Citation Nr: 21001806 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 14-36 096 DATE: January 11, 2021 ORDER Entitlement to service connection for erectile dysfunction is denied. FINDING OF FACT The preponderance of evidence does not support a finding that the Veteran’s erectile dysfunction was not incurred in service or that the condition was proximately caused or proximately aggravated by his service-connected disabilities, including posttraumatic stress disorder, a low back disability, hypertension, hypertensive heart disease, and herpes. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction due to service or service-connected disability, including posttraumatic stress disorder, a low back disability, hypertension, hypertensive heart disease, and herpes, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from October 1987 to October 1990, and from January 1991 to May 1991. This appeal comes before the Board of Veterans’ Appeals (Board) from a July 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. In February 2018, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge sitting at the Central Office in Washington, D.C. A transcript of the hearing is available in the record. This matter has previously come before the Board. In August 2020, the Board remanded this issue for medical opinions addressing whether the Veteran’s condition was caused or aggravated by his service-connected disabilities. Subsequently, an addendum medical opinion was prepared by the examiner who performed the Veteran’s previous VA examination. Thus, the Board finds that its remand instructions were substantially complied with. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for erectile dysfunction (ED) is denied. The Veteran seeks service connection for ED, arguing that the condition was caused or aggravated by medications he takes for his service-connected disabilities, or by the disabilities themselves. 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). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. Id. At his hearing before the Board, the Veteran testified that he has suffered from an ED condition for approximately 13 or 14 years (early 2000s). The Veteran argued that he believed the condition arose due to medication he takes for his multiple service-connected disabilities, or from the disabilities themselves. See February 2018 Hearing Transcript. The Veteran is competent to report the occurrence of lay-observable events such as symptoms or certain readily-observable disabilities. 38 U.S.C. § 1153(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, the Veteran is not competent to diagnose his own medical condition. Nonetheless, the Board finds the Veteran’s statements about his observations of his symptoms to be credible and probative. In September 2016, the Veteran provided VA with a letter from a private doctor. The doctor indicated it was “possible” that the Veteran’s ED arose due either to medication he took for hypertension, or to the effects of the high blood pressure itself. See September 2016 Medical Treatment Record – Non-Government Facility. In July 2019, the Veteran underwent a VA examination for his ED. The examiner confirmed an ongoing diagnosis of ED. The Veteran described symptoms for approximately 16 years, for which he had not sought treatment by a urologist nor taken any medications. The examiner indicated review of the Veteran’s private medical records, including the letter submitted from the private doctor in September 2016. Lab results conducted at the time of the examination showed a low testosterone count. The examiner indicated that the Veteran’s ED was therefore caused by hypogonadism, which had not been previously detected, as the Veteran had not previously undergone urology treatment. The examiner stated that the Veteran’s medical records did not show any previous history of a low testosterone level. See July 2019 Compensation and Pension (C&P) Examination. In November 2020, the same VA examiner completed an addendum / clarification questionnaire following the previous Board remand. The examiner wrote an opinion that it was less likely than not (less than 50 percent probability) that the Veteran’s ED was caused or aggravated by his service-connected conditions. The examiner acknowledged the letter from the Veteran’s private doctor, and explained that the Veteran’s hypertension condition preceded the diagnosis of ED by decades, which did not support that the medications nor the hypertension caused or aggravated ED. The Veteran’s other service-connected conditions, including a low back disability, PTSD and herpes, are not causal for ED. Further, the Veteran was not on any medications for his posttraumatic stress disorder (PTSD) which would cause secondary ED from antidepressant side effects. The Veteran’s only other medication for his service-connected back pain was Motrin, which was not known to have a side effect of ED. The examiner explained that the Veteran’s ED was likely caused by the hypogonadism state with low testosterone, which was found in July 2019. However, the Veteran’s decreased testosterone level was also not aggravated by his service-connected disabilities. See November 2020 C&P Examination. The Board finds the examiner’s addendum opinion to be highly probative based on its thorough discussion of the Veteran’s conditions, medications, and medical history. The Veteran’s diagnosis of ED satisfies the first requirement for service connection as secondary to another service-connected disability. The second Allen v. Brown requirement is evidence that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. The Board concludes that the preponderance of evidence does not support a finding that the Veteran’s condition was proximately caused or proximately aggravated by his service-connected disabilities. No medical opinion of record has affirmatively linked the Veteran’s ED to any of his service-connected disabilities. The private opinion provided in September 2016 indicates that such a connection is “possible,” but the private doctor did not establish that any disability proximately caused or aggravated the Veteran’s ED. The private opinion is speculative and has no probative value with regarding to whether ED is caused or aggravated by a service-connected disability. The Board finds the VA examiner’s opinion that that ED is due to hypogonadism to be more probative. The examiner’s probative opinion concluded that hypergonadism was not identified until decades after military service, and it is not caused or aggravated by any of the Veteran’s service-connected disabilities. The opinion concluded that ED is not caused or aggravated by a service-connected disability. Accordingly, the second Allen v. Brown requirement is not satisfied. (Continued on the next page)   The Veteran’s service treatment records are silent for any history of ED during military service, and the Veteran has asserted that his condition arose at least 10 years after his last period of active service. Therefore, service connection cannot be granted on a direct basis, as the second Hickson v. West requirement has not been satisfied. As the preponderance of evidence weighs against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim for service connection, to include on a secondary basis, is denied. 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.