Citation Nr: 21065225 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 19-22 595 DATE: October 25, 2021 ORDER Entitlement to service connection for vasectomy, secondary to service-connected bipolar disorder with depression and anxiety is denied. FINDING OF FACT The preponderance of the evidence is against a finding that vasectomy is caused or aggravated by a service-connected disease or injury. CONCLUSION OF LAW The criteria for service connection for vasectomy, secondary to service-connected bipolar disorder with depression and anxiety have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1991 to March 1994. This case initially came to the Board of Veterans' Appeals (Board) on appeal from a February 2018 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO), which denied entitlement to service connection for PTSD, sleep apnea, and vasectomy. In March 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the record. In May 2021, the Board remanded the matter for further evidentiary development. While in remand status, in a July 2021 rating decision, the RO granted service connection for sleep apnea and assigned a 50 percent rating, effective December 18, 2017. The RO also granted service connection for erectile dysfunction and assigned a noncompensable rating, effective March 2, 2021. The grant of service connection for sleep apnea and erectile dysfunction constitutes a full award of the benefits sought on appeal with respect to those issues. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997) (holding that a separate notice of disagreement must be filed to initiate appellate review of downstream elements such as the disability rating or effective date assigned). The record currently available to the Board contains no indication that the Veteran initiated an appeal with the initial ratings or effective dates assigned for sleep apnea and erectile dysfunction disabilities. Thus, those matters are not in appellate status. 1. Vasectomy Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The Veteran contends that his vasectomy is secondary to his service-connected bipolar disorder with depression and anxiety. Specifically, he asserts that his bipolar disorder caused high risk behavior including premarital sex, which resulted in his desire to prevent children outside of marriage that he could not support due to his manic behavior. See March 2021 Hearing Transcript. For the following reasons, the Board finds that service connection for vasectomy is not warranted. In support of his claim, the Veteran was afforded a VA examination in January 2018. The examiner opined that the Veteran's vasectomy was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that the Veteran's records were thoroughly reviewed, and there was no mention of need for vasectomy because of depression in his mental health notes or his mental health C&P exam. The examiner further explained that all the urology notes pertaining to his vasectomy indicate that it is being done for "permanent contraception". The examiner noted that nothing is mentioned about depression being a reason. Having a vasectomy, which is often permanent, is a very conscious decision. The examiner further noted that if an individual were having it done for anything but contraception or disease condition, a provider would likely not perform the procedure. The examiner concluded that the consent form is very clear on purpose of the procedure and potential complications, and there is no evidence to support that the Veteran underwent vasectomy due to his depression. In July 2021 the Veteran was afforded a VA telehealth examination. The examiner opined that the Veteran's vasectomy was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that vasectomy is an elective contraceptive procedure. The Veteran made a conscious decision to have the procedure as he attested today that he did not want to have any more children which was the indication for this procedure. The examiner noted that vasectomy stated is not secondary to anxiety/depression or bipolar disorder. The examiner further noted that neither is anxiety/depression or bipolar disorder aggravating vasectomy. As the January 2018 and July 2021 VA examiners explained the reasons for their conclusions based on an accurate characterization of the evidence, to include consideration of the Veteran's lay statements, their opinions are entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning; threshold considerations are whether the person opining is suitably qualified and sufficiently informed). Moreover, there is no contrary medical opinion in the evidence of record. In addition, although the Veteran explained that he had sought the vasectomy due to concerns about his behavior due to his service-connected psychiatric disorder, the medical opinions considered these lay statements and found that, based on the consent form and the nature of the procedure, it was not likely performed by the medical provider on this basis. Moreover, although inclusion of the issue of entitlement to service connection for erectile dysfunction as part of this claim was discussed during the hearing, service connection was subsequently granted for this disability and therefore need not be addressed in connection with this claim. (Continued on the next page) For the reasons and bases set forth above, the preponderance of the evidence is against the claim of service connection for vasectomy, secondary to service-connected bipolar disorder with depression and anxiety. The benefit of the doubt doctrine is therefore not for application and the claim must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Walker, 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.