Citation Nr: 21008667 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 17-05 481 DATE: February 17, 2021 ORDER Service connection for hypertension, secondary to service-connected diabetes mellitus, type II (diabetes) is granted. Service connection for erectile dysfunction, secondary to service-connected diabetes mellitus, type II (diabetes) is granted. FINDINGS OF FACT 1. Resolving all doubt in the Veteran's favor, the currently diagnosed hypertension, is secondary to the service-connected diabetes. 2. Resolving all doubt in the Veteran's favor, the currently diagnosed erectile dysfunction, is secondary to the service-connected diabetes. CONCLUSIONS OF LAW 1. The criteria to establish service connection for hypertension, secondary to the service-connected diabetes have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310 (2017). 2. The criteria to establish service connection for erectile dysfunction, secondary to the service-connected diabetes have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in the United States Air Force from January 1968 to July 1972. He was awarded the Vietnam Campaign Medal and Vietnam Service Medal, among other decorations, for this service. These matters come to the Board of Veterans' Appeals (Board) on appeal from an August 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2020, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A copy of the transcript has been associated with the electronic claims file. Neither the Veteran, not his representative has not raised any issues with the duty to notify or duty to assist. See Scott v McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board...to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument). Further, given the favorable outcome in this decision that represents a full grant of the issues on appeal, further explanation of how VA has fulfilled the duties to notify and assist is not necessary. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). Service Connection The Veteran contends his currently diagnosed hypertension and erectile dysfunction are the result of his service-connected diabetes. For the reasons that follow, and resolving reasonable doubt in the Veteran's favor, the Board finds that service connection for hypertension and erectile dysfunction secondary to service-connected diabetes is warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Service connection may be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R. § 3.310(a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). To prevail on the theory of secondary service causation, generally, the record must show (1) medical evidence of a current disability, (2) a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). As an initial matter, the Board finds that the Veteran has currently diagnoses of hypertension and erectile dysfunction. Specifically, both the January 2011 VA examination and March 2017 private examination show a diagnoses of hypertension and erectile dysfunction. Next, the Veteran is service-connected for diabetes. There are three medical opinions of record on the etiology of the Veteran's hypertension and erectile dysfunction. First, the Veteran underwent a VA examination in January 2011. The VA examiner diagnosed the Veteran with hypertension and erectile dysfunction. The VA examiner then opined that the Veteran’s hypertension was most likely permanently aggravated by the service-connected diabetes. The rationale provided was that hypertension is part of metabolic syndrome and even though the hypertension antedated the diabetes, that they are related. The VA examiner added that glycemic control aggravated the hypertension through release of epinephrine in response to high or low blood sugar. The VA examiner next indicated that the Veteran’s erectile dysfunction was most likely permanently aggravated by the Veteran’s diabetes. The rationale provided was that despite the Veteran having multiple risk factors for erectile dysfunction, that a major contributor was diabetes because it is a major contributor to erectile dysfunction through both vascular and neurological changes. The VA examiner indicated these findings were true despite the erectile dysfunction having its onset before the diabetes. Next, in August 2012, the January 2011 VA physician offered an addendum opinion on the etiology of the Veteran’s hypertension and erectile dysfunction. After review of the claims file, the VA physician opined that the Veteran’s hypertension was less likely than not proximate to or permanently aggravated by the service-connected diabetes. The rationale provided was that there was no evidence that the hypertension was worsened beyond a baseline of elevated blood pressure. The VA physician similarly opined that the erectile dysfunction was less likely than not aggravated by the diabetes because there was no additional disability. However, the VA physician then added that it is anticipated that the Veteran’s diabetes will permanently aggravate the erectile dysfunction. Finally, in March 2017 a private physician reviewed the Veteran’s claims file and opined that it was more likely than not that the Veteran's hypertension and erectile dysfunction was directly related to the service-connected diabetes. The rationale provided was the close relationship between diabetes and hypertension. The private physician indicated that diabetes is an 80-percent or greater reliable predictor of hypertension. The private physician then added that both diabetes and hypertension were contributors to the erectile dysfunction. The physician further supported the opinions with treatise evidence. Based on a review of the evidence, both lay and medical, the Board finds that the weight of the evidence of record is in relative equipoise. The March 2017 private physician opined that the Veteran's currently diagnosed hypertension and erectile dysfunction were related to his service-connected diabetes. The opinion contains clear conclusions with supporting data and a reasoned medical explanation connecting the disabilities. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The January 2011 VA examiner also opined there was a nexus between the hypertension and erectile dysfunction and the service-connected diabetes and provided a supporting rationale. The Board notes that while there are some contradictions in the August 2012 addendum opinion, the VA physician still indicates that the conditions are related. Based on the opinions, the Board finds that the weight of the competent and probative evidence supports a finding that the Veteran's current hypertension and erectile dysfunction are secondary conditions to the service-connected diabetes. There can be no doubt that further medical inquiry could be undertaken with a view towards development of the claim. Specifically, the Board could seek further examination to clarify and more definitively opine on the etiology of the current hypertension and erectile dysfunction. However, under the law, where there exists "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter," the Veteran shall prevail upon the issue. Ashley v. Brown, 6 Vet. App. 52, 59 (1993); see also Massey v. Brown, 7 Vet. App. 204, 206-207 (1994). Here, there are two adequate opinion of record that found the Veteran's hypertension and erectile dysfunction were caused or aggravated by the service-connected diabetes. Therefore, service connection for hypertension and erectile dysfunction, claimed as secondary to service-connected diabetes is warranted. See 38 U.S.C.§ 5107; 38 C.F.R. § 3.102. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Teague, 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.