Citation Nr: 21023117 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 18-51 216 DATE: April 20, 2021 ORDER Entitlement to service connection for erectile dysfunction secondary to a service-connected lumbar spine disability is denied. FINDING OF FACT The most probative evidence indicates the Veteran’s erectile dysfunction is not related to service nor caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction due to a service-connected lumbar spine disability are not met.38U.S.C. §§1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1971 to July 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2017 rating decision by a Department of Veterans Affairs(VA) Regional Office (RO). In August 2019, the Board denied the Veteran’s claim for service connection for erectile dysfunction secondary to a service-connected lumbar spine disability. The Veteran appealed the August 2019 Board decision to the United States Court of Appeals for Veterans Claims (CAVC). Pursuant to a Joint Motion for Partial Remand (JMPR), the CAVC vacated and remanded the portion of the Board’s decision that denied entitlement to service connection for erectile dysfunction claimed as secondary to a service-connected lumbar spine disability because the Board erred when it relied on an inadequate examination. This matter was last before the Board in January 2021, when it was remanded for further development. 1. Entitlement to service connection for erectile dysfunction secondary to a service-connected lumbar spine disability The Veteran contends his erectile dysfunction is secondary to his service connected lumbar spine disability. As an initial matter, the Veteran has a current diagnosis of erectile dysfunction. Thus, the question for the Board is whether the Veteran’s current erectile dysfunction is related to service and/ or his service-connected disabilities. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Generally, to prove service connection there must be: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Moreover, where a veteran served continuously for 90 days or more during active service, and organic disease of the nervous system or endocrine disorders become manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). Service connection may also be established for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439 (1995). However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice- connected disease or injury. 38 C.F.R. § 3.310. The Veteran has not asserted, and the record does not suggest, that his erectile dysfunction is directly related to service. Service treatment records show no diagnosis of, or treatment for, male reproductive organ during service. Additionally, a March 1975 separation examination reflects a normal endocrine system. Thereafter, the record shows no complaints of symptoms prompting a treatment until 2012, which is decades after separation from service. In November 2017, the Veteran reported erectile dysfunction for about 15 years. The lapse of time between service separation and the earliest documentation of current disability is a factor for consideration in deciding a service connection claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). There is also no competent and probative opinion linking the Veteran’s erectile dysfunction to service on a direct incurrence basis. Based on the foregoing, service connection for erectile dysfunction is not warranted on a direct incurrence basis. With respect to secondary service connection, an August 2020 private treatment record notes that the Veteran’s private physician suspects the Veteran’s back pain and back surgery predated his erectile dysfunction and may have contributed to the erectile dysfunction. In accordance with the January 2021 Board remand directive, an opinion was obtained in February 2021. The February 2021 examiner opined that the claimed condition is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected condition. The examiner provided the rationale that while the condition of status post L4-S1 posterior lumbar decompression, posterolateral fusion, posterior lumbar interbody fusion, and instrumentation could represent a potential risk factor for erectile dysfunction, the Veteran’s erectile dysfunction is more likely due to hypogonadism which is a well-established primary etiology of erectile dysfunction in medical literature. The examiner also addressed whether the Veteran’s erectile dysfunction is aggravated beyond its natural progression by his service-connected lumbar spine disability. In that regard, the examiner opined that the medical evidence is not sufficient to support a determination of the baseline level of severity of erectile dysfunction, and that regardless of an established baseline, the Veteran’s erectile dysfunction was not at least as likely as not aggravated beyond its natural progression by the service-connected lumbar spine disability. The examiner explained that the diagnosis of erectile dysfunction with difficulty achieving or maintaining erection with or without treatment falls within the projected natural history of the condition and does not represent aggravation beyond natural progression. Upon review of the record, the Board finds that the most probative evidence is against the claim. The Board finds the February 2021 VA examiner’s opinion highly probative and entitled to great weight. The examiner reviewed the claims file, including the medical and lay evidence, and provided a reasoned rationale for the conclusions reached. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Conversely, the statements from the Veteran’s private physician, Dr. D.M., relating the Veteran’s erectile dysfunction to his back pain and back surgery were largely conclusory and had no rationale. Accordingly, the Board finds these statements are entitled to less probative weight. Id. While the Veteran believes his erectile dysfunction is secondary to his service-connected back disability, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and anatomical relationships. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App.428 (2011). The Board finds the opinion of the 2021 VA examiner to be significantly more probative than the Veteran’s lay assertions. In sum, the most probative evidence is against the claim, and service connection for erectile dysfunction is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Asare, 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.