Citation Nr: 21023410 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 13-20 860 DATE: April 20, 2021 ORDER Entitlement to service connection for erectile dysfunction (ED), as secondary to major depressive disorder, recurrent, moderate with anxious distress (depression), is granted. FINDING OF FACT The Veteran’s ED is proximately due to his depression. CONCLUSION OF LAW The criteria for entitlement to service connection for ED, as secondary to depression, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from July 1950 to December 1954. This matter comes before the Board on appeal from a May 2014 rating decision of an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA). Most recently, the Board remanded this matter in December 2019 to provide the Veteran an examination and secure a medical opinion as to the nature an etiology of his ED. The Board directed the examiner to consider direct service connection and service connection as secondary to depression. In February 2020, the AOJ afforded the Veteran an examination and obtained a medical opinion. In December 2020, the Veteran’s attorney submitted an appellate brief and argued that the VA examiner did not adequately address secondary service connection. The Veteran’s attorney also submitted a private medical opinion. See Dr. M.C. Opinion. As the Veteran’s attorney only argues that secondary service connection is warranted, and the Board concludes that secondary service connection is established, the Board need not address the issue of entitlement to direct service connection. Against the claim is the opinion of the February 2020 examiner, a nurse practitioner specializing in family medicine. The February 2020 examiner opined that aging and nonservice-connected hypertension are more likely responsible for the Veteran’s ED than service-connected depression. The examiner noted that the Veteran’s depression was diagnosed after ED, and explained that aging causes many changes, including ED due to a process similar to a deficiency of sex hormones. The examiner further explained that while the Veteran submitted an article indicating that depression is associated with ED, “the fact remains that the [v]eteran’s age and cardiovascular disease are more likely responsible for the ED than the [depression].” The examiner also explained that ED was not aggravated by depression, as once ED is present it cannot be made worse. See February 2020 VA Medical Opinion. In favor of the claim is the private medical opinion of Dr. M.C., a physician with board certifications in Internal Medicine, Psychiatry and Neurology, and Addiction Medicine. Dr. M.C. opined that the Veteran’s ED was proximately due to his depression. He noted that the Veteran’s psychiatric symptoms began in service and have continued until the present, and that his ED began approximately 15 years ago. Dr. M.C. explained that ED is a multifactorial clinical entity that cannot be wholly ascribed to physical changes in the body. Thus, explained Dr. M.C., while the February 2020 examiner’s description of ED’s relationship to physical changes is correct, it provides only one aspect of ED’s pathophysiology. He noted that the Veteran’s physician had recently stopped his blood pressure medication but his ED persisted, and explained that the Veteran’s hypertension should not negate the strong relationship between psychiatric disorders and ED. Additionally, he noted that the 2020 examiner relied on dated references and the medical literature has advanced. Here, the Dr. M.C.’s opinion is the most probative evidence of record. The February 2020 examiner explained how ED is etiologically related to nonservice-connected causes, the examiner did not adequately explain why depression does not cause ED. Moreover, the February 2020 examiner’s rationale as to secondary service connection is terse and largely relies on ED being diagnosed prior to depression. This aspect of the opinion is not probative. See Frost v. Shulkin, 29 Vet. App. 131 (2017). Indeed, the Board emphasized this point in the December 2019 remand directives. In contrast, Dr. M.C.’s opinion is well-reasoned and thorough. Dr. M.C. is a physician specializing in internal medicine and psychiatry, and this expertise is highly relevant to the question of whether ED is etiologically related to depression. His explanation that the February 2020 examiner’s description of ED is correct but failed to consider alternate causes of ED is well-reasoned and well supported with medical evidence and fully considers the history of the Veteran’s disability. Critically, Dr. M.C. explained that the Veteran’s depression had been present since service, and his opinion does not rely on the fact that ED was diagnosed prior to the psychiatric disability. Thus, as the probative evidence of record weighs in favor of the claim, the criteria for service connection for ED, as secondary to depression, are met. Accordingly, appeal is granted. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.M. Badaczewski, 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.