Citation Nr: 18122012 Decision Date: 07/27/18 Archive Date: 07/27/18 DOCKET NO. 15-15 073 DATE: July 27, 2018 ORDER The previously denied claim for service connection for diabetes mellitus, type 2, is reopened; to this limited extent, the appeal of that claim is granted. Service connection is granted for erectile dysfunction. REMANDED Entitlement to service connection for prostate cancer, status post radical prostatectomy, is remanded. Entitlement to service connection for diabetes mellitus is remanded. Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance, or at the housebound rate, is remanded. FINDINGS OF FACT 1. By a decision entered in February 2009, the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri denied the Veteran’s claim for service connection for diabetes mellitus, type 2; he was advised of the RO’s decision, and of his appellate rights. 2. The Veteran did not initiate an appeal of the RO’s February 2009 decision during the one-year period following the mailing of notice of that decision; nor was any new and material evidence received within a year. 3. New evidence received since the time of the RO’s February 2009 decision, when considered with the evidence previously of record, relates to an unestablished fact necessary to substantiate the Veteran’s claim for service connection for diabetes mellitus, type 2, and raises a reasonable possibility of substantiating the claim. 4. It is at least as likely as not that the Veteran’s erectile dysfunction has been aggravated by medications used to treat his service-connected major depressive disorder. CONCLUSIONS OF LAW 1. The RO’s February 2009 decision denying service connection for diabetes mellitus, type 2, is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.200, 20.201, 20.1103. 2. New and material evidence has been received to reopen the Veteran’s claim for service connection for diabetes mellitus. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. Resolving reasonable doubt in the Veteran’s favor, the criteria for an award of service connection for erectile dysfunction have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active service in the United States Marine Corps from August 1972 to May 1974. He also served in the United States Marine Corps Reserve. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from September 2012 and May 2015 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. New and Material Evidence The Veteran’s claim for service connection for diabetes mellitus was denied in a February 2009 rating decision. The RO determined that the evidence of record did not demonstrate a diagnosis of diabetes mellitus. The Veteran did not appeal the decision within one year. Nor was any new and material evidence received within that time. As a result, the February 2009 decision became final. See 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.156(b), 20.1103. Since that final decision, evidence has been received which reflects that the Veteran has a diagnosis of diabetes. See August 2013 CAPRI, p. 1. This evidence, when considered with the evidence previously of record, relates to an unestablished fact necessary to substantiate the Veteran’s claim for service connection for diabetes mellitus, type 2, and raises a reasonable possibility of substantiating the claim. 38 U.S.C. § 5108; 38 C.F.R. § 3.156; Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). Accordingly, the claim is reopened. Service Connection for Erectile Dysfunction Secondary service connection may be granted for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). To prevail on the issue of secondary service connection, the record must show: (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). In the present case, there is no dispute that the Veteran has a current disability. The evidence demonstrates a diagnosis of erectile dysfunction. See September 2014 VA Examination, p. 3. The Veteran is also service-connected for major depressive disorder. Accordingly, the Board finds that both the first and second elements of secondary service connection are established. See Wallin, 11 Vet. App. at 512. As to the nexus, or link, between the Veteran’s erectile dysfunction and his service-connected major depressive disorder, the Board notes that the Veteran was afforded VA examinations in August 2012 and September 2014. The August 2012 examiner opined that it was less likely than not that the Veteran’s erectile dysfunction was caused by medications used to treat his major depressive disorder. August 2012 VA Examination, p. 9. Instead, the examiner attributed the Veteran’s erectile dysfunction to medications used to treat his non-service-connected hypertension. On the other hand, the September 2014 examiner opined that it was as likely as not that the Veteran’s erectile dysfunction was caused by antidepressant medications. September 2014 VA Examination, p. 6. Also of record is a note from the Veteran’s primary care physician in which he opines that the Veteran’s erectile dysfunction is more likely than not made worse by his antidepressant medications. November 2012 VA Treatment Records, p. 1. In support of this opinion, the Veteran’s physician provided information on the side effects of one of the Veteran’s medications. One listed side effect is decreased sexual ability in males. Id. at p. 2. The Board finds that the evidence regarding nexus is at least in equipoise. The positive opinions from the September 2014 VA examiner and the Veteran’s primary care physician are at least as probative as the negative opinion provided by the August 2012 VA examiner. When the evidence for and against a claim is in relative equipoise, the Board has an obligation to resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection for erectile dysfunction is granted. REASONS FOR REMAND Service Connection for Prostate Cancer, Status Post Radical Prostatectomy Service Connection Diabetes Mellitus The Veteran contends that his prostate cancer and diabetes mellitus are etiologically related to in-service exposure to herbicide agents. Specifically, the Veteran contends that he was exposed to Agent Orange while stationed in Japan from 1973 to 1974. October 2014 Statement in Support of Claim, p. 1. The Veteran asserts that he attended a school in Okinawa that was adjacent to a dump site. He further maintains that he buried Agent Orange drums in the dump site with bulldozers as part of a bulldozer operations course. The agency of original jurisdiction (AOJ) attempted to verify the Veteran’s contentions by emailing VA’s Compensation Service Agent Orange Mailbox. See April 2015 VA Memo, p. 1, and Marine Corps University Archive; March 2015 Correspondence, p. 1. The Agent Orange Mailbox returned a negative response, but there is no indication that Marine Corps University Archive responded or that any additional attempts were made to elicit a response. Moreover, the AOJ did not request a search by the Joint Services Records Research Center (JSRRC) pursuant to the M21-1 Adjudication Procedures. See VA Adjudication Procedures Manual, M21-1, IV.ii.1.H.7.a. Additional development is required. SMC The issue of entitlement to SMC is inextricably intertwined with the issue of entitlement to service connection for prostate cancer. Issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a second issue. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The Veteran contends that his need for regular aid and attendance is due to his prostate cancer, and his claim for service connection for prostate cancer is being remanded. See August 2014 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, p. 1. As such, the issue of SMC must also be remanded. These matters are REMANDED for the following action: Contact all appropriate repositories to obtain any outstanding records that pertain to the Veteran’s service in Okinawa, including any records that relate to the bulldozer operations course the Veteran completed in August 1973 in the Pre-Discharge Education Program, and his alleged associated exposure to herbicide agents. Efforts should include follow-up with the Marine Corps University Archive and JSRRC, as described. All efforts made and responses received should be documented and associated with the claims file. DAVID A. BRENNINGMEYER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD W.V. Walker, Associate Counsel