. Although the Veteran is competent to report the symptoms he experiences and may believe that his erectile dysfunction is due to his service-connected disabilities, he is not competent to opine as to the etiology of the condition because the casual relationship, if any, between two separate disabilities is a complex medical question. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board assigns his statements only limited probative weight. The Board finds that the May and December 2015 VA examinations are the most probative evidence of record and that the preponderance of the evidence is against the Veteran’s claim. Accordingly, the Veteran’s claim for entitlement to service connection for erectile dysfunction, including as due to his service-connected disabilities, must be denied. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Evan Thomas Hicks