Citation Nr: 19149130 Decision Date: 06/25/19 Archive Date: 06/24/19 DOCKET NO. 15-15 568 DATE: June 25, 2019 ORDER Service connection for obstructive sleep apnea (OSA) secondary to traumatic brain injury (TBI) is granted. Service connection for erectile dysfunction secondary to TBI is granted. Special Monthly Compensation (SMC) for loss of use of a creative organ is granted. FINDINGS OF FACT 1. The evidence is at least in equipoise as to whether the Veteran’s OSA was caused or aggravated by his service-connected TBI. 2. The evidence is at least in equipoise as to whether the Veteran’s erectile dysfunction was caused or aggravated by his service-connected TBI. CONCLUSIONS OF LAW 1. The criteria for service connection for sleep apnea secondary to TBI have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for erectile dysfunction secondary to TBI have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for entitlement to SMC based on loss of use of a creative organ have been met. 38 U.S.C. § 1114 (k) (2012); 38 C.F.R. §§ 3.102, 3.350(a) (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran honorably served from May 1964 to April 1967. This matter is before the Board of Veterans Appeals (Board) on appeal from a May 2015 rating decision. Service Connection Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). “To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”- the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected condition. 38 C.F.R. § 3.310 1. Service connection for OSA secondary to a TBI Factual Background The Veteran was diagnosed with moderate obstructive sleep apnea following an August 2013 sleep study. The Veteran underwent a VA examination in July 2014. The examiner opined that the Veteran’s sleep apnea was caused by intermittent upper airway obstruction and was not caused by the Veteran’s service-connected TBI. The Veteran testified during the November 2018 hearing that fellow servicemembers complained of his heavy snoring while he was recovering in the hospital following his TBI during service. The Veteran also stated that his sleep apnea symptoms had their onset immediately following the TBI during service and have persisted since that time. Additionally, the Veteran’s wife submitted a statement that the Veteran’s snoring was severe for many years following his service prior to his sleep apnea diagnosis. See November 2018 Sworn Statement. Also of record is a medical journal study that states that as many as 50 to 70 percent of patients with TBI may suffer from some form of sleep-disordered breathing (SDB) and that sleep apnea is one of the most common forms of SDB. See June 2015 Correspondence. Analysis After weighing the evidence, the Board can only afford the July 2014 VA examiner’s opinion minimal probative value. The examiner did not have the benefit of the Veteran’s lay statements regarding the onset of his sleep apnea symptoms or chose not to address them in the opinion. Moreover, the opinion does not engage with any peer-reviewed medical literature regarding the relationship between TBIs and OSA, whereas the Veteran has submitted probative evidence suggesting a causal relationship. Given the lay testimony, statements of record, and submitted medical literature, the Board finds that the evidence is at least equally balanced for and against (in “relative equipoise”) a finding that the Veteran’s sleep apnea was caused or aggravated by his service-connected TBI. 2. Service connection for erectile dysfunction secondary to TBI Factual Background The May 2009 VA TBI examination confirms that the Veteran currently suffers from erectile dysfunction. The Veteran underwent a VA reproductive systems exam in July 2014. The examiner opined that the Veteran has complete loss of function which is “most likely secondary to diabetes mellitus.” The examination report also documents the onset of the Veteran’s erectile dysfunction as occurring four to five years prior to the exam. During the November 2018 hearing, the Veteran testified that he first noticed symptoms of erectile dysfunction shortly after the incurrence of the TBI during service. He stated that he did not seek treatment due to the embarrassment of suffering from erectile dysfunction at twenty years of age. These statements are corroborated by the Veteran’s wife who confirmed that the Veteran told her his erectile dysfunction symptoms began shortly after the TBI during service. See November 2018 Sworn Statement. Analysis After weighing the evidence, the Board can only afford the July 2014 VA examination report minimal probative value. The examiner did not have the benefit of the Veteran and his wife’s lay statements regarding the onset of his erectile dysfunction. Moreover, the examiner attributed the Veteran’s erectile dysfunction to his diabetes mellitus without providing a rationale. The examiner did not address a possible causal relationship between erectile dysfunction and TBI or engage with any medical literature that supports a possible relationship. Accordingly, given the lay testimony and statements of record, the Board finds that the evidence is at least equally balanced for and against (in “relative equipoise”) a finding that the Veteran’s erectile dysfunction was caused or aggravated by his service-connected TBI. Therefore, after resolving all doubt in favor of the Veteran, the Board finds that the evidence supports establishing service connection for erectile dysfunction. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. SMC for loss of use of a creative organ With regard to the Veteran’s claim for entitlement to SMC for loss of use of a creative organ, the Veteran has been granted service connection for erectile dysfunction herein. VA provides SMC if a Veteran, as a result of service-connected disability, has suffered the anatomical loss or loss of use of a creative organ. 38 U.S.C. § 1114 (k). SMC based on loss of use of a creative organ can also be granted based on erectile dysfunction. 38 C.F.R. § 3.350 (a)(1)(ii). The Veteran has full functional loss of use of his creative organ. See July 2014 VA examination. In light of the grant of service connection for erectile dysfunction, the Board also finds that SMC for loss of use of a creative organ is also warranted. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. McKone, Attorney for the Board The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.