Citation Nr: 20028029 Decision Date: 04/21/20 Archive Date: 04/21/20 DOCKET NO. 19-26 432 DATE: April 21, 2020 ORDER Entitlement to service connection for erectile dysfunction (ED), as secondary to service-connected unspecified depression, is granted. FINDING OF FACT The evidence is at least in equipoise that the Veteran’s service-connected unspecified depression caused or aggravated his erectile dysfunction. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction, secondary to service-connected unspecified depression, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from August 1984 to August 2008. This appeal comes before the Board of Veterans’ Appeals (Board) from a November 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for erectile dysfunction (ED), as secondary to service-connected unspecified depression, is granted. The Veteran has argued entitlement to service connection for his ED, as secondary to his service-connected unspecified depression. Specifically, the Veteran has argued that his ED developed shortly after his depression. Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any injury or disease diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d). Generally, service connection requires: (1) medical evidence of a current disability; (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease; and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310 (b). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154 (a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The evidence of record shows that the Veteran has been diagnosed with ED, and has received treatment for it since September 2013. See June 2018 VAMC Other Output / Records. Thus, the first Allen element is established. As to the second Allen element, a showing that the present disability was proximately caused or aggravated by a service-connected disability, the Board finds the evidence of record to be conflicting. In August 2018, the Veteran submitted a report from a private physician regarding the Veteran’s ED. The physician indicated having confirmed the diagnosis of ED, and then offered an opinion that it was more likely than not (greater than a 50 percent probability) that the Veteran’s ED condition is secondary to, related to, and/or aggravated by his service-connected unspecified depression. As a rationale for the opinion, the examiner offered that the Veteran’s depression has resulted in symptoms of depressed feelings, anxiety, helplessness, hopelessness, and difficulty maintaining relationships. The physician indicated that medical literature has established that those suffering from mental health illness experience a loss in sexual interest, arousal, and overall interference in intimacy, due to the mood changes, difficulty focusing, and hormonal changes that occur related to such conditions. See August 2018 VA Examination. The Board finds this examination to be competent, credible, and probative regarding the etiology of the Veteran’s ED. In October 2018, the Veteran was afforded a VA examination to determine the nature and etiology of his ED. The examiner indicated having reviewed the Veteran’s claim file, and confirmed the diagnosis of ED. The examiner offered an opinion that it was less likely than not (less than a 50 percent probability) that the Veteran’s ED was proximately due to or the result of the Veteran’s service-connected depression. The examiner stated that because of the pharmacological mechanism of ED medication, it is more likely that the Veteran’s ED was due to a physical reason, such as aging, rather than a mental reason. The Board finds this opinion to be competent, credible, and probative regarding the etiology of the Veteran’s ED. The Board finds that the evidence is at least in equipoise that the Veteran’s ED was caused or aggravated by his service-connected depression. Both the private physician and the VA physician’s opinions were based on reviews of the Veteran’s record, and in-person examinations. The Board finds both the examinations and opinions to be probative, and based on sound medical practice. The evidence thus suggests that the Veteran’s ED could be due either to his mental health, as noted by his private examiner, or due to his physical aging, as noted by the VA examiner. To this point, the Board finds the evidence of record to be in approximate balance between the two contentions; the Veteran’s ED could be either the result of mental or physical processes. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (b). The Board concludes that, as the evidence is in approximate balance, the benefit of the doubt shall be afforded to the Veteran. The Board thus finds the evidence is at least in equipoise that the Veteran’s ED was caused or aggravated by the mental effects of his service-connected unspecified depression. Reasonable doubt being afforded to the Veteran, the claim is granted. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Hermsdorfer, 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.