Citation Nr: 21071903 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 16-32 862 DATE: December 1, 2021 ORDER Service connection for nocturia is granted. Service connection for erectile dysfunction is granted. FINDINGS OF FACT 1. The evidence is in relative equipoise as to whether the Veteran has chronic nocturia with onset during his active service. 2. The evidence is in relative equipoise as to whether the Veteran's erectile dysfunction occurred during his active service or was caused by his service connected hypertension. CONCLUSIONS OF LAW 1. The criteria for service connection for nocturia have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 2. The criteria for service connection for erectile dysfunction have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1989 to June 2012. He filed service connection for nocturia and erectile dysfunction (ED), among other claims in April 2012 while he was still in service. A Board decision in June 2019 found that VA medical opinions on the etiology of the Veteran's nocturia and ED issued in 2016 without an examination of the Veteran were premature, and remanded the issues for further development to include obtaining additional medical records, providing the Veteran with VA examinations and obtaining medical opinions on the etiology of the Veteran's nocturia and ED. Such developments have since been completed and the Board is satisfied that there has been substantial compliance with the remand directives. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (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 (nexus). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection can also be established on a secondary basis for a disability which is proximately due to, or the result of a service connected disability. 38 C.F.R. § 3.310 (a). In his service connection claim he filed in April 2012 while he was still in service, the Veteran stated that he was recently diagnosed with nocturia and ED. He provided medical records dated March 2012 showing that he complained of ED being present for several years with symptoms of partial erection (not sufficient for) and he also complained of nocturia four time per night being present for approximately one year. The impression was nocturia and impotence with organic origin. VA examination for kidney condition in May 2012 noted that the Veteran had history of chronic renal failure (stage 1) in 2011 with no current symptoms of renal dysfunction. VA general examination in May 2012 also noted that the Veteran did not have genitourinary or reproductive system condition. Private medical records in August 2014 show that the Veteran reported history of chronic renal failure and ED since March 2012. However, the physician did not list ED and nocturia as active problems at that time. VA examination in June 2016 without an in-person examination indicated that the Veteran did not have any diagnosis of ED, but noted history of kidneys disease. The examiner opined that the Veteran's chronic kidney disease and ED were less likely incurred during or caused by his service. VA examination in January 2020 diagnosed the Veteran with ED and nocturia. The Veteran reported that he noticed in 2010 that he got up two to three times a night; and if he drank water before bedtime, he would get up six times a night. He stated that he dealt with it and did not realize it was an issue until 2012, that he had not sought medical treatment for it since discharge, and that he currently got up twice a night to urinate. He also reported that his ED started since he had been on blood pressure medications in 2004. The examiner opined that it was less likely than not (less than 50 percent probability) that the Veteran's ED and nocturia began during or was otherwise caused by his service. The examiner indicated that no service treatment records (STRs) were available for review at that time, and that the records did not show that the Veteran had sought treatment for ED or nocturia after separation from his service. After the January 2020 VA opinion was issued, VA obtained additional STRs in August 2020, which showed that the Veteran did seek treatment for frequent urination while he was in service. For example, records in March 2011 showed that he was seen for chronic renal failure; records in May 2011 showed that chronic renal insufficiency and chronic rental failure were listed on his problem list; records in August 2011 showed that the Veteran had going issues with his kidneys with renal inefficiency; and records in January 2012 showed that Veteran reported new finding of increased urination with a history of stage 1 renal disease. Although the Veteran did not seek treatment for ED, records in August 2010 showed that he was prescribed with a new hypertension medication (Carvedilol) in addition to his old hypertension medication (Atenolol). The physician indicated that these medications had side effect of ED, and noted that the Veteran already had ED with previously prescribed Atenolol. In light of the additional STRs obtained in August 2020, VA obtained an addendum medical opinion in September 2020. The examiner opined that it was less likely than not (less than 50 percent probability) that the Veteran's nocturia and ED had the onset during active service. The examiner explained that the Veteran currently stated he had nocturia approximately two times per night, this was common in the average men of his age, these conditions were related to his aging process rather than a medical condition or caused by medication, and STRs were silent for any complaints of ED. The examiner also opined that it was less likely than not (less than 50 percent probability) that the Veteran's hypertension medications prescribed during service caused his ED because the Veteran had no complaints of ED in service. (Continued on the next page) The Board finds that the Veteran credibly reported that he had experienced nocturia and ED since he was in service. STRs clearly show that he was diagnosed with chronic renal disease during service and had sought treatment for frequent urination. Although STRs did not show he sought treatment for ED, the STRs show that he was given different types of hypertension medications with side effect of ED, and the doctor had noted that he was already had ED with one medication during service. While the January 2020 VA medical opinion and September 2020 VA addendum opinion did not link the Veteran's ED and nocturia with his service due to age related risk factor as well as lack of treatment records since separation, given the Veteran's credible lay statements, the Board finds that the evidence is in relative equipoise as to whether the Veteran had nocturia and ED since service, and as to whether the medication for his service connected hypertension caused his ED. Accordingly, service connection for nocturia and ED is granted. L. Chu Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Wang, Associate 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.