Citation Nr: 21024213 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 19-14 227 DATE: April 22, 2021 ORDER Service connection for erectile dysfunction, as secondary to service-connected sarcoidosis, is granted. FINDING OF FACT The Veteran’s erectile dysfunction was caused by the service-connected sarcoidosis. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran’s favor, the criteria for service connection for erectile dysfunction, as secondary to service connected sarcoidosis, have been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 3.326. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant, had active service from February 1976 to October 1976. This matter came before the Board of Veterans’ Appeals (Board) on appeal from a December 2018 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. The Veteran testified at a January 2021 virtual Board hearing before the undersigned Veterans Law Judge. The hearing transcript has been associated with the record. The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). As the instant decision grants service connection for erectile dysfunction, which is a complete grant as to the issue on appeal, no further discussion of VA’s duties to notify and assist is necessary. Service Connection for Erectile Dysfunction Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Service connection may be granted for disability that is proximately due to or the result of a service-connected disability. An increase in severity of a non service connected disorder that is proximately due to or the result of a service connected disability, and not due to the natural progress of the non service connected condition, will be service connected. Aggravation will be established by determining the baseline level of severity of the non service connected condition and deducting that baseline level, as well as any increase due to the natural progress of the disease, from the current level. See 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Veteran seeks service connection for erectile dysfunction, to include as due to the service-connected sarcoidosis. At the outset, the Board notes that the Veteran is currently diagnosed with erectile dysfunction. Such diagnosis can be found within the reports from April 2018 and April 2019 VA reproductive system examinations. Next, having reviewed all the evidence of record, lay and medical, the Board finds the evidence at least in equipoise on the question of whether the currently diagnosed erectile dysfunction was caused by the service-connected sarcoidosis. During the course of this appeal VA received a private medical opinion dated January 2021. Per the opinion report, the private physician reviewed the evidence of record, to include VA and private treatment records. After a review of all the evidence, the private physician opined that it was at least as likely as not that the Veteran’s erectile dysfunction was secondary to the service-connected sarcoidosis. In rendering this opinion, the private examiner explained that sarcoidosis causes tiny nodules to form in multiple organs, which can bind together to form granulomas. When sarcoidosis manifests in the testes, it causes a sharp decrease in testosterone production, which, in turn, leads to infertility and erectile dysfunction. Based on this medical process and the evidence of record, a positive secondary service connection opinion was rendered. The Board notes that a negative secondary service connection opinion was rendered by a VA examiner in April 2019. In rendering that negative opinion, the VA examiner explained that sarcoidosis can infiltrate the pituitary gland and cause hypogonadism. As an April 2019 examination report showed a normal pituitary gland, the VA examiner opined it less likely than not that the erectile dysfunction was due to the service-connected sarcoidosis; however, as discussed above, the positive January 2021 secondary service connection opinion was based upon a finding that sarcoidosis manifested in the testes, which caused a drop in testosterone production. As the VA examiner did not address the question of whether sarcoidosis may have manifested in the testes and subsequently caused erectile dysfunction, the Board does not find the VA opinion to be of significant probative value. In sum, a private examiner in January 2021 opined that it was at least as likely as not that service-connected sarcoidosis manifested in the Veteran’s testes and subsequently caused a sharp decrease in testosterone production, leading to the currently diagnosed erectile dysfunction. While a VA examiner in April 2019 rendered a negative secondary service connection opinion, such opinion was based upon a finding that sarcoidosis had not negatively impacted the Veteran’s pituitary gland. The VA examiner did not consider whether sarcoidosis had manifested in the testes. As such, the evidence is at least in equipoise on the question of whether the service-connected sarcoidosis caused the currently diagnosed erectile dysfunction. For the above stated reasons, and resolving all reasonable doubt in favor of the Veteran, the Board finds that the criteria for service connection for erectile dysfunction, as secondary to service connected sarcoidosis, on a causation basis, have been met. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Blowers, 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.