Citation Nr: 18147414 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 10-14 847 DATE: November 5, 2018 ORDER Service connection for erectile dysfunction is granted. FINDING OF FACT Resolving all doubt in the Veteran’s favor, erectile dysfunction is proximately due to service-connected disabilities. CONCLUSION OF LAW The criteria for entitlement to service connection for erectile dysfunction have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1977 to August 1986, with additional service in the Army National Guard from January 1989 to January 1990. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in August 2009 by a Department of Veterans Affairs (VA) Regional Office. In November 2010, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In June 2013 and December 2014, the Board remanded the claim on appeal for additional development and, in March 2017, denied the claim. The Veteran appealed the denial of that claim to the United States Court of Appeals for Veterans Claims (Court). In December 2017, the Court granted a Joint Motion for Partial Remand (JMPR) that vacated and remanded the claim. Thereafter, in June 2018, the Board sought a medical expert opinion from the Veterans Health Administration, which was rendered in October 2018. Entitlement to service connection for erectile dysfunction, to include as secondary to gunshot wound to abdomen with injury to small bowel and colon (gunshot wound), spastic bladder due to gunshot wound (bladder disability), and/or posttraumatic stress disorder (PTSD), and/or medications taken for service-connected disabilities. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996). Alternatively, service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 U.S.C. § 1131; 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Where a service-connected disability aggravates a nonservice-connected condition, a Veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Id. 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; 38 C.R.F. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran asserts his currently diagnosed erectile dysfunction, initially claimed as impotency, is related to an in-service gunshot wound, or proximately due to his service-connected residuals thereof, to include a bladder disability and/or PTSD. In June 2013 and December 2014, the Board found the opinions of record were inadequate to decide the claim, and obtained an addendum opinion in August 2015. Thereafter, the Board denied service connection for erectile dysfunction based on the August 2015 VA opinion. However, in the December 2017 JMPR, the Court found that such opinion was also inadequate for the purpose of determining entitlement to service connection. Consequently, the Board sought a medical expert opinion from VHA in June 2018, which was rendered in October 2018. In the October 2018 VHA opinion, a VA physician opined it was at least as likely as not the Veteran’s erectile dysfunction was caused by his service-connected PTSD and/or associated medications, residual effects of his in-service gunshot wound, and spastic bladder. The VA physician reported PTSD is a known cause of erectile dysfunction in general and in the veteran population. Additionally, she observed that physical injury to the small bowel, colon, and bladder from one gunshot indicates regional destruction of multiple tissues of the peritoneum. The anatomic structures, most particularly the nerves that affect bowel, urinary, and erectile functioning, are located in close proximity, and an explosive, tearing injury is as likely as not to affect the other, either at the time of initial injury, surgical repair, and/or with time, as internal scar tissue develops and adheres to the nerves, blood-vessels, and connective tissue. Consequently, she found that it was at least as likely as not that both the original injury, and the scarring that gradually developed over the next years, had an effect on the nerves in the same vicinity that control erectile function. The VA physician added that any inconsistency with respect to the Veteran’s reports of continuity of symptomatology were not likely to be contradictions given the nature of erectile dysfunction. As the October 2018 VA physician considered all relevant evidence, to include the Veteran’s lay statements regarding his symptomatology, and offered a complete rationale for the opinion, the Board affords the opinion probative value in support of entitlement to service connection for erectile dysfunction. Further, as noted above, the Board and Court found all other opinions of record to be inadequate. Therefore, the Board resolves all doubt in the Veteran’s favor and finds his current erectile dysfunction is proximately due to service-connected disabilities. Consequently, service connection for such disorder is warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. M. Celli, Counsel