Citation Nr: 21020902 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 15-14 697A DATE: April 8, 2021 ORDER Entitlement to service connection for erectile dysfunction (ED), for purposes of accrued benefits, is denied. Entitlement to service connection for peripheral vascular disease (also peripheral artery disease), for purposes of accrued benefits, is denied. FINDINGS OF FACT 1. The Veteran's ED is not etiologically related to service, to include as secondary to a service-connected condition and/or exposure to jet fuels. 2. The Veteran’s peripheral vascular disease (peripheral artery disease) is not a result of his military service, to include exposure to jet fuels. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for erectile dysfunction, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 3.307, 3.309. 2. The criteria for entitlement to service connection for peripheral vascular disease (also peripheral artery disease), for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Air Force from May 1980 to May 1992. The appellant is the Veterans spouse. Service Connection The law provides that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) 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. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may be granted, on a secondary basis, for a disability, which is proximately due to, or the result of an established service-connected disorder. 38 C.F.R. § 3.310. Additionally, when aggravation of a Veteran’s nonservice-connected condition is proximately due to or the result of a service-connected condition, the Veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Id.; Allen v. Brown, 7 Vet. App. 439 (1995). 1. Entitlement to service connection for erectile dysfunction (ED) 2. Entitlement to service connection for peripheral vascular disease (also peripheral artery disease) The appellant is seeking entitlement to service connection for erectile dysfunction (ED) and peripheral vascular disease as a result of exposure to jet fuels during the Veterans military service. As an initial matter, VA has conceded exposure to jet fuel during active service, by virtue of the Veteran’s military occupational specialty. Therefore, the Board must address a possible medical nexus between his erectile dysfunction and his conceded in-service exposure. However, the service treatment records do not indicate that the Veteran experienced any erectile dysfunction or peripheral vascular disease while in service. Notably, an April 1991 periodic examination did not note any such symptoms. In fact, the first indication of either of these two disorders was 2008, where he was diagnosed with peripheral vascular disease. Erectile dysfunction was not until April 2018, where the Veteran reported problems with his penis during a visit to his primary care provider. Additionally, the Veteran’s medical records reveal that he denied erectile dysfunction in October 2013 and October 2014. The Board notes the earliest indication of either of these disorders is approximately 16 years after he left active duty. Therefore, there is no indication that either disorder has persisted since service. Indeed, the Veteran himself has not asserted such continuous symptoms. Next, the evidence does not otherwise reflect that there is a relationship between the Veteran's peripheral vascular disease or ED and his active duty service, his exposure to jet fuel or a service-connected disability. As initial matter, the Veteran is currently in receipt of service connection for dermatitis, adjustment disorder, residuals of esophageal adenocarcinoma, degenerative arthritis lumbar spine, radiculopathy, tinnitus, hearing loss, headaches, scars. Hence, as the Veteran is not in receipt of a service-connected disability for which medical evidence indicates his ED or peripheral vascular disease could be proximately related to. 38 C.F.R. § 3.310. Moreover, a VA opinion was provided in December 2020 where the examiner opined that the Veteran’s ED was less likely than not related to his military service nor his exposure to jet fuel. In support of this opinion, the examiner stated based on review of the provided medical records, there is no evidence in the provided medical records documenting that exposure to aircraft fuels directly or indirectly caused ED. Furthermore, there is no plausible pathophysiologic mechanism discussed in the medical literature and known medical principles that would explain such a causal relationship between these conditions. In this case, the veteran has multiple comorbid conditions that are known to contribute to development of ED, including hypertension, HLD, obesity, cigarette smoking, and age. Therefore, the examiner concluded that these conditions are the most likely cause of his current ED. As for his peripheral vascular symptoms, the Veteran underwent a VA examination in November 2018, where he reported an onset in 2008 when he experienced bilateral lower extremity pain and swelling. At that time, he stated that he felt his symptoms were related to being exposed to jet fuel. The VA examiner opined that it less likely as not that the Veteran's peripheral vascular disease was incurred in, related to, or caused by any incident during the Veteran's military service, including his exposure to jet fuel. In support of his opinion the examiner stated after review of medical literature and the veteran’s records, including jet fuel toxicity document, he is unable to find sufficient evidence that links jet fuel to the veteran’s diagnosis of peripheral vascular disease related to the claim of peripheral artery disease. Therefore, the condition is less likely than not incurred or caused by the claimed in-service injury, event, or illness. In arriving at this conclusion, the Board recognizes the statements from the Veteran and the appellant regarding the relationship between the Veteran’s ED and peripheral vascular disease and active service. However, as previously discussed, while they are competent to provide testimony regarding observable symptomatology, they are not competent to provide a nexus opinion in this case. Jandreau, 492 F.3d at 1377 n.4. Therefore, the unsubstantiated statements regarding the claimed diagnosis and etiology of the Veteran's ED are found to lack competency. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for ED or for peripheral vascular disease Because the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990). For these reasons, the claims are denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Vample, Erica