Citation Nr: 21066421 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 15-03 929A DATE: November 1, 2021 ORDER Service connection for erectile dysfunction is denied. FINDINGS OF FACT 1. The probative evidence of record does not show that the Veteran's erectile dysfunction is related to his active-duty service. 2. The probative evidence of record does not show that the Veteran's erectile dysfunction is related to or aggravated by his service-connected disease or injury (Unspecified Trauma and Stressor Related Disorder). CONCLUSION OF LAW The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310, 3.317, 3.320. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from November 18, 1968 to December 31, 1969 and received a discharge Under Honorable Conditions. He also has intermittent periods of active-duty service in the National Guard and Air Force Reserves between 2001-2011. Many of these periods are short durations. The Veteran performed active-duty service with the Army National Guard from January 5, 2002 to July 2, 2002 and with the Air Force Reserves from April 3, 2005 to April 2, 2006. The Veteran retired from the Air Force Reserve in 2012. 1. Service connection for erectile dysfunction. The Veteran seeks service connection for erectile dysfunction based on receiving the anthrax or other in-service vaccinations, on exposure to burn pits, or as a secondary condition related to his service-connected Unspecified Trauma and Stressor Related Disorder. The Veteran initially filed his claim on April 12, 2012 for service connection for erectile dysfunction "secondary to depression." Subsequently, the Veteran was granted service connection for "Unspecified Trauma and Stressor Related Disorder (Claimed as any Psychiatric Condition to Include Depression)." Other evidence in the record suggests a theory of entitlement related to in-service vaccinations or exposure to burn pits in Southwest Asia. The Veteran's service treatment records do not contain entries for complaints of erectile dysfunction during service nor do they contain entries for injuries or complaints related to vaccinations or burn pit exposure. Following an earlier remand, an April 16, 2021 Supplemental Statement of the Case addressed the possible etiology related to vaccinations or burn pit exposure noting that medical examinations and opinions in October 2020 and April 2021 respectively concluded the Veteran's erectile dysfunction is less likely than not related to an in-service injury or event including vaccination or burn pit exposure. On July 7, 2021, the Board most recently remanded the Veteran's claim for erectile dysfunction to include as secondary to his unspecified trauma and stressor-related disorder. The agency of original jurisdiction (AOJ) has substantially complied with the Board's remand instructions with respect to the erectile dysfunction, so the Board may proceed to the merits. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999)(noting that Stegall requires substantial compliance with remand orders, rather than absolute compliance). Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show: (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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010)(quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after service 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). Secondary service connection may be granted for any disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a); see Allen v. Brown, 7 Vet.App. 439, 448 (1995) (allowing secondary service connection for aggravation of non-service-connected condition by service-connected disability.). On remand, the AO obtained a medical opinion dated August 12, 2021 concluding, "Veteran's erectile condition is multifactorial, with the primary etiology being a long-time current smoker. [I]f the etiology was purely psychological (due to unspecified trauma/stressor related disorder) Cialis would have worked, because he wouldn't have any underlying blood flow issues." This opinion is consistent with others in the record in that it attributes the likely etiology of the Veteran's erectile dysfunction to other risk factors such as obesity and heavy smoking. The record contains vague, conclusory submissions by two private physicians (received on April 3, 2012 and June 28, 2013, respectively). One doctor opined, the Veteran may have knee pain, back pain, erectile dysfunction, and sleep disorder caused by carrying heavy equipment and anthrax poisoning. The other reported that he was treating the Veteran for erectile dysfunction "possibly" related to his military service. The Board appreciates the care provided by these practitioners Veterans such as the claimant, and it has considered this favorable evidence to support the claim. However, in the context of this appeal, this evidence has limited probative weight. A medical opinion obtains probative weight from "factually accurate, fully articulated, sound reasoning for the conclusion." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). These submissions lack rationale and they do not support their respective conclusions with analysis that the Board can consider and weigh against contrary opinions. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). When compared the rationale supporting the conclusions discussed above, the Board finds the probative value of the private medical opinions to be outweighed by those of the VA examiners. The Veteran's lay testimony recalls that a physician one told him that his erectile dysfunction may be related to his military service. This hearsay medical evidence cannot constitute actual medical evidence, as "the connection between what a physician said and the layman's account of what he purportedly said, filtered as it was through a layman's sensibilities, is simply too attenuated and inherently unreliable to constitute 'medical' evidence." See Robinette v. Brown, 8 Vet. App. 69 (1995). (Continued on the next page) The supported, first hand medical opinions in this case conclude that the Veteran's erectile dysfunction is less likely than not incurred in or caused by the claimed in-service injury, event, or illness and less likely than not proximately due to or the result of the Veteran's service-connected condition (unspecified trauma and stressor-related disorder). Erectile dysfunction is not an undiagnosed illness or a medically unexplained chronic multi-symptom illness that would be subject to a presumption of service-connection due to the Veteran's service in the Persian Gulf. 38 C.F.R. §3.317. Erectile dysfunction is not a chronic respiratory condition that is presumed service-connected due to exposure to particulate matter from burn pits. 86 F.R. 42724 (August 5, 2021)(amending 38 C.F.R. § 3.159 and adding 38 C.F.R. §3.320). RAY BARTO SLABBEKORN, JR. Veterans Law Judge Board of Veterans' Appeals 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.