Citation Nr: 21024170 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 15-11 668 DATE: April 22, 2021 ORDER Service connection for erectile dysfunction is granted. REMANDED Entitlement to service connection for prostate cancer, to include as secondary to service-connected prostatitis, is remanded. FINDING OF FACT Erectile dysfunction is etiologically related to service-connected prostatitis. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction, as secondary to service-connected prostatitis, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from August 1973 to August 1976. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in May 2013 by the Department of Veterans Affairs (VA) Regional Office in San Juan, Puerto Rico. The Veteran testified at a hearing before the undersigned in December 2017. A transcript of that hearing has been associated with the record. These claims were previously before the Board in September 2018, at which time they were remanded for further development. Service Connection – Erectile Dysfunction Establishing service connection generally requires medical evidence or, in certain circumstances, lay evidence of the following: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) nexus between the claimed in-service disease and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Under section 3.310(a) of VA regulations, service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 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). As an initial matter, the Board notes that the Veteran has a current diagnosis of erectile dysfunction. Medical treatment records reflect that the Veteran was noted to have the condition as early as 2010. The Board finds that the evidence is at least in equipoise as to whether the Veteran’s erectile dysfunction is secondary to a service-connected disability. The Veteran underwent a VA examination in September 2020, at which time it was determined that his erectile dysfunction was a symptom of his prostate cancer, for which service connection is not in effect. Also in September 2020, the Veteran underwent a separate VA examination related to prostatitis, and the examiner concluded that erectile dysfunction was a symptom of that condition. Subsequent to that examination, the Veteran was awarded service connection for prostatitis. Thus, the Board finds that the medical evidence is in equipoise on the question of whether the Veteran’s erectile dysfunction developed due to a service-connected disability; here, prostatitis. The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran’s favor, a grant of service connection for erectile dysfunction, as secondary to service-connected prostatitis, is warranted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The claim is granted. REASONS FOR REMAND As noted supra, the Veteran underwent a VA examination in relation to his claim for service connection for prostate cancer in September 2020. At that time, the examiner concluded it was less likely than not that his cancer was due to service, to include in-service symptoms of prostatitis. However, at the same time, the Veteran underwent a kidney examination. In the report of that examination, the examiner (who, it is noted, performed the prostate cancer examination) noted that the Veteran first experienced symptoms such as bloody urine, full bladder and lightheaded feelings in service, and that the symptoms had evolved to include erectile dysfunction and malignant prostate cancer. Taken together, these two examination reports, authored by the same examiner at the same time, are internally inconsistent on the question of whether or not the Veteran’s prostate cancer first manifested in, or developed as a result of, his military service. Thus, the Board finds that an addendum opinion in required. Also, the Board notes that at the time of the September 2020 examination, service connection was not in effect for prostatitis and, thus, no opinion was obtained regarding a link, if any, between the disability and prostate cancer. In a September 2020 rating decision, service connection was granted for prostatitis. Thus, the Board finds that a medical opinion is needed concerning any association between the two conditions. Finally, following the September 2020 examinations, the Veteran submitted two internet articles concerning a connection between prostatitis and prostate cancer. The Board notes that such evidence can, in some circumstances, constitute competent medical evidence. 38 C.F.R. § 3.159 (a)(1). However, treatise evidence must “not simply provide speculative generic statements not relevant to the [claimant]’s claim.” Wallin v. West, 11 Vet. App. 509, 514 (1998). Here, the articles only provide general information as to the possibility that a relationship exists between prostatitis and prostate cancer, without any corresponding clinical evidence specific to the Veteran. However, because the Board is remanding the claim to obtain an addendum opinion, the examiner will be asked to review and address the internet articles submitted by the Veteran. The matter is REMANDED for the following action: Return the file to the examiner who authored the September 2020 VA examination reports. If she is unavailable, the opinion should be rendered by another appropriate medical professional. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. Following a review of the file, the examiner is asked to address the following questions: a) whether it is at least as likely as not (that is, a 50 percent or greater degree of probability) that the Veteran’s prostate cancer is related to his service. The examiner is asked to specifically address the Veteran’s in-service genitourinary symptoms such as frequent urinary tract infections, prostatitis and bloody urine and bloody ejaculate. b) whether it is at least as likely as not (a 50 percent or greater degree of probability) that the Veteran’s prostate cancer is caused or aggravated by his service-connected prostatitis. For VA purposes, aggravation is defined as a permanent worsening of the disability beyond its natural progression. If aggravation is found, the examiner should determine, if possible, to what extent the prostate cancer was aggravated beyond its natural progression. In rendering an opinion, the examiner is asked to review and specifically address the following articles, provided by the Veteran on November 28, 2020 and contained in his file: “When Men with Prostate Cancer Get Prostatitis” by Dr. J. Curtis Nickel, M.D. “Correlation between Prostatitis, Benign Prostatic Hyperplasia and Prostate Cancer: A systematic review and Meta-analysis” by Lei Zhang, et. al. A detailed rationale for any opinion offered should be provided. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jeremy J. Olsen, 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.