Citation Nr: 21061531 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 09-49 168 DATE: October 4, 2021 ORDER Entitlement to service connection for impotence, to include as secondary to service-connected hypertension, is granted. REMANDED Entitlement to service connection for a right foot disorder is remanded. Entitlement to service connection for a left foot disorder is remanded. FINDING OF FACT The Veteran's impotence is proximately due to his service-connected hypertension. CONCLUSION OF LAW The criteria for service connection for impotence as secondary to service-connected hypertension are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from April 1974 to October 1980. The Veteran testified at a hearing before a member of the Board of Veterans' Appeals (Board) in December 2010, and a transcript of the hearing is of record. The Acting Veterans Law Judge (VLJ) that conducted the hearing is no longer employed at the Board. Pursuant to 38 C.F.R. § 7107(c) and 38 C.F.R. § 20.707, the Veteran elected to testify before a new VLJ. The Veteran testified before the undersigned VLJ in May 2019. In general, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or a disease incurred or aggravated in the line of duty during active military service. This means that the facts establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces or, if preexisting such service, was aggravated therein. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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 disease or injury in service and the current disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. However, VA will not concede aggravation unless the baseline level of severity of the non-service-connected disease is established by medical evidence. 38 C.F.R. § 3.310(b). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical evidence. VA must also consider all favorable lay evidence of record. See 38 U.S.C. § 5107(b). The Veteran is competent to report on that of which he has actually observed and is within the realm of his personal knowledge. See Layno v. Brown, 6 Vet. App. 465 (1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Board acknowledges that the Veteran has a current diagnosis of erectile dysfunction. See November 2018 VA Male Reproductive Systems Conditions Disability Benefits Questionnaire (DBQ). Therefore, the only question for the Board is whether the current disability was caused by his active service or is proximately due to, or aggravated by, his service-connected disabilities. The Veteran's service treatment records (STRs) are silent for any impotence issues. The Board notes that there are extensive post service treatment records addressing the Veteran's impotence. These records clearly establish that the Veteran suffers from erectile dysfunction throughout the appeal. In a May 2014 VA examination, the examiner confirmed a diagnosis of erectile dysfunction with an onset date in 1993. Here, the examiner opined that it was less likely than not that the Veteran's condition was due to hypertension. See May 2014 Male Reproductive System Conditions Disability Benefits Questionnaire (DBQ). In a November 2018 VA examination, the examiner opined that the Veteran's condition was a result of his tumor and the removal of the tumor. See November 2018 VA Male Reproductive System Conditions DBQ. In January 2020, a new VA medical opinion was obtained to determine service connection. Here, the examiner opined that the Veteran's condition was less likely than not related to his active duty. Furthermore, it is less likely than not that the Veteran's condition is due to his narcolepsy and/or hypertension. The examiner opined that it was more likely than not a result of his resection of his pituitary adenoma and resultant hypogonadal. See January 2020 VA Addendum. Unfortunately, the Board finds the above medical opinions inadequate as the examiners failed to provide a sufficient rationale for the medical opinions. In addition, the above medical opinions failed to opine whether the Veteran's erectile dysfunction was caused or aggravated by his narcolepsy or hypertension with an adequate rationale. In July 2021, a new VA medical opinion was obtained for the Veteran's erectile dysfunction. Here, the examiner opined that it was at least as likely as not that the Veteran's condition was proximately due to or the result of the Veteran's service-connected hypertension. In support of the opinion, the examiner stated that it is well known that hypertension may result in impotence (erectile dysfunction) due to damage to the walls of the arteries which reduces blood flow. See July 2021 VA Medical Opinion DBQ. Based on a thorough review of the claims file, the Board finds that the evidence of record is at least in equipoise as to whether the Veteran's impotence related to his service-connected hypertension. Resolving all doubt in the Veteran's favor, the Board finds the July 2021 VA medical opinion and the record meet all material elements of the claim for secondary service connection, and secondary service connection for impotence is warranted. REASONS FOR REMAND Unfortunately, the Board finds a remand is necessary for the Veteran's claims for service connection for right foot disability and left foot disability (bilateral foot disability). Specifically, the prior April 2021 Board remand directed the RO to obtain a new VA medical opinion to ascertain the nature and etiology of the Veteran's bilateral foot condition. The examiner was directed to provide an opinion on whether it is at least as likely as not that the Veteran's condition had its onset in or is related to active service. The examiner was directed to address the Veteran's lay statements. In the July 2021 VA medical opinion obtained in accordance with the April 2021 Board remand, the examiner failed to address the Veteran's lay statements. Accordingly, the July 2021 VA medical opinion does not fulfill the Board remand directives, and the issues must be remanded in order to fully comply with those directives as outlined in the April 2021 remand. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: The RO must obtain a VA medical opinion for the Veteran's bilateral foot conditions. The examiner is asked to specifically address the following, with a full rationale provided: For each diagnosed right and left foot disorder, to include calluses and arch abnormalities, whether it is at least as likely as not (at least an approximate balance of positive and negative balance) that the Veteran's bilateral foot disability had its onset in or is related to active service. The examiner is directed to address and discuss the Veteran's lay statements. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Glaeser, Jennifer 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.