Citation Nr: 21020916 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 16-58 062 DATE: April 8, 2021 ORDER Service connection for erectile dysfunction is denied. Special monthly compensation (SMC) for loss of use of a creative organ due to erectile dysfunction is denied. FINDINGS OF FACT 1. The Veteran’s erectile dysfunction has not been shown to be caused or aggravated by a service-connected disability including medication taken to treat a service-connected disability. 2. The Veteran has not established service connection for erectile dysfunction. CONCLUSIONS OF LAW 1. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.310. 2. The criteria for SMC based on loss of use of a creative organ have not been met. 38 U.S.C. §§ 1114 (k), 5107; 38 C.F.R. §§ 3.102, 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from December 1986 to December 1996. This matter is on appeal to the Board of Veterans’ Appeals (Board) from a November 2017 rating decision issued by the Agency of Original Jurisdiction (AOJ). In September 2019, the Veteran testified at a Board hearing via videoconference before the undersigned Veterans Law Judge of the Board. A transcript of the hearing is associated with the record. Service Connection Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence showing that (1) a current disability exists and (2) the current disability was either (a) caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448-49 (1995). 1. Entitlement to service connection for erectile dysfunction. The Veteran contends that his erectile dysfunction is caused or aggravated by his service-connected disabilities, in particular the medication prescribed by the VA as treatment for his service-connected disabilities. See September 2019 Hearing Transcript at 12. The Veteran filed a claim for erectile dysfunction and SMC in September 2017 which was denied by a rating decision of November 2017. The Board notes that the Veteran has advanced secondary service connection theory of entitlement for erectile dysfunction, no other theories have been presented. While the record shows a current diagnosed disability, the Board concludes that the preponderance of the evidence weighs against finding that the Veteran’s erectile dysfunction is secondary to a service-connected disability including medication taken to treat the service-connected disability. Meaning, there is no probative evidence to show a medical link between the current erectile dysfunction to a service-connected disability. In this regard and to specifically address this complex medical question, the Board remanded the matter in January 2020 to obtain adequate medical opinions. In compliance with the Board’s remand, the record shows a VA contract examination and medical opinion of January 2021, which the Board finds highly probative. After clinical examination of the Veteran and thorough review of the available medical history, the examiner opined the Veteran’s erectile dysfunction is less likely than not proximately due to or the result of Veteran’s service-connected disabilities to include medications prescribed for treatment. The examiner noted the Veteran was seen in 2016 for benign prostatic hyperplasia (BPH) symptoms and placed on testosterone. He was prescribed Viagra in 2017 and treatment note states that the Veteran’s symptoms are compatible with BPH. In the rationale, the examiner indicated that the conditions of erectile dysfunction and service-connected disabilities to include medications prescribed for treatment “are not medically related.” The examiner added that “erectile dysfunction is a separate entity entirely from the service-connected disabilities to include medications prescribed for treatment and unrelated to it. A thorough review of medical literature failed to demonstrate a causal relationship. A nexus has not been established.” See Male Reproductive Organ Conditions Disability Benefits Questionnaire (DBQ) and Medical Opinion dated January 2021. In the same opinion, the examiner also addressed secondary aggravation finding it less likely that the Veteran’s erectile dysfunction was aggravated beyond its natural progression by service connection disabilities. Rather, the examiner indicated that the Veteran’s “erectile dysfunction is at least as likely as not related to his BPH that is well documented in his chart.” Citing medical research from the Mayo Clinic on risk factors associated with erectile dysfunction, the examiner explained that the Veteran “currently prescribed Testosterone and has BPH as well as being obese and these are most likely what is causing his erectile dysfunction.” In addressing the Veteran’s contention that his medication (Gabapentin) is causing his erectile dysfunction, the examiner cited medical literature from the Mayo Clinic (2020) and explained that erectile dysfunction is not a side effect of Gabapentin. Id. In view of the above, the Board assigns significant probative value to the January 2021 VA contract opinion to support a finding that the Veteran’s erectile dysfunction is not related to his service-connected disabilities to include medications prescribed for treatment, and there is no competent medical evidence establishing service connection on a secondary basis. The Board further observes that the January 2021 VA contract opinion is based on a comprehensive review of the Veteran’s claims file, consideration of lay evidence of record, and provide sufficient rationale to support the examiner’s conclusion. The opinion provides substantial reasoning and explanation as to why the Veteran’s erectile dysfunction is not related to or aggravated by his service-connected disabilities to include medications prescribed for treatment. The opinion is sufficient to satisfy the statutory requirements of producing an adequate statement of reasons and bases where the expert has fairly considered material evidence which appears to support the Veteran’s position. Wray v. Brown, 7 Vet. App. 488, at 492-93 (1995). Accordingly, the Board finds great probative value in the January 2021 VA medical opinion. Additionally, the Board observes that the Veteran, as a layperson, is not competent to independently opine as to the specific etiology or render a medical nexus of a disability to a service-connected disability, as such requires medical expertise and the ability to interpret diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Accordingly, the Veteran’s assertions do not constitute competent medical evidence and therefore, the Board assigns more weight to the VA opinion provided by a medical professional. Moreover, the Veteran has not submitted any evidence supporting his contention that his erectile dysfunction is related to his service-connected disabilities to include medications prescribed for treatment. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for erectile dysfunction on a secondary basis. The benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 2. Entitlement to SMC. The Veteran contends he is entitled to SMC based on loss of use of a creative organ due to his erectile dysfunction. VA provides SMC if a veteran, as a result of service-connected disability, has suffered the anatomical loss or loss of use of one or more creative organs. 38 U.S.C. § 1114 (k). Entitlement to SMC based on loss of use of a creative organ can also be granted based on erectile dysfunction. 38 C.F.R. § 3.350 (a)(1)(ii). In this case, the award of entitlement to SMC based on the loss of use of a creative organ is directly related to a finding of service connection for erectile dysfunction, which has not been established. Accordingly, the criteria for SMC is not met, and the claim is denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. An, Associate 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.