Citation Nr: 21063606 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 10-21 803 DATE: October 14, 2021 ORDER Entitlement to service connection for sterility, to include as secondary to service-connected disabilities including right inguinal hernia and right inguinal hernia repair, is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had a diagnosis of sterility at any time during or approximate to the appeal period. CONCLUSION OF LAW The criteria for service connection for sterility, to include as secondary to service-connected disabilities including right inguinal hernia and right inguinal hernia repair, have not been met. 38 U.S.C. §§ 1131, 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 U.S. Army from October 1984 to October 1987. This matter is before the Board of Veterans' Appeals (Board) on appeal from a June 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this matter in December 2013, September 2017, and March 2021 for additional development. As the actions specified in the most recent remand have been substantially completed, the case has been properly returned to the Board for appellate consideration. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998). Duties to Notify and Assist Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159. Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection may be established on a secondary basis for a disability which is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). Entitlement to service connection for sterility, to include as secondary to service-connected disabilities including right inguinal hernia and right inguinal hernia repair The Veteran alleges carrying a heavy backpack and a bazooka during training which made his groin swell, causing a right inguinal hernia. He indicated that prior to his right inguinal hernia repair he was warned by the surgeon that the risks included possible sterility. He additionally alleges that prior to the surgery he was personally assaulted by four servicemembers. The Veteran further alleges that the sexually transmitted diseases (STDs) he developed during service caused his sterility. He stated that he has not fathered any children and has been unable to have children with a partner who has had children with another partner. The Veteran is service-connected for a right inguinal hernia, status post repair and an inguinal hernia repair scar. The Veteran's service treatment records (STRs) from October 1984 indicate that he complained of groin pain. November 1984 STRs from an STD clinic state that the Veteran complained of experiencing clear penile discharge for a month. February 1985 STRs diagnosed a right inguinal hernia. STRs from March 1985 included an operative report which indicated that the Veteran complained of an intermittent right groin bulge since January 1985. A right inguinal hernia repair was performed, and an indirect inguinal hernia was discovered. The sac was ligated and a ringplasty was performed. The Veteran's condition upon discharge was noted as good and he was placed on temporary physical profile. October 1985 STRs documented that the Veteran complained of dysuria and white discharge, and lab findings indicated that he had syphilis. STRs from February 1986 indicate that the Veteran complained of genital itching and crabs, and crab lice was diagnosed. STRs from July 1986 indicated that the Veteran developed a rash, yellow discharge and discomfort while urinating. He noted recently having sex. A January 2014 VA examination by a VA resident physician indicated that he reviewed the Veteran's claims file. He reviewed the Veteran's medical history and indicated that the Veteran refused to have a physical examination until a semen analysis was conducted to determine his fertility status. A December 2015 semen analysis by a private lab displayed forwardly progressive motility and a 64 percent viability stain. A September 2019 semen analysis by a private lab indicated poor sperm motility and suggested a repeat analysis within 3 to 4 days to confirm results. A September 2019 VA examination by a VA physician indicated that she reviewed the Veteran's claims file and stated that the Veteran declined a physical examination and reported normal anatomy with no testicular deformities or abnormalities. She additionally stated that the Veteran did not have a voiding dysfunction. The September 2019 VA physician opined that the September 2019 semen analysis revealed a diagnosis of poor sperm motility, and she explained that poor sperm motility is diagnosed when less than 32 percent of the sperm can move efficiently. She opined that the Veteran's claimed sterility was less likely than not proximately due to or the result of the Veteran's right inguinal hernia repair, as there is no anatomical, physiological, pathological, biomechanical, physiogenic, or neurological connection between an inguinal hernia repair and the development of the male reproductive system. The September 2019 VA physician explained that there are multiple causes for poor sperm motility such as age, testicular damage, long-term use of anabolic steroids, and other drug use. A May 2020 addendum opinion by the September 2019 VA physician indicated that she additionally reviewed the Veteran's December 2015 semen analysis which showed 64 percent sperm viability. She noted that while the September 2019 sperm analysis displayed poor sperm motility, in otherwise healthy sperm, pregnancy with low sperm motility can occur. The September 2019 VA physician also noted that the Veteran's progressive motility score was 3, and the normal range was 3 or 4. She concluded that there was therefore no evidence of sterility, and she opined that the Veteran's claimed sterility condition was less likely than not proximately due to or the result of the Veteran's right inguinal hernia repair, as there is no anatomical, physiological, pathological, biomechanical, physiogenic, or neurological connection between an inguinal hernia repair and the development of the male reproductive system. A May 2021 VA examination by a VA nurse practitioner indicated that she reviewed the Veteran's claims file and conducted a physical examination. The Veteran stated that over the years his erections have weakened and there has been an increase in urinary frequency and leakage. A physical examination of the Veteran's penis, testis, and epididymis indicated normal results. The May 2021 VA nurse practitioner indicated that she did not examine the Veteran's prostate as it was not relevant to the Veteran's claimed condition. She noted that the Veteran had a voiding dysfunction which causes urinary frequency, and she stated that the relevant evidence included a September 2019 semen analysis which showed poor sperm motility and suggested a repeat analysis. The May 2021 VA nurse practitioner stated that she was unable to confirm a current chronic diagnosis with the available records or with her physical examination, and therefore the Veteran's claimed condition was less likely than not incurred in or caused by his military service or proximately due to or the result of his service-connected condition. After reviewing the evidence of record, the Board finds the most probative medical evidence of record to be the May 2020 addendum opinion by the September 2019 VA physician, in which the September 2019 VA physician opined that the Veteran does not have a diagnosis of sterility. The September 2019 VA physician provided a fully-articulated conclusion adequately supported by medical rationale and citations to the Veteran's claims file and medical history. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 300 (2008) (holding that conclusions that are factually accurate, fully articulated, and contain sound reasoning contribute to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (stating that the physician's access to the claims folder and the Veteran's history, and the thoroughness and detail of the opinion, are important factors for assessing the probative value of a medical opinion). The May 2020 addendum opinion by the September 2019 VA physician reviewed the relevant evidence in the Veteran's claims file, specifically both the December 2015 and September 2019 semen analyses. She stated that the Veteran's December 2015 sperm analysis showed 64 percent sperm viability, and she noted that while the September 2019 sperm analysis displayed poor sperm motility, in otherwise healthy sperm, pregnancy with low sperm motility can occur. The September 2019 VA physician also noted that the Veteran's progressive motility score was 3, and the normal range was 3 or 4. She concluded that there was therefore no evidence of sterility. While the Veteran contested the September 2019 VA physician's assertion that he declined a physical examination, a subsequent physical examination of the Veteran's penis, testis, and epididymis by the May 2021 VA nurse practitioner displayed normal results. The Board therefore finds that a new physical examination is not necessary in order to determine this decision. Furthermore, the Veteran's STRs do not contain a sterility diagnosis, his December 2015 and September 2019 semen analyses do not contain a sterility diagnosis, his January 2014 and May 2021 VA medical examinations do not contain a sterility diagnosis, and the Veteran has not presented any medical records diagnosing sterility. The Board has considered the Veteran's lay contentions, but he lacks the training and credentials to provide a competent opinion as to a medical diagnosis or etiology. His lay opinion accordingly does not constitute competent and probative evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. § 1110; see also 38 C.F.R. § 3.310. Thus, where, as here, competent, probative evidence establishes that the Veteran does not have the sterility disability for which service connection is sought, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In sum, the most probative evidence shows that the Veteran does not have a current sterility disorder, nor has he been diagnosed with such disability during or approximate to the appeal period. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (disallowing service connection where there was no current disability). See also McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). As such, service connection for sterility, to include as secondary to service-connected disabilities including right inguinal hernia and right inguinal hernia repair, must be denied because the first essential criterion for an award of service connection-evidence of a current disability upon which to predicate such an award-has not been met. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ahuva D. Sunshine 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.