Citation Nr: 21074932 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 19-18 539 DATE: December 16, 2021 ORDER Service connection for erectile dysfunction as secondary to bladder cancer is denied. FINDING OF FACT The Veteran's erectile dysfunction is not related to service or any other service-connected disability. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction as secondary to bladder cancer have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102 , 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from September 1966 to August 1968, including service in the Republic of Vietnam. This matter comes before the Board of Veterans Appeals (Board) on appeal from an April 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in a September 2021 decision for additional development. Service Connection Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Service connection may also be established for disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310; El-Amin v. Shinseki, 26 Vet. App. 136 (2013); Allen v. Brown, 7 Vet. App. 439 (1995). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that it was either caused or aggravated by a service-connected disability. Id. Service connection for erectile dysfunction as secondary to bladder cancer The Veteran asserts that he currently has erectile dysfunction that is secondarily caused by his service-connected bladder cancer. See December 2017 VA 21-526EZ, Fully Developed Claim. The Board held in September 2021 that Veteran was not provided a VA examination and medical opinion regarding the etiology of his erectile dysfunction (ED) and any relationship between the service-connected bladder cancer and the claimed ED. The claim was therefore remanded to obtain a VA examination and medical nexus opinion. The Veteran was afforded a post-remand VA examination and medical opinion in October 2021. He was diagnosed with erectile dysfunction, reporting the onset of the condition was in 2016 and has resulted in frustration, anxiety and trouble with concentration. The VA examiner opined that it is less likely than not that Veteran's ED is causally related to his history of bladder cancer and treatment; Veteran's history of coronary artery disease, hypertension, hyperlipidemia, and tobacco use are all known contributors to the development of ED due to vascular damage, and all were present prior to the diagnosis of his bladder cancer. The examiner referenced increasing evidence that suggests ED is predominantly a vascular disorder while atherosclerosis is also the main cause of ED development in the general population. Epidemiologic data has confirmed that hyperlipidemia is a strong independent risk factor for ED development; additionally, the Veteran also has a history of benign prostatic hyperplasia (BPH) dating back to 2013, which also may be a contributing factor for changes in erectile function. The examiner added that BPH causes lower urinary tract symptoms and approximately 70 percent of men with BPH have co-existing ED. See October 2021 VA Medical Opinion. The VA examiner additionally concluded that the Veteran's ED was less likely than not aggravated beyond its natural progression by his bladder cancer and treatment as his preexisting comorbid conditions are known risk factors for ED due to vascular damage that decreases blood flow to the penis. See Id. While the Veteran asserts that his erectile dysfunction is proximately due to his service-connected bladder cancer, he has not shown that he has specialized training sufficient to render such an opinion. Although lay witnesses are competent to provide evidence regarding matters that can be perceived by the senses, they are not competent to provide an opinion regarding etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Barr, 21 Vet. App. 303 (lay testimony is competent to establish the presence of observable symptomatology). For the reasons discussed above, however, the Board finds that the opinion provided by the VA examiner in October 2021 is more probative than the Veteran's lay assertions. The VA examiner has expertise, education, and training that the Veteran is not shown to have. As such, the examiner's opinion warrants more weight. In sum, the preponderance of the competent, credible, and probative evidence indicates that the Veteran's erectile dysfunction is not related to service or caused or aggravated by service or a service-connected disability, including his bladder cancer. As such, the claim for service connection for erectile dysfunction is denied. (Continued on the next page) In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Zarar Ahmed, Attorney Advisor 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.