Citation Nr: 20003448 Decision Date: 01/15/20 Archive Date: 01/14/20 DOCKET NO. 13-11 435 DATE: January 15, 2020 ORDER Entitlement to service connection for a psychiatric disorder, to include adjustment disorder with anxiety, as secondary to service-connected sleep apnea, is granted. Entitlement to service connection for erectile dysfunction is denied. FINDINGS OF FACT 1. The Veteran’s psychiatric disorder, to include adjustment disorder with anxiety, is proximately due to or caused by his service-connected sleep apnea. 2. The preponderance of the evidence of record is against a finding that the Veteran has had erectile dysfunction at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for service connection for psychiatric disorder, to include adjustment disorder with anxiety, as secondary to service-connected sleep apnea are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from December 2003 to March 2005, and from February 2008 to March 2009, to include service in Southwest Asia. He has additional periods of active duty for training in the United States Army from May 1991 to November 1991. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2015, these matters were remanded to the Agency of Original Jurisdiction (AOJ) for additional development. Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. It is the Board’s responsibility to evaluate the entire record on appeal. 38 U.S.C. § 7104(a). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Service connection for psychiatric disorder The Veteran contends that his anxiety is related to his active duty service. See December 2011 Statement in Support of Claim. The Veteran has a diagnosis of adjustment disorder with anxiety. See April 2019 VA Examination. Thus, the remaining question is whether his disability is related to his active service or a service-connected disability. Service treatment records (STRs) are silent of complaints, diagnosis, or treatment related to adjustment disorder with anxiety. The Veteran presented for a VA examination in April 2019, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The examiner opined that there is no documentary evidence nor historical evidence that this veteran had a mental disorder before nor during active military service. In support of this conclusion, the examiner explained that Veteran has not sought mental health treatment with the VA or in the private sector. Further, the examiner notes that Veteran’s adjustment disorder is related to a family situation where his wife has a hostile relationship with his son. The Board finds this opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. The Veteran submitted a private medical opinion in December 2014. The private examiner reviewed Veteran’s service and VA treatment records and opined that Veteran’s sleep apnea is a substantial contributory factor to Veteran’s anxiety. In support of this conclusion, the private examiner explained that over 50% of obstructive sleep apnea patients suffer from anxiety, higher than the prevalence of anxiety in the general population. Further, the examiner noted that it is thought that the sensations of choking and sleep deprivation are among the causes of this anxiety. Apart from other service-connected stressors which may have played a part in development of Veteran’s anxiety, the private examiner indicated that it is at least as likely as not that Veteran’s sleep apnea constitutes a source of his anxiety. With respect to medical opinions involving secondary service connection claim, this is the primary medical opinion of record, and there is no competent and credible evidence in significant conflict with the private examiner’s medical opinion. The VA examiner’s opinion noted above relates to direct service connection. As such, the Board assigns greater probative weight to the private medical examiner as it was made by a medical professional with consideration of the specific facts, a review of the medical evidence, and reasonably drawn conclusions with supportive rationale. Upon a review of the evidence, the Board finds the criteria for entitlement to service connection for psychiatric disorder, to include adjustment disorder with anxiety, on a secondary basis is met. The record shows a current diagnosis and a competent medical opinion indicated anxiety was proximately due to or aggravated beyond its natural progression from Veteran’s sleep apnea, a disability that is service-connected. Resolving the benefit of the doubt in the Veteran’s favor, service connection for psychiatric disorder, to include adjustment disorder with anxiety, is granted. 2. Service connection for erectile dysfunction The Veteran contends that he has an erectile dysfunction that is related to active duty service. The Board concludes that the Veteran does not have a current diagnosed erectile dysfunction disability or functional impairment associated with the male reproductive system and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 C.F.R. § 3.303(a), (d); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). A review of the Veteran’s STRs reflect an absence of complaints for erectile dysfunction. There was no treatment rendered nor was any diagnosis provided in reviewing the STRs relating to erectile dysfunction. Further, a review by the Board of the record indicates that the Veteran does not receive VA medical treatments for erectile dysfunction. In a May 2009 VA General Examination, it was noted that the Veteran did not have a history of erectile dysfunction. The Veteran presented for a VA examination in April 2019, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The examiner opined that the Veteran does not have a diagnosis and has not previously been diagnosed with any conditions of the male reproductive system. In support of this conclusion, the examiner explained that a after a review of the record, the medical literature, and an interview of the Veteran, a diagnosis of erectile dysfunction could not be rendered. The examiner noted that although the Veteran noticed having a loss of libido, he is still able to get an erection as well as being able to penetrate and ejaculate. The examiner indicated that the Veteran was not taking any medication and has not sought medical treatment regarding his erectile dysfunction. The Board finds this opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. Veteran submitted a private medical opinion in December 2014. The private examiner reviewed Veteran’s service and VA treatment records and opined that Veteran’s sleep apnea is a substantial contributory factor to Veteran’s erectile dysfunction. The private examiner explained that erectile dysfunction is a characteristic in men with sleep apnea, and it is also a well-known problem in men with hypertension. Further, in the absence of other causes of erectile dysfunction, such as medical or surgical castration, or abnormalities of the penis, the private examiner concluded that it is at least as likely as not that the Veteran’s erectile dysfunction is caused or exacerbated by his sleep apnea or hypertension. However, the examiner did not provide any underlying basis for finding that the Veteran had erectile dysfunction, nor did the examiner note the Veteran’s complaints or symptoms. As such, the Board gives greater probative value to the VA examination. As noted above, the VA examiner provided a detailed discussion as to the nature of the Veteran’s reported symptoms and an explanation as to why they did not support a diagnosis. The VA examiner’s findings are consistent with the Veteran’s documented treatment history, which shows no findings of erectile dysfunction. For these reasons, the Board finds the December 2014 report to be outweighed by the opinion of the VA examiner. For the above reasons, the Board therefore finds that the competent evidence is against the conclusion that the Veteran has an erectile dysfunction disability. The Board acknowledges the Veteran’s reports of loss of libido and notes the holding in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) that pain with functional loss can constitute a disability. The Board also acknowledges Veteran’s competency, with his occupation as a nurse is competent to provide an opinion based on his education, training, and expertise. However, after interviewing the Veteran, conducting an examination, and reviewing the record, the April 2019 VA examiner found that Veteran did not have any erectile dysfunction disability. Essentially, Veteran’s primary support for his claim is that he has a loss of libido, without any supporting evidence nor a clear rationale to explain the etiology of his erectile dysfunction. Furthermore, the VA examiner noted that the Veteran could still get an erection, penetrate, ejaculate, and has not taken any medication nor sought any medical treatment for his erectile dysfunction. Notably, the examiner specifically found that there was no functional impact associated with the Veteran’s male reproductive system. As with all claims for service connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is therefore not warranted. 38 C.F.R. § 3.303. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mathew 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.