Citation Nr: 21069754 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 18-33 021 DATE: November 19, 2021 ORDER Entitlement to service connection for erectile dysfunction (ED), to include as secondary to service-connected disabilities, is denied. FINDING OF FACT Erectile dysfunction did not develop in service and is not otherwise etiologically related to service, and was not caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction are not met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.303, 3.310 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from April 1978 to November 1978 and from October 2003 to April 2005 This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in February 2020. A transcript of that hearing has been added to the record. This case was previously before the Board in May 2020, at which time it was remanded for additional development. The case has now been returned to the Board for further appellate action. Service Connection - Erectile Dysfunction The Veteran first filed for ED in October 2014. The Veteran contends that his ED was caused by the medications he takes for his service-connected PTSD, mechanical low back pain, and lumbar radiculopathy of the bilateral lower extremities. Service treatment records are silent for complaints of, or treatment for, ED. The Veteran left the service for the first time in 1978. The first documented complaints of ED occur in an August 2001 medical record. That record also includes prostate complaints. However, there is no indication from the record as to when the Veteran's ED actually began. The records specify that the Veteran should continue taking Viagra. At his February 2020 Board hearing, the Veteran indicated that he first had problems with ED beginning in 2012. The medical evidence of record contradicts that claim. The Veteran further indicated at the hearing that he believed his prescribed PTSD anti-depressants and Gabapentin were the cause of his ED. It was noted that the Gabapentin was prescribed for his service-connected back and leg conditions. The Veteran underwent a VA examination in May 2018 for his ED. While the May 2020 Board decision found that examination to be inadequate for failing to address the Veteran's contentions regarding his medications being a causative factor in his development of ED, the examination report can be instructive in other ways. At that time, the Veteran reported that he experienced difficulty achieving and maintaining an erection. The examiner confirmed a diagnosis of ED. The examiner opined that the Veteran's ED was less likely as not proximately due to, or the result of one of the Veteran's service-connected disabilities. In so finding, the examiner noted that none of the conditions are medically related to ED, and the claimed ED was a separate entity without medical literature supporting a relationship to any of the service-connected disabilities. The examiner found that the Veteran's ED was as likely as not attributable to the nonservice-connected disabilities of epididymitis, epididymo-orchitis, prostate hypertrophy, and prostatitis. Also of record is a February 2020 treatment note by the Veteran's VA Medical Center treatment provider. At that time, it was noted that the Veteran was requesting a letter stating that prescribed Gabapentin and Bupropion caused his ED. However, the treatment provider noted that ED was not a commonly reported adverse effect of Bupropion, and further noted that incidence of sexual dysfunction with Bupropion was generally lower than with other selective serotonin reuptake inhibitors (SSRIs). The treatment provider also noted that ED was not a commonly reported adverse effect of Gabapentin. The treatment provider further noted that both medications also had low incidences for reporting decreased libido, and that while low libido should not be confused with ED, the two conditions could co-exist. In June 2020, VA addendum medical opinions were obtained. Based on a thorough review of the claims file, the examiner found that the Veteran's ED was less likely as not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the VA examiner noted that STRs were negative for complaints of ED during the Veteran's active service. Further, the examiner cited to the 2001 medical record noting a diagnosis of ED, which was not during a period of active service. The examiner also opined that it was less likely as not that the Veteran's ED was proximately due to, the result of, or aggravated by a service-connected disability, to include medication prescribed for such. In so finding, the examiner noted that the medical records showed a diagnosis of ED in 2001, which was prior to the Veteran being prescribed any medications for PTSD, mechanical low back pain, or lumbar radiculopathy. The examiner further noted that the medical evidence did not support a finding of aggravation as the Veteran was shown to have been prescribed Sildenafil as recently as February 18, 2020, indicating that the medication remained effective and continued to produce results. As such, there was no aggravation by other disabilities or medication prescribed for treatment of such. The Board finds that the May 208, February 2020, and June 2020 medical opinions are adequate, especially when read in conjunction with one another. In this regard, the examiners thoroughly reviewed and discussed the relevant evidence, considered the contentions of the Veteran, and provided a supporting rationale for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Further, there are no medical opinions of record to the contrary. As such, the VA medical opinions are the most probative evidence of record. While the laypersons are competent to report observable symptoms, the Veteran is not competent to provide a medical opinion linking his ED to a service-connected disability, or medication prescribed for such. A medical opinion of that nature would require medical knowledge, training, and expertise and would not be capable of lay observation. As such, a medical opinion of that nature is simply outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Veteran is not competent to provide an etiology opinion in this case. Accordingly, the Board finds that the preponderance of the evidence is against the claim, and entitlement to service connection for ED is not warranted. 38 U.S.C. § 5107 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Andrew Ledman II 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.