Citation Nr: 21009038 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 14-04 415 DATE: February 18, 2021 ISSUE Entitlement to service connection for erectile dysfunction (ED), to include as secondary to a service-connected disability. ORDER Entitlement to service connection for ED, to include as secondary to a service-connected disability is denied. FINDING OF FACT ED was not shown in service or for many years thereafter, and has not been shown to be related to service or a service-connected disability. CONCLUSION OF LAW The criteria for service connection for ED have not been met or approximated. 38 U.S.C. §§ 1110, 5107 (West 2014); 38 C.F.R. § 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1968 to March 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a January 2018 travel Board hearing. A transcript of that hearing has been associated with the claims file. When this case was previously before the Board in August 2020, it was decided in part and remanded in part for additional evidentiary development. It has since been returned to the Board for further appellate action. The Board finds that there has been substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Subsequently, in a September 2020 rating decision, service connection for degenerative arthritis of the thoracolumbar spine, status post microdiscectomy was granted. The Veteran has appealed this decision through VA’s test program the Rapid Appeals Modernization Program (RAMP); as such, this issue will be addressed in a separate Board decision. Duties to Notify and Assist The Veteran and his representative have not raised any argument(s) with respect to the adequacy of notice and assistance. 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 a duty to assist argument). Therefore, the appeal may be considered on the merits. Service Connection Generally, service connection may be granted for disability or injury incurred in or aggravated by active military service. See 38 U.S.C. §§ 1110, 1131 (West 2014); 38 C.F.R. § 3.303 (2017). In order to establish service connection for the claimed disorder, there must be (1) competent evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) competent evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Service connection is available for a disease or disability that is proximately caused by a service connected disease or disability; and for the aggravation of a non-service connected disability by a service connected disease or disability. 38 C.F.R. § 3.310 (2017). Certain chronic diseases may be presumed to have been incurred during service if the disorder manifests to a compensable degree within one year of separation from active duty. 38 C.F.R. § 3.309. However, ED is not considered to be a “chronic disease” under 38 C.F.R. § 3.309. Therefore, service connection for ED on a presumptive basis is not warranted. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). VA treatment records show diagnoses of ED. Therefore, Hickson element (1) is met. With respect to Hickson element (2), in-service disease or injury, the Veteran asserts that his ED is related to his service-connected anxiety disorder. Accordingly, Hickson element (2) is at least arguably met. The Veteran was afforded a VA-contracted examination in January 2019 in which the examiner stated that he had a history of hypogonadism requiring testosterone treatment according to a progress report from November 2011; therefore, the etiology for his ED was probably related to his low testosterone and less likely due to anxiety and depression [as] a major factor. The examiner stated that the Veteran’s history of anxiety and depression may be a minor cause for his ED. An addendum opinion was obtained in September 2019 in which the examiner stated that the Veteran’s ED was more likely related to low testosterone; anxiety and depression did not cause low testosterone; anxiety and depression was less likely the cause for ED. In response to the Board’s remand, an addendum VA-contracted opinion was obtained in September 2020 in which the examiner stated that the Veteran had low libido due to hypogonadism. The examiner stated that the Veteran was noted to have hypogonadism since at least 2009 with also low libido noted with this condition which would be baseline. The examiner stated that there were numerous records after that time showing hypogonadism requiring testosterone injections for many years along with ED that occurred as a result. The examiner opined that there was no evidence from the records that the Veteran's mental disorders were a contributing factor nor an aggravating factor. The examiner noted that there was a letter from the Veteran's spouse noting that his ED condition worsened, and this worsened his depression and not other way around. The examiner stated that the Veteran's ED condition was less likely than not aggravated beyond its natural progression by his anxiety disorder. In this case, as to the issue of the etiology of the Veteran’s ED, the Board finds that the VA examiners made it clear that it was their opinions that the Veteran’s ED was not related to service or to his service-connected anxiety disorder. To this point, the Board notes that medical reports must be read as a whole, and the Board is permitted to draw inferences based on the overall report so long as the inference does not result in a medical determination. Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012). Here, the examiners made it clear that ED was caused by low testosterone and that the service-connected anxiety disorder did not cause or aggravate the ED. Accordingly, the Board concludes that the VA opinions carry significant weight. No other competent opinion providing a positive nexus between service or the service-connected anxiety disorder and the Veteran’s ED has been presented. The Board acknowledges that the Veteran is competent to testify as to his beliefs that his ED is related to service or the service-connected anxiety disorder. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology. See 38 C.F.R. § 3.159 (a)(1) (2017) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. Therefore, the Veteran’s claims that his ED was etiologically related to service or to the service-connected disability are outweighed by the competent and probative medical opinion. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); Charles v. Principi, 16 Vet. App. 370, 374-75 (2002); Layno v. Brown, 6 Vet. App. 465 (1994). The Board finds the to the VA examiners’ opinions are competent and probative as they were rendered after an evaluation of the Veteran, review of the Veteran’s history, and consideration of medical principles by licensed medical professionals. Therefore, a nexus between service and the Veteran’s ED and service or the service-connected anxiety disorder cannot be established, and the criteria of Hickson element (3) are not met. In reaching this determination, the Board acknowledges that VA is statutorily required to resolve the benefit of the doubt in favor of the Veteran when there is an approximate balance of positive and negative evidence regarding the merits of an outstanding issue. That doctrine, however, is not applicable in this case because the preponderance of the evidence is against the Veteran’s claim. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); 38 U.S.C. § 5107(b) (West 2014). MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R.M.K., 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.