Citation Nr: 21022680 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 18-22 864 DATE: April 19, 2021 ORDER Entitlement to service connection for erectile dysfunction (ED), as secondary to type II diabetes mellitus, is granted. FINDING OF FACT There is an approximate balance of evidence as to whether the Veteran’s service-connected type II diabetes mellitus proximately caused his ED. CONCLUSION OF LAW The criteria for service connection for ED as secondary to type II diabetes mellitus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from December 1980 to December 2004. This matter comes to the Board of Veterans’ Appeals (Board) from a rating decision dated in October 2015 of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran testified at a Board hearing in March 2021. A copy of the transcript has been associated with the record. Initially, the Board notes that, in the rating decision on appeal, the AOJ reopened the claim for entitlement to service connection for ED, and denied the claim on the merits. Generally, a previously denied claim that is final may not be reopened and readjudicated unless new and material evidence is submitted. The AOJ first denied the claim in an April 2014 rating decision. The Veteran submitted new and material evidence within a year of the decision, in January 2015, and the Veteran was afforded a VA examination in April 2015. Therefore, the April 2014 rating decision did not become final. The AOJ again denied the claim in April 2015, and the Veteran submitted a petition to reopen the claim in June 2015. New evidence was added to the claims file in the form of a VA examination for diabetic peripheral neuropathy and VA outpatient treatment records. The AOJ issued another rating decision in October 2015. Given that the April 2014 and June 2015 rating decisions did not become final, the Board finds that new and material evidence is not required to reopen the claim for service connection, and will adjudicate it on the merits. 1. Entitlement to service connection for erectile dysfunction (ED), as secondary to type II diabetes mellitus Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110. Service connection can be established by evidence that shows “(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-the so-called “nexus” requirement.” Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists; and (2) that the current disability was either: (a) proximately caused by; or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). In order to prevail under a theory of secondary service connection, there must be: (1) evidence of a current disorder; (2) evidence of a service-connected disability; and, (3) a medical nexus between the service-connected disability and the current disorder. See Wallin v. West, 11 Vet. App. 509, 512 (1998). In adjudicating a claim, the Board is charged with the duty to assess the credibility and weight given to evidence. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. The Veteran has contended that his ED is secondary to his service-connected type II diabetes mellitus. As explained below, the Board finds that service connection is warranted. The Board notes that the first two prongs of Wallin are satisfied. First, a VA rating code sheet shows that the Veteran has been service-connected for diabetes mellitus since 2003. Second, while a March 2014 VA examination indicate that the Veteran has not been diagnosed with a disability of the male reproductive system, the same examination report indicates that the Veteran has ED. The Veteran’s outpatient records indicate a diagnosis of ED, as does an April 2015 VA examination. Therefore, the Board finds that the Veteran has a disability for which service connection may be granted. The Veteran’s claim hinges on the third prong of Wallin, whether there is a medical nexus between the Veteran’s diabetes mellitus and ED. The Veteran had a VA examination for diabetes mellitus in October 2012. It was noted that the onset of his diabetes was in July 2003. The Veteran was afforded a VA examination in March 2014. The examiner indicated that the etiology of the Veteran’s ED was unknown, but it was less likely than not attributable to the Veteran’s diabetes. The VA examiner explained that the presence of the microvascular side effects of diabetes mellitus is typically noted in individuals with poorly controlled diabetes, and the Veteran’s diabetes had been under excellent control. The examiner also indicated that the Veteran had not tried PDE5 inhibitors, and was able to achieve an erection without medication. An October 2014 outpatient record indicates that the Veteran has ED “associated with type 2 diabetes mellitus.” The Veteran underwent another VA examination in April 2015. The examiner indicated that the Veteran’s ED was diagnosed in 2011. The examiner explained that, given his excellent diabetes control with minimal medication, date of diagnosed onset, and declining use of interventions indicate there is little to connect the Veteran’s ED to diabetes. Therefore, it is less likely than not that his ED was proximately caused by diabetes. The Veteran had a VA examination for diabetic peripheral neuropathy in July 2015. The examiner provided a positive nexus opinion for neuropathy, explaining that the onset was after the Veteran’s diabetes, it was a known complication, and was diagnosed by a provider with positive sensory findings. The Veteran and his spouse testified at a Board hearing in March 2021. The Veteran explained that he did not try medication because of a kidney condition, and the information in the VA examinations was incorrect. The Veteran’s spouse explained that the onset of ED was before 2011, and that they weighed the option of medication, but decided against it. Based on the competent evidence of record, the Board finds that service connection for ED secondary to type II diabetes mellitus is warranted. While there is no positive nexus opinion with rationale of record, the Board resolves reasonable doubt in the Veteran’s favor. The record reflects that the Veteran was diagnosed with diabetes mellitus in 2003, the onset of his ED was after that, and he is service connected for peripheral neuropathy, which is another complication of diabetes. Even though the March 2014 and April 2015 VA examiners explained that diabetic complications are found in people with poorly controlled diabetes and the Veteran’s diabetes was well-controlled, the Board notes that the Veteran’s blood glucose has not always been in “normal” range. The Veteran’s outpatient records indicate that his hemoglobin A1C at the time of diagnosis was labeled as “high” at 6.1. The Veteran had an A1C of 6.0 in April 2010, and at his most recent VA examination for diabetes mellitus in October 2016, it was noted that his A1C was 6.5. Additionally, the laboratory results of blood glucose tests show “high” results. The laboratory’s normal range was 70 to 110, and the Veteran reported blood sugars of 110 to 170 in April 2011. In May 2010, his blood glucose was 119; in December 2011, it was 123; and in June 2012, it was 127. Moreover, the rationale from the peripheral neuropathy examination could be applicable to the Veteran’s ED in that it had its onset after his diabetes mellitus, and was clinically diagnosed. Importantly, the Veteran’s outpatient records explicitly indicate that the Veteran’s ED is “associated” with diabetes. While the April 2015 examiner reviewed this record, the Board notes that the Veteran and his spouse testified there were inaccuracies in the examination report.   Because of the inaccuracies and medical evidence showing abnormal blood glucose, the Board affords the negative opinions little weight. Having resolved reasonable doubt in the Veteran’s favor, the Board will grant the claim. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Smith, 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.