Citation Nr: 18152001 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 15-12 680 DATE: November 20, 2018 ORDER New and material evidence having been received, the claim for service connection for erectile dysfunction, claimed as secondary to service-connected PTSD, is reopened. Service connection for erectile dysfunction, secondary to service-connected PTSD, is granted. REMANDED The issue of entitlement to an increased evaluation for postoperative residuals, comminuted fracture, right fibula with traumatic arthritis of the right ankle and tibiotalar fusion, evaluated as 30 percent disabling from January 3, 2012, 100 percent disabling from March 18, 2013, and 30 percent disabling from July 1, 2013, is remanded. The issue of entitlement to an initial compensable evaluation for postoperative surgical scar, right ankle, is remanded. FINDINGS OF FACT 1.A June 2008 rating decision denied service connection for erectile dysfunction on direct and secondary bases. 2.Evidence added to the record since the June 2008 rating decision does relate to an unestablished fact necessary to substantiate the Veteran’s claim and does raise a reasonable possibility of substantiating that claim. 3.The evidence is in equipoise as to whether the Veteran’s erectile dysfunction is proximately due to medication taken for his service-connected PTSD. CONCLUSION OF LAW New and material evidence has been submitted to reopen the claim, and the criteria for secondary service connection for erectile dysfunction are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.156, 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from June 1977 to June 1994. The Veteran seeks to reopen a claim of entitlement to service connection for erectile dysfunction, secondary to service-connected PTSD. The claim was previously denied in a June 2008 rating decision because the medical evidence of record failed to show a current chronic disability. The initial question before the Board is whether new and material evidence has been submitted to reopen the claim. Evidence added to the record since the June 2008 rating decision includes the report of a November 2013 Male Reproductive System Conditions Disability Benefits Questionnaire (DBQ). The DBQ provides a current diagnosis of erectile dysfunction. The Board finds this evidence is “new” in that it had not been previously submitted. Moreover, the evidence is “material” because it relates to an unestablished fact necessary to substantiate the Veteran’s claim; that is, whether the Veteran has a current diagnosis of erectile dysfunction. The claim is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156; Shade v. Shinseki, 24 Vet. App. 110 (2010). The RO reopened the claim and considered it on the merits. The question for consideration on a de novo basis by the Board is whether the Veteran’s erectile dysfunction is related to a service-connected disability. The Board finds that it is at least as likely as not that the Veteran's erectile dysfunction is proximately due to medication taken for service-connected PTSD. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. §§ 3.3102, 3.310(a). The report of a January 2008 VA contract examination provides a diagnosis of erectile dysfunction. The report provides that it was the examiner’s professional opinion that it was at least as likely as not that the Veteran's erectile dysfunction was secondary to medications taken for his PTSD. The examiner explained that it was a well-established fact that antidepressant medications such as Wellbutrin and trazodone, which the Veteran had been prescribed, can cause erectile dysfunction. The Board observes that in January 2008 the Veteran was not service-connected for PTSD. A March 2011 rating decision granted service connection for PTSD, effective July 27, 2010. A November 2013 DBQ Medical Opinion provides the medical opinion that the Veteran’s erectile dysfunction was less likely than not (less likely than 50 percent probability) proximately due to or the result of the Veteran’s service-connected condition. The examiner explained that more likely than not, the Veteran’s erectile dysfunction was due to the very low testosterone level (despite bimonthly testosterone injections), indicative of hypogonadism. The Veteran’s obesity was a likely prime contributor to the hypogonadism. The Board finds that each VA examiner is equally competent to provide a medical opinion, and each medical opinion is equally credible. In addition, the Board finds that each medical opinion is of equal probative weight. The January 2008 examiner reviewed all records from the Veteran’s claims file that were provided to him as relevant to the Veteran’s claim. The November 2013 examiner reviewed the Veteran’s claims file. Each medical opinion is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran informed the November 2013 examiner that his erectile dysfunction was due to hypogonadism, the Veteran is not competent to provide that medical opinion and his assertion does not support the November 2013 examiner’s medical opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Overall, the Board finds that the medical evidence is in equipoise regarding whether the Veteran's erectile dysfunction is related to his service-connected PTSD. The Board resolves the reasonable doubt in the Veteran’s favor, to find that erectile dysfunction is proximately due to medication taken for the Veteran's service-connected PTSD. REASONS FOR REMAND The most recent VA examination of the right ankle/tibia disability and related scar occurred in November 2013, five years ago. The Veteran’s representative asserted in a November 2018 Informal Hearing Presentation that the Veteran needed to be reexamined. Therefore, due to the passage of time, the Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of the service-connected disabilities on appeal.   The matters are REMANDED for the following action: Schedule the Veteran for an examination of the current severity of his postoperative residuals, comminuted fracture, right fibula with traumatic arthritis of the right ankle and tibiotalar fusion and the surgical scar. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to postoperative residuals, comminuted fracture, right fibula with traumatic arthritis of the right ankle and tibiotalar fusion alone and discuss the effect of the Veteran’s disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). (Continued on the next page)   A complete rationale must be provided for any opinion offered. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Davitian, Counsel