Citation Nr: 21010576 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 20-22 976 DATE: February 25, 2021 ORDER Entitlement to service connection for erectile dysfunction (ED) is granted. FINDING OF FACT The Veteran’s ED is at least as likely as not related to his service-connected ischemic heart disease and coronary artery bypass. CONCLUSION OF LAW The criteria for service connection for ED have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the United States Army from December 1962 to December 1966. This matter comes before the Board of Veterans’ Appeals (Board) from an October 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The procedural history of the appeal was outlined in detail in a September 2020 Board decision and remand. The Board notes that a December 2018 congressional correspondence suggests the Veteran attempted to opt into the Rapid Appeals Modernization Program (RAMP). Review of the claims file is negative for such a request. Nevertheless, as the below constitutes a full grant of benefit sought on appeal, the Board considers the matter, and/or any procedural error potentially stemming from it, to be moot. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (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. Shedden v. Principi, 381 F.3d 1163, 1166-67(Fed. Cir. 2004). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303 (d). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Compensation may be established for any incremental increase in disability any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence. Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). If there is at least an approximate balance of positive and negative evidence regarding any issue material to the claim, the Veteran shall be given the benefit of the doubt in resolving each such issue. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49(1990). The Veteran seeks service connection for ED as secondary to his service-connected heart disabilities. Following consideration of the record, and affording the Veteran the benefit of the doubt, entitlement to service connection is granted. Current disability of ED is established by way of a December 2020 VA examination. The Veteran is also service connected for coronary artery disease and ischemic artery bypass. The first and second elements are met. What remains is nexus. This matter was remanded in September 2020 to address etiology, to include whether service connection was warranted based on incremental increase. Opinions were obtained on December 1, 2020 and on December 21, 2020. The December 1, 2020 opinion was deemed inadequate by the RO as it failed to adequately address secondary service connection. As to the December 21, 2020 addendum, the Board also finds it inadequate. In brief, the examiner opined against an etiological relationship between the Veteran’s currently diagnosed ED and service and/or his service-connected disabilities. The examiner stated that the record lacked “documented evidence” to support such a finding. The Board finds this opinion to be conclusory as the examiner did not indicate what would constitute “documented evidence” sufficient to support the Veteran’s claim. See Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007). In that regard, the examiner also failed to address the positive opinions and findings of record. Given the above, this opinion is afforded no probative value. That said, the Board finds that a remand for additional development is not necessary. The collective evidence, when combined and affording the Veteran the benefit of the doubt, is enough to grant the claim. As to positive evidence, the Veteran’s private cardiologist in March and November 2017 opined that his condition was etiologically related to his heart disabilities and/or the medication used to treat the conditions. These opinions were essentially predicated on having treated the Veteran’s heart conditions for nearly a decade and in turn witnessing the manifestations of his related ED condition. The claims file also contains an opinion from a December 2019 VA examiner. The 2019 examiner, in relevant part, found that the Veteran’s “atherosclerotic heart disease has likely contributed to the development of [his] ED.” Pairing this finding with the findings of the Veteran’s 2017 cardiologist the record is sufficient to warrant service connection. Finally, in December 1, 2020, a VA examiner opined that the Veteran’s ED was caused by the same processes that caused his service-connected diagnosed coronary artery disease (CAD). As the Veteran’s CAD has been deemed due to service, such a finding essentially indicates that the Veteran’s ED was also caused by service. The Board finds the examiners combined opinions highly probative as they were predicated on review of the claims file, in person examination, and diagnostic testing. In summary, the claims file contains multiple opinions which indicate a correlation between the Veteran’s ED, his service, and his service-connected disabilities. Comparatively, the claims file contains no adequate negative opinion addressing this collective evidence. Affording the Veteran, the benefit of the doubt, entitlement to service connection for erectile dysfunction is granted. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. L. Burroughs, 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.