Citation Nr: 21004485 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 07-31 100A DATE: January 27, 2021 ORDER Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected psychiatric disorder is denied. FINDINGS OF FACT The preponderance of the competent medical evidence is against a finding that the Veteran’s currently diagnosed erectile dysfunction was caused or aggravated as secondary to his service-connected PTSD. CONCLUSIONS OF LAW The criteria for service connection for erectile dysfunction, to include as secondary to the Veteran’s service-connected PTSD, have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from May 1970 to November 1972. The Veteran presented sworn testimony at a hearing before the undersigned in July 2013. In January 2019 and October 2020, the Board remanded this issue for additional development. Service Connection Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA’s policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.303(a). Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by an established service-connected disability. 38 C.F.R. § 3.310 (2015); see also Allen v. Brown, 7 Vet. App. 439 (1995). Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected psychiatric disorder At the July 2013 Board hearing, the Veteran testified that he believed he developed erectile dysfunction as a result of medication he was given to treat his psychiatric conditions. See July 2013 Board Hearing Transcript at 12. As previously noted, the Board remanded this issue for additional development, to include a new VA examination and opinion that would address secondary service connection. See January 2019 Board remand. The December 2019 VA examiner provided a negative nexus opinion; however, the examiner did not provide adequate reasoning to support his opinion. Accordingly, the Board again remanded this issue in October 2020. See October 2020 Board Decision. The Veteran has a current diagnosis of erectile dysfunction. See December 2019 Male Reproductive Organ Conditions DBQ. In October 2020, the VA examiner provided an addendum opinion. The October 2020 VA examiner opined that it is less likely than not that his erectile dysfunction was caused or aggravated beyond its natural progression by his service-connected disabilities to include medications used to treat his psychiatric disability. The examiner acknowledged the medical literature does indicate the Veteran has comorbid conditions to include PTSD and obstructive sleep apnea (OSA) that are contributing factors for the development of erectile dysfunction. This also includes the medications used to treat his PTSD/psychiatric conditions. However, the examiner reasoned, that the medical literature indicates that the best predictors of erectile dysfunction in ranking order are: diabetes, hypertension, obesity, dyslipidemia, cardiovascular disease and smoking all which Veteran has. The examiner considered all of the Veteran’s other risk factors which include hypertension (includes medications to treat), smoking history, alcohol dependence, hyperlipidemia, diabetes, cannabis use, and older age. He noted, that while the Veteran may not currently smoke, use cannabis, or alcohol, those conditions are contributing factors and must be considered in the overall determination of possible cause. The examiner noted, the Veteran has many risk factors for the development of erectile dysfunction most of which are not conditions for which service connection has been established. The examiner opined that the evidence presented cannot specifically indicate his erectile dysfunction was caused or aggravation beyond its normal progression by his service-connected conditions to include medications. The examiner noted that the timeframe of the Veteran’s erectile dysfunction diagnosis was April 2006. See June 2007 Medical Record The record shows the Veteran was evaluated by urology in 2007. However, the evaluation did not give an indication as to the etiology of his erectile dysfunction. The October 2020 VA examiner noted that the presence of co-morbid conditions are associated with a higher risk for the development of erectile dysfunction. As previously mentioned in the December 2019 opinion, erectile dysfunction is multifactorial. The examiner stated that the lowest prevalence was noted in men without chronic medical problems who engaged in healthy behaviors. However, in obese men with erectile dysfunction, weight loss and increased physical activity are associated with an improvement in erectile function in approximately one-third of patients. Additional risk factors for erectile dysfunction include the presence of risk factors for coronary heart disease such as smoking, obesity and dyslipidemia. He noted that the best predictors of erectile dysfunction are diabetes mellitus, hypertension, obesity, dyslipidemia, cardiovascular disease, smoking, and medication use. To the extent that the Veteran has asserted that his diagnosed erectile dysfunction has a nexus to his service-connected disability, he is not competent to diagnose or directly link any current disability to service, to include as secondary to service-connected conditions or medications used to treat them, as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran’s own opinion is nonprobative evidence. As such, at this time, there is no competent evidence of a nexus between the Veteran’s erectile dysfunction, to include as secondary psychiatric disability. Therefore, the preponderance of the evidence is against the claim. The Veteran has submitted no competent evidence to contradict the October 2020 VA medical opinion. For all the reasons laid out above, the Board finds that the preponderance of the evidence is against the claim for service connection for erectile dysfunction, to include as secondary to PTSD. As the preponderance of the evidence is against the claim for service connection, the benefit-of-the-doubt doctrine does not apply, and the claim for service connection is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jacquelynn M. Jordan, 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.