Citation Nr: 21021683 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 15-14 212A DATE: April 13, 2021 ORDER Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected chronic prostatitis is granted. Entitlement to service connection for a left knee disability is denied. REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to an initial compensable rating for sinusitis with epistaxis (claimed as nose bleeds) is remanded. Entitlement to an initial compensable rating for environmental allergies is remanded. Entitlement to an initial compensable rating for sinus headaches is remanded. FINDINGS OF FACT 1. It is at least as likely as not that the Veteran’s erectile dysfunction is aggravated beyond is natural progression by his service-connected chronic prostatitis. 2. The preponderance of the evidence of record is against finding that the Veteran has had a left knee disability at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for service connection for erectile dysfunction as secondary to service-connected chronic prostatitis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy with honorable service for VA purposes from March 17, 1997 to May 21, 2002. The Veteran had dishonorable service for VA purposes from May 22, 2002 to June 13, 2008. This matter was previously before the Board in July 2018 but was remanded to the Agency of Original Jurisdiction (AOJ) for issuance of a Statement of the Case (SOC) for the increased rating claims listed above. The SOC was issued in November 2018 and the Veteran perfected his appeal in December 2018. The case was also remanded to obtain VA medical opinions for the Veteran’s bilateral knee disabilities and erectile dysfunction. The required examinations were completed in September 2020. The VA knee examination is adequate for the left knee. The examination report reflected that no left knee disability is present, as will be discussed below. Therefore no etiology opinion was needed. Accordingly, the Board finds there has been substantial compliance with the remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence in light of the entirety of the record. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. In order to prevail on the issue of service connection there must be competent evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). 1. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected chronic prostatitis is granted. The Veteran contends that his current erectile dysfunction was caused or aggravated by his service-connected chronic prostatitis. A September 2020 male reproductive conditions disability benefits questionnaire (DBQ) notes that the Veteran has a current diagnosis of erectile dysfunction. The examiner noted that he was originally diagnosed with erectile dysfunction in 2002. At examination, the Veteran noted that his erectile dysfunction was associated with episodes of chronic prostatitis. He further explained that his erectile dysfunction was intermittent, occurring approximately four times a year. At issue in the present case is whether the Veteran’s erectile dysfunction was caused or aggravated by his service-connected chronic prostatitis. Following a review of the Veteran’s medical treatment records and in-person examination of the Veteran, a September 2020 medical opinion noted that regardless of an established baseline of severity, the Veteran’s erectile dysfunction was at least as likely as not aggravated beyond its natural progression by service connected chronic prostatitis. The examiner reasoned, “[c]hronic prostatitis is in fact a cause of [erectile dysfunction] and combined with the [V]eteran's low testosterone levels has likely as not been aggravated beyond the natural progression.” The Board finds that the September 2020 medical opinion is thorough and well-reasoned. The September 2020 examination and opinion are adequate because they were based upon consideration of the Veteran’s pertinent medical history, his lay assertions, and current complaints, an in-person examination and because it describes his erectile dysfunction in detail sufficient to allow the Board to make a fully informed determination. Ardison v. Brown, 6 Vet. App. 405, 407 (1994). Based on the medical evidence of record, the Board finds that it is at least as likely as not that the Veteran’s erectile dysfunction was aggravated beyond its natural progression by his service-connected chronic prostatitis. Accordingly, entitlement to service connection for erectile dysfunction is warranted. 2. Entitlement to service connection for a left knee disability is denied. 3. During the appeal period, a left knee disability was not diagnosed. However, the Veteran credibly reports left knee pain. He has not shown that his left knee pain results in a functional impairment of earning capacity. “To establish the presence of a disability, a veteran will need to show that her pain reaches the level of a functional impairment of earning capacity.” Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018). Prior the appeal period, the Veteran had a normal MRI and x-ray of his left knee in November 2008. At a March 2009 VA joints examination, he reported constant pain in his left knee, and stated he had been prescribed a brace for it. Upon examination, he had normal range of movement (ROM) with pain, as well as tenderness, guarding, and crepitus. A March 2009 x-ray was normal. In February 2013, he reported “problems with [his] left knee.” In January 2013, he had a normal x-ray of his left knee. In September 2013, his left knee was found to be stable in all planes without meniscal signs on tibial rotation. In March 2014, he had left knee crepitus but it was noted that it caused no functional loss or impact. He filed his claim in June 2014. In November 2014, he reported that his left knee “just popped” while walking up stairs at his mother’s house, and that he had a sensation of cold, fluid, and burning. In March 2015, he had a normal MRI of the left knee. In March 2017, he reported left knee pain, and reported being seen for it in boot camp in 1997. He reported current pain, giving out, clicking, and locking. He reported a history of a meniscus tear. At his April 2018 hearing, the Veteran’s attorney stated that under Saunders, the Veteran has a knee disability even though there is no diagnosis. At his hearing, he testified about his functional impairment in his right knee. He stated that while shopping his “knee” gave out, that “it” locked up, and his wife had to pop “it.” Later he stated, “if I put any weight on my right leg for a very long time it gives out….” This testimony is about the right knee. When describing his left knee he stated that he had pain, and that he was told by a doctor that his left knee pain is due compensating for his right knee. He testified that he had been issued a knee brace by VA. With regard to “both” knees he stated that he could not run or stand for prolonged periods of times. He also stated he could no longer run, play hockey, hunt, or ride a bicycle. This description does not show a functional impairment of earning capacity. In September 2020, the Veteran underwent a VA knee and lower leg conditions examination. The examiner diagnosed right knee arthritis. The Veteran reported having bilateral knee pain throughout service and then had constant bilateral sharp knee pain. He denied experiencing flare-ups. He also did not report having functional loss or functional impairment of either knee joint. His left knee ROM was normal and there was no evidence of pain with weight bearing and no crepitus. The examiner stated that pain was noted on examination but that it did not result in or cause a functional loss. There was no tenderness of the left knee. There was no change to ROM after three repetitions. The examiner found that pain, weakness, fatigability, or incoordination would not significantly limit functional ability with repeated use over time. There was pain on passive range of motion testing and no objective evidence of pain when the joint was used in non-weight bearing. The right knee was also examined. His left knee strength was normal and he did not have atrophy. The examiner found that the left knee was stable to all tests and that there was no current symptoms of a meniscus condition. At the time of the examination, no assistive devices were used. Significantly, the examiner stated that the knee conditions did not impact his ability to perform any type of occupational task. The Veteran served as a corpsman in the military. Therefore, he is not a layperson. His descriptions of his symptoms are both competent and credible. However, the most probative evidence of record is the September 2020 examination report. The Veteran has not described functional impairment of earning capacity and the VA treatment records and examination report do not reflect functional impairment of earning capacity. The September 2020 VA examiner conducted multiple tests of the left knee including active and passive ROM and stability tests. Although there was pain and tenderness, the examiner found no functional loss, functional impact, or impact on the Veteran’s ability to perform occupational tasks. The most probative evidence of record shows that the Veteran does not have a diagnosed left knee disability, and that he has not shown that his pain and other symptoms have caused a functional impairment of earning capacity. The existence of a current disability is the cornerstone of a claim for VA disability compensation. Degmetich v. Brown, 104 F. 3d 1328 (Fed. Cir. 1997); Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). In the absence of evidence of a current disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see McClain v. Nicholson, 21 Vet. App. 319 (2007) (finding that the requirement for a current disability is satisfied if the claimant has a disability at the time a claim was filed or at any time during the pendency of the appeal, even if the disability resolves prior to the Secretary’s adjudication of the claim). Accordingly, the preponderance of the evidence of record does not show that the Veteran has a left knee disability for VA purposes. Therefore, the Board finds that the service connection is not warranted. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a right knee disability A September 2020 knee and lower leg conditions DBQ noted that the Veteran was diagnosed with degenerative arthritis of the right knee in April 2017. The Veteran’s VA treatment records also note a diagnosis of knee derangement in March 2017. However, the examiner does not provide a rationale regarding if the Veteran’s diagnosed degenerative arthritis of the right knee, and diagnosed derangement of the knee, was incurred during or caused by the Veteran’s period of active service. An addendum medical opinion is necessary addressing the Veteran’s diagnosed right knee disability, to include right knee derangement and degenerative arthritis of the right knee. 2. Entitlement to an initial compensable rating for sinusitis with epistaxis (claimed as nose bleeds) 3. Entitlement to an initial compensable rating for environmental allergies 4. Entitlement to an initial compensable rating for sinus headaches The Veteran claims entitlement to initial compensable disability ratings for sinusitis, environmental allergies, and sinus headaches. The most recent examinations to determine the severity of the Veteran’s disabilities were completed in October 2018. In a November 2020 Appellate Brief, the Veteran’s attorney requested that the Veteran be scheduled for new VA examinations to determine the current severity of his disabilities. The Veteran’s attorney stated that the severity of the disabilities has worsened. The Veteran’s attorney also stated that a new VA examination is requested for environmental allergies because the previous exam was not conducted during a flare up and the Veteran’s symptoms were temporarily mitigated by treatment. The Veteran contends the examination is not indicative of the current level severity of his environmental allergies. Given the above, the Board finds that the severity of the Veteran’s sinusitis, environmental allergies, and sinus headaches may have worsened, and that new VA examinations are thereby necessary to determine the current disability evaluation of the Veteran’s service-connected sinusitis, environmental allergies, and sinus headaches. See Weggenmann v. Brown, 5 Vet. App. 281, 284 (1993). Accordingly, the matters are REMANDED for the following action: 1. Return the Veteran’s claims file to the examiner who conducted the September 2020 knee and lower leg conditions examination so a supplemental opinion may be provided for the Veteran’s right knee disability. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not that the Veteran current degenerative arthritis of the right knee was incurred during or caused by the Veteran’s period of active service; or began within one year after discharge from active service. The examiner is advised that only the Veteran’s period of service from March 17, 1997 to May 21, 2002 may be considered for the purposes of this opinion. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Schedule the Veteran for a VA sinusitis/rhinitis, and other conditions of the nose, throat, larynx, and pharynx examination to determine the current severity of his service-connected sinusitis and environmental allergies disabilities. The entire claims file and a copy of this remand must be made available to the examiner for review. The examiner must provide all findings, along with a complete rationale for his or her opinion(s), in the examination report. 3. Schedule the Veteran for a VA headache examination to determine the current severity of his service-connected sinus headaches. The entire claims file and a copy of this remand must be made available to the examiner for review. The examiner must provide all findings, along with a complete rationale for his or her opinion(s), in the examination report. (Continued on the next page)   4. After all completed development, the AOJ should then readjudicate the claims. If the benefits sought on appeal are not granted, the Veteran and his representative should be provided a Supplemental Statement of the Case and afforded the requisite opportunity to respond before the case is returned to the Board. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Riordan, 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.