Citation Nr: 18123701
Decision Date: 08/02/18	Archive Date: 08/02/18

DOCKET NO. 09-47 123
DATE:	August 2, 2018
ORDER
Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected diabetes mellitus, type II, is granted.
FINDING OF FACT
Resolving all doubt in favor of the Veteran, the probative medical evidence of record has shown that his current erectile dysfunction is proximately due to his service-connected diabetes mellitus, type II.
CONCLUSION OF LAW
The criteria for service connection for erectile dysfunction have been met.  38 U.S.C. §§1110, 1131, 5107(b) (2012); 38 C.F.R. § 3.310 (2017).
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran served on active duty from March 1969 to November 1970.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a March 2009 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan.
Service Connection
Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty, in the active military, naval, or air service.  38 U.S.C. §§ 1110, 1131 (2012).  Service connection may also 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) (2017).
Generally, to establish service connection for a disability resulting from a disease or injury incurred in service, there must be (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of incurrence of a disease or injury in active service; and (3) competent evidence of a nexus or connection between the current disability and the disease or injury incurred in service.  Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); cf. Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)).
In addition, service connection is also warranted where the evidence of record establishes that a disability is proximately due to or the result of a service connected disease or injury.  38 C.F.R. § 3. 310(a).
Erectile Dysfunction
The Board requested a medical opinion in December 2017, asking a urologist to opine on the etiology of the Veteran’s erectile dysfunction, including whether his diabetes mellitus and/or diabetes mellitus medications caused or aggravated his erectile dysfunction and low testosterone.  
A VA urologist provided a medical opinion in February 2018 and found that the Veteran’s diabetes mellitus, type 2, was one of many contributing factors to his erectile dysfunction.  He also indicated that recent medical literature had associated the Veteran’s diabetes medication Metformin with low testosterone.  In addition, metabolic syndrome was very strongly associated with low testosterone.  As a result, the urologist opined that Metformin may be associated with low testosterone, but it was just as likely that his low testosterone was the result of aging and metabolic syndrome.  
The Board finds the February 2018 opinion highly probative because by saying diabetes mellitus was one of the contributing factors to the Veteran’s erectile dysfunction, the Board finds that the examiner established a causal relationship between the two.  Thus, the medical report, at the very least, places the evidence in a state of relative equipoise as to whether the Veteran’s erectile dysfunction is proximately due to his service-connected diabetes mellitus, type II.  On this point, therefore, the Board must resolve doubt in the Veteran’s favor and grant the claim for service connection for erectile dysfunction. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990).
 
Michael J. Skaltsounis
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Daniels, Associate Counsel