Citation Nr: 21022657 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 15-10 000 DATE: April 16, 2021 ORDER Entitlement to service connection for erectile dysfunction is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s erectile dysfunction began during or is etiologically related to his active duty or that it is secondary to any service-connected disability. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. § 1110, 1112, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1963 to November 1965 and May 1966 to December 1968. In July 2018, the Board denied service connection for erectile dysfunction on a secondary basis. In April 2019, the Veteran appealed the Board’s July 2018 decision to United States Court of Appeals for Veteran Claims (Court) which granted a Joint Motion for Partial Remand (JMPR) filed by the parties. Accordingly, the Court’s April 2019 Order vacated, in part, the Board’s July 2018 decision with regard to the issue of service connection for erectile dysfunction and remanded the matter to the Board consistent with the terms of the joint motion. The Board remanded this issue in October 2019 for further development. There has been substantial compliance with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Entitlement to service connection for erectile dysfunction is denied. The Veteran is claiming entitlement to service connection for erectile dysfunction as secondary to Diabetes Mellitus Type II. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be established on a secondary basis for a disability that is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310 (a). Secondary service connection may be established for a disorder that is caused or aggravated by a service-connected disability. Id. § 3.310(b); Allen v. Brown, 7 Vet. App. 439, 44748 (1995). To establish secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 511 (1998). The Veteran was diagnosed with erectile dysfunction in October 2006. Service treatment records note the Veteran sought treatment for a venereal disease in 1965. As such, Shedden element (1) is met. Turning to Shedden elements (2) and (3), the Veteran’s service treatment records are silent for any complaints of, treatment for, or diagnoses related to erectile dysfunction. Evidence of record before the Board does not note any complaints of erectile dysfunction until decades following the Veteran’s separation from active duty service, which weighs against his claim. See Mense, 1 Vet. App. at 356. Further, the Veteran has not submitted any lay statements regarding the onset and continuity of symptoms relating to his period of active service. The Board notes that there is evidence of in-service treatment for venereal disease in 1965. However, treatment notes show that after receiving penicillin, the disease resolved completely, without residuals. Neither the Veteran nor his attorney have claimed that the Veteran experienced erectile dysfunction during service nor have they submitted evidence showing a nexus. As such, the Veteran’s claim for service connection for erectile dysfunction on a direct basis is denied. The Board has considered the benefit of the doubt doctrine; however, as the evidence weighs against the Veteran’s claim, it is not applicable. See 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. at 56. Turning to secondary service connection for erectile dysfunction, a current erectile dysfunction disability is well documented, and he was awarded service connection for Diabetes Mellitus, Type II, effective May 1, 2014. Wallin elements (1) and (2) are met. Turning to Wallin element (3), the Veteran underwent a Diabetes Mellitus VA examination in August 2014. The examiner diagnosed the Veteran with Diabetes Mellitus, Type II and stated that he did not have any recognized complications of diabetes. A February 2016 VA examiner opined that the Veteran’s erectile dysfunction was less likely than not caused by or aggravated by diabetes. The examiner explained that the Veteran’s erectile dysfunction began in 2003 and showed significant problems around 2005. The Veteran’s diabetes was reported in 2014, approximately 11 years after initial complaints of erectile dysfunction. The examiner stated that there was no evidence supporting the Veteran’s claim of aggravation. In February 2018, a VA examiner stated that the Veteran suffered from erectile dysfunction which was caused by service-connected Diabetes Mellitus, Type II. The examiner did not provide discuss the basis of his opinion nor was rationale provided in the February 2018 VA examination report. A March 2020 Diabetes Mellitus VA examination report stated that the Veteran did not suffer from erectile dysfunction as a result of his service-connected diabetes. A December 2020 examiner confirmed that diabetes mellitus did not cause nor aggravate this Veteran’s erectile dysfunction. A December 2020 examiner explained that diabetes was diagnosed 10 years after the onset of erectile dysfunction. The examiner noted that the Veteran’s blood glucose levels were normal on September 30, 2008, approximately 4-5 years after the onset of erectile dysfunction. This leads the examiner to believe that erectile dysfunction cannot be considered an early complication of diabetes. Neither the Veteran nor his attorney have contended that erectile dysfunction was caused by or aggravated a service-connected disability other than diabetes. Nevertheless, the examiner explained that there is no medical evidence that bilateral hearing loss, coronary spasm, chronic sinusitis, peripheral neuropathy, chloracne, tinnitus, urinary tract infections, or hemorrhoids cause or aggravate diabetes. Regarding the February 2018 conflicting medical opinion, the examiner stated that he could not provide a comment because the 2018 examiner did not provide any rationale for the positive finding. The Board finds that the preponderance of the evidence is against a finding that erectile dysfunction is etiologically related to service, or that the Veteran’s erectile dysfunction was caused or aggravated by a service-connected disability, specifically, diabetes. The February 2016 and March 2020 VA examination reports are highly probative, sufficiently rationalized, and are based on a thorough review of the record. Conversely, the February 2018 VA examination report stating diabetes caused erectile dysfunction lacks any rationale and appears to be a conclusory statement at best. See Bloom v. West, 12 Vet. App. 185 (1999) (holding that a medical opinion based on speculation, without supporting clinical data or other rationale, does not provide the required degree of medical certainty). Consideration has also been given to the Veteran’s assertion that his service-connected diabetes caused or aggravated his current erectile dysfunction. However, while lay persons are competent to provide opinions on some medical issues, the specific issue in this case falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The disability at issue is not a condition that is readily amenable to lay diagnosis or probative comment regarding etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Board finds greater probative in the competent VA examination reports which found the Veteran’s service-connected disability did not cause nor aggravated his erectile disability disorder. Accordingly, service connection on a secondary basis is not warranted. (Continued on the next page)   The Board notes that the Veteran, through his attorney, has argued that diabetes was present long before he was diagnosed in 2014, and that his problems with erectile dysfunction were present prior to his formal diabetes diagnosis. In support of his claim, he has submitted articles discussing the fact that diabetes frequently goes undiagnosed for many years and that erectile is often linked to insulin resistance, which is associated with pre-diabetes. See March 2015 notice of disagreement, “Diagnosis and Classification of Diabetes Mellitus” and “Surprising Symptoms of Diabetes.” As the record stands, he started having symptoms of erectile dysfunction in 2003 and he was not diagnosed with diabetes until 2014, and multiple medical experts have opined that the erectile dysfunction was not caused or aggravated by diabetes and has given a reasonable explanation for his findings. As the weight of the evidence is against the Veteran’s claim, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mohammad Mahmoudi, 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.