Citation Nr: 20021617 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 14-35 012 DATE: March 26, 2020 ORDER Entitlement to special monthly compensation (SMC) for loss of use of a creative organ is granted. FINDING OF FACT After affording the Veteran the benefit of the doubt, he has erectile dysfunction (ED) that was caused by or otherwise related to his service-connected disability of ischemic heart disease (IHD). CONCLUSION OF LAW The criteria for entitlement to special monthly compensation (SMC) based on loss of use of a creative organ have been met. 38 U.S.C. § 1114(k) (2012); 38 C.F.R. § 3.350(a) (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1963 to February 1975. The issue on appeal arises from an underlying claim of entitlement to an increased rating for ischemic heart disease (IHD); that claim was denied by the Board in June 2018. The Veteran appealed the decision to the U.S. Court of Appeals for Veterans Claims (Court), specifically challenging the failure to adjudicate a claim for entitlement to SMC for loss of use of a creative organ as part of a claim for entitlement to a higher disability evaluation for IHD. In August 2018, the Court issued a Memorandum Decision that set aside the portion of the June 2018 Board decision that failed to adjudicate the SMC claim and remanded the matters for readjudication consistent with the instructions outlined in the decision. Special Monthly Compensation (SMC) for Loss of Use of a Creative Organ. The August 2018 Court Memorandum Decision noted that in September 2017, the Veteran, through counsel, indicated that “the record before VA establishes that [SMC] due to loss of use of a creative organ is warranted.” He asserted that “erectile disfunction [(ED)] is so closely associated with heart disease that it is considered a diagnostically useful early symptom of the condition,” referencing a 2011 article, “Cardiovascular Implications of Erectile Dysfunction.” Further, he stated that treatment or his service-connected IHD had worsened his ED because pharmacologic treatment for ED was contraindicated while he was using nitroglycerin for his IHD. The Regional Office (RO) considered the statement as “a request for an application for SMC” and informed the Veteran that if he intended to file a claim for compensation, he must file a claim using a standardized form. The Court stated Veterans who, as a result of service-connected disability, experience the anatomical loss or loss of use of one or more creative organs may be entitled to SMC(k), 38 U.S.C. § 1114(k); 38 C.F.R. § 3.350(a), and that the plain text of section 1114(k) does not limit potential entitlement to SMC(k) to Veterans with certain service-connected disabilities.” Payne v. Wilkie, 2019WL 3757614,at *3 (U.S. Vet. App. Aug. 9, 2019). Thus, the Veteran is not legally barred from seeking SMC(k) for ED as due to his service-connected IHD. The Court ultimately found that the Veteran claimed SMC(k) as part of the underlying claim for a higher evaluation for IHD, yet neither VA nor the Board adjudicated the expressly raised issue as part of the increased evaluation claim and concluded that the Board erred when it failed to adjudicate the issue of entitlement of SMC(k). The Board will adjudicate such below. Special monthly compensation under 38 U.S.C. § 1114(k) is payable for anatomical loss or loss of use of a creative organ as a result of a service-connected disability. 38 C.F.R. § 3.350(a). The statute is interpreted as including erectile dysfunction as loss of use of a creative organ. The amount of special monthly compensation for loss of use of a creative organ is a non-variable amount and is set by statute and the rate of compensation for the loss of use of a creative organ is described under the provisions of 38 U.S.C. § 1114(k), subject to a maximum capped amount. VA medical records show that the Veteran was prescribed Viagra for treatment of ED in June 2003, however, in February 2004 was advised against the use of Viagra because he was on nitroglycerin and the risks associated with the combined use included death and was told to discontinue use of Viagra. A July 2009 VA medical record notes that because of the Veteran’s atherosclerotic coronary artery disease and history of stent placement he would need to continue aggressive medical therapy and was placed on nitroglycerin patch. Specifically, the Veteran was on Levitra for ED and it was discontinued as he was advised not to use it while on nitroglycerin. This supports a finding that treatment for ED was limited due to treatment for the Veteran’s service-connected IHD. In September 2017, the Veteran’s representative asserted that, “ED is so closely associated with heart disease that it is considered a diagnostically useful early symptom of the condition,” referencing a 2011 article, “Cardiovascular Implications of Erectile Dysfunction.” The article concludes that ED is frequently a sign of atherosclerosis, a clogging or narrowing of the blood vessels that causes heart attacks. Moreover, the Veteran proffered a February 2020 medical opinion from a private physician who opined that it is more likely than not that the Veteran’s ED is related to his service-connected IHD. He cited to an article, “Association Between Erectile Dysfunction and Coronary Artery Disease and It’s Severity,” and indicated both were vascular events and risk factors for either are the same. The physician explained that having endothelial dysfunction and low blood flow to the arteries in the heart leads to IHD and low blood flood in the arteries of the penis leads to ED, respectfully. The Board finds that the evidence proffered provides sufficient support of a relationship between the Veteran’s ED and his service-connected IHD. The Board finds that given the forgoing and after affording the Veteran the benefit of the doubt, he has lost the use of a creative organ secondary to his ED attributable to his service-connected disability of IHD. The requirements for SMC based on loss of use of a creative organ are met and the claim for SMC is granted. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Cheng, Associate Counsel 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.