Citation Nr: 21000545 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 20-00 182A DATE: January 5, 2021 ORDER Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for erectile dysfunction, to include as secondary to prostate cancer and diabetes mellitus, is denied. REMANDED Entitlement to service connection for osteoarthritis of the right hip is remanded. FINDING OF FACT The probative evidence of record does not show that the Veteran’s diabetes and erectile dysfunction are related to his active duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 2. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1975 to February 1995. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In order to establish service connection, the record must show competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). When considering such a claim for service connection, the Board must consider on a case-by-case basis, the competence and sufficiency of lay evidence offered to support a finding of service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 Fed. Cir. 2007)). The mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Entitlement to Service Connection: Diabetes and Erectile Dysfunction The Veteran contends that his diabetes mellitus and erectile dysfunction are related to his active duty service. As an initial matter, the Board acknowledges that the Veteran has been diagnosed with diabetes mellitus and erectile dysfunction. Therefore, the issue turns upon whether there is evidence of an in-service event or injury and a nexus between the claimed in-service disease or injury and the present disabilities. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board finds there is not. The Board notes that the Veteran’s service treatment records are silent for any diabetes or erectile dysfunction diagnosis, notations of potential diabetes, issues with his glucose and/or insulin level, or issues with his erections. There are no documented issues related to diabetes or his genitals during the Veteran’s active service. Additionally, the medical evidence of record is silent for any opinion relating the Veteran’s conditions to his service. In fact, the Veteran was not found to be at risk for diabetes or diagnosed with erectile dysfunction until 2016, which is over 20 years after his service. Prior to 2016, it was consistently noted that the Veteran was negative for diabetes during regular VA medical center visits and reported having normal erections. Further, the Board notes that neither the Veteran nor his representative have provided any statements or theories of contentions relating the Veteran’s diabetes to his active duty service, to include any mentioning of an in-service event or injury. Regarding the Veteran’s erectile dysfunction, the Veteran has only contended that his erectile dysfunction is related to his prostate cancer and/or diabetes mellitus, but the Board notes the Veteran is not service-connected for either. Moreover, his erectile dysfunction has been noted by his VA physicians as a potential complication of both his prostate cancer and diabetes. Therefore, upon review of the foregoing evidence, the Board finds that the probative evidence of record does not show the Veteran’s diabetes mellitus and erectile dysfunction are related to his active duty service. The Board acknowledges the Veteran’s assertions that his conditions are related to his active duty service. The Board recognizes that lay persons are competent to provide medical opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, although the Veteran is competent to report his symptoms, any opinion regarding whether any disability is related to his military service, to include diabetes mellitus and erectile dysfunction, requires medical expertise that the Veteran has not demonstrated since the claimed disabilities could have many causes. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (2007). Further, the Board again notes that the Veteran has provided no statements regarding an in-service injury or reasons why he believes his diabetes is related to his active duty service, as well as has only contended his erectile dysfunction is related to conditions he is not service-connected for. As the Veteran has a diagnosis of diabetes mellitus, the Board has also considered presumptive service connection or service connection based on a continuity of symptomatology. However, there is no evidence that the Veteran had diabetes that manifested within one year after discharge from service. To the extent that the Veteran asserts that he experienced diabetes continuously since discharge from service, the Board again notes that the Veteran has provided no evidence showing treatment for diabetes until 2016, over 20 years after his active duty service, and thus his lay statements are not credible. In light of the foregoing, the Board concludes that the preponderance of evidence is against the claims and the benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). REASONS FOR REMAND Although the Board regrets further delay, additional development is required prior to adjudication of the Veteran’s remaining claim. Entitlement to Service Connection: Right Hip Osteoarthritis The Veteran contends that his right hip osteoarthritis is related to his active duty service, to include as due to or related to his service-connected lumbar spine disability. The Board finds that the Veteran has not been afforded a VA examination for the claimed condition. VA’s duty to assist includes providing a medical examination and obtaining an opinion when it is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d) (2012); 38 C.F.R. § 3.159 (2019). Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of a diagnosed disability or symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The threshold for finding a link between a current disability and service so as to require medical examination is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon, 20 Vet. App. at 83. Here, the evidence of record shows the Veteran has been diagnosed with osteoarthritis of the right hip. Further the Veteran is service-connected for degenerative arthritis of the lumbar spine with intervertebral disc syndrome (IVDS). Given the above, the Board finds that a remand is required in order to obtain an examination with an opinion on the etiology of the claimed condition.  McLendon v. Nicholson, 20 Vet. App. 79 (2006).     The matters are REMANDED for the following action: 1. Obtain and associate with the electronic file any outstanding VA treatment records relevant to the Veteran’s claim. 2. Then, schedule the Veteran for a VA examination with an appropriate examiner to determine the etiology of the Veteran’s right hip osteoarthritis.  The examination may be conducted via telehealth or similar service during the social distancing restrictions of the COVID-19 pandemic.  The record and a copy of this Remand must be made available to the examiner.    (a) Is it at least at least as likely as not (50 percent probability or more) that the Veteran’s right hip condition is due to his service-connected lumbar spine disability?    (b) Is it at least as likely as not (50 percent probability or more) that the Veteran’s right hip condition is aggravated by his service-connected lumbar spine disability, to include any abnormal gait caused by the condition and/or medications taken for the condition?  “Aggravation” is defined as any worsening beyond the natural progression of the disability.    (c) If the Veteran’s right hip condition is NOT related to his service-connected disability, then is it at least as likely as not (50 percent probability or more) that the Veteran’s right hip condition is related to his period of active service? In offering any opinion, the examiner must consider the full record, to include the lay statements regarding in-service incurrence, and the opinion should reflect such consideration.  A clearly-stated rationale for any opinion offered should be provided and must not be based solely on the lack of any in-service records.    If the examiner is unable to provide an opinion without resort to speculation, he or she should explain whether the inability is due to the limits of the examiner’s medical knowledge, medical knowledge in general or there is evidence that, if obtained, would permit the opinion to be provided.   JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Negron, 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.