Citation Nr: 21024650 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 16-08 247 DATE: April 23, 2021 ORDER Entitlement to service connection for erectile dysfunction (ED), to include as secondary to the service-connected service-connected benign prostatic hypertrophy and hyperplasia, is denied. Entitlement to service connection for spermatocele is denied. Entitlement to service connection for dermatitis is denied. FINDINGS OF FACT 1. The weight of the evidence is against finding that the Veteran’s ED is related to his service or was caused or aggravated by his service-connected service-connected benign prostatic hypertrophy and hyperplasia. 2. The weight of the evidence is against finding that the Veteran’s spermatocele is related to his active service. 3. The weight of the evidence is against finding that the Veteran’s dermatitis is related to his active service. CONCLUSIONS OF LAW 1. The criteria for service connection for erectile dysfunction, to include as secondary to the service-connected service-connected benign prostatic hypertrophy and hyperplasia, have not been met. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303, 3.310(a). 2. The criteria for service connection for spermatocele have not been met. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303, 3.310(a). 3. The criteria for service connection dermatitis have not been met. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303, 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1986 to May 2006. The Board of Veterans’ Appeals (Board) remanded this current appeal in April 2019 for further evidentiary development, including obtaining additional records and addendum medical opinions to reconcile the medical evidence. That development has been completed, and the case returns to the Board for adjudication. The April 2019 Board remand is incorporated herein by reference. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (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. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). Service connection may also be established with certain chronic diseases based upon a legal presumption by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from 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. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Service connection may be established for any disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. To prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). ED The Veteran contends that his diagnosed ED is related to his active service, to include as secondary to his service-connected benign prostatic hypertrophy and hyperplasia. The Board finds the preponderance of the evidence is against a finding that service connection for ED is warranted. On VA examination in March 2015, the Veteran’s diagnoses were listed as ED, with an onset in 2011 and prostate hypertrophy, with an onset in 2007. The examiner opined that there was a nexus between the Veteran’s prostate hypertrophy and his active service. The cause of the Veteran’s ED was unknown, and the examiner did not provide an etiology opinion. BPH was granted service connection in an April 2015 rating decision. The Veteran submitted a March 2016 evaluation wherein the examiner suggested that the Veteran’s ED could possibly be due to his benign prostatic hypertrophy (BPH). However, no other rationale or explanation was offered in that report. On review examination in November 2019, the examiner opined that ED was not etiologically related to the Veteran’s service-connected BPH. The examiner explained that ED is not medically related to BPH, which is a noncancerous enlargement of the prostate. ED is a separate entity entirely from the service-connected BPH and is unrelated to it. Medical literature does not support a nexus. BPH does not cause ED, although many men who have BPH also experience ED. BPH, while affecting a sexual organ, is a urination issue and not sexually related. The November 2019 examiner also stated that the service treatment records show no evidence of a diagnosis of, treatment for, or complaints of male erectile disorder during active service or within one year of separation. Indeed, relevant evidence of record indicates that ED was diagnosed in May 2007. The Board finds that the preponderance of the medical evidence of record shows that the Veteran’s ED is not related to his active service or his service-connected BPH. While there is one suggestion of possible connection, the November 2019 examiner clearly and persuasively explained that BPH is not etiologically related to his ED. There is no competent medical evidence with a rationale indicating that the Veteran’s ED was caused, or worsened, by his BPH. While the March 2016 examiner made a notation that there was a possible connection, even that examiner used the word “possible” and a question mark, without further indication of a relationship between ED and BPH. As such, the Board affords more weight to the well-reasoned opinion of the November 2019 examiner in finding that service connection is not warranted. The preponderance of the evidence is against this service connection claim, and the benefit of the doubt rule is inapplicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. At 55-57. Spermatocele The Veteran contends that his spermatocele is related to his active service. The Board finds the preponderance of the evidence is against finding the Veteran’s diagnosed spermatocele is related to his active service. Initially, and in this regard, the Board notes that the March 2015 examination did not find a diagnosis of spermatocele. However, the March 2016 listed it as a condition without further discussion. Based on the March 2016 evaluation, the Board remanded the issue to obtain a medical opinion. Pursuant to the April 2019 Remand, a review examination was obtained in November 2019, where the examiner explained that spermatocele is a retention cyst of a tubule of the rete testis or the head of the epididymis distended with barely watery fluid that contains spermatozoa. Small spermatoceles are relatively common, occurring in an estimated 30 percent of all mend. They vary in size from several millimeters to many centimeters. Spermatoceles are generally not painful, but some men may experience discomfort from larger spermatoceles. They are not cancerous, nor do they cause an increased risk of testicular cancer. Additionally, unlike varicoceles, they do not reduce fertility or cause male erectile disorder. The examiner went on to state that the service treatment records did not show evidence of the diagnosis, treatment or complaint of spermatocele while on active duty or within on year of separation. The Board finds the preponderance of the evidence shows that the Veteran’s spermatocele is unrelated to his active service. The medical opinion of record is thorough and well-reasoned in determining that spermatocele is unrelated to the Veteran’s service. There is no evidence or argument to the contrary. As such, service connection is not warranted. The preponderance of the evidence is against this service connection claim, and the benefit of the doubt rule is inapplicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. At 55-57. Dermatitis The Veteran contends that he has chronic dermatitis related to his active service. The Board finds the preponderance of the evidence is against finding that the Veteran’s dermatitis is related to his active service. Initially, and in this regard, the Board notes that the Veteran has been granted service connection for residuals of a mole removal and a post appendectomy scar. These conditions will not be discussed as part of his claim for dermatitis. A March 2015 VA skin evaluation report indicates that the Veteran had contact dermatitis in 2001, which was treated with no chronic residuals or chronic dermatitis. The examiner opined that dermatitis was less likely than not incurred in, or caused by, the Veteran’s active duty. There is no objective medical evidence in the claims file for a chronic dermatitis condition during service. There are two entries in the claims file dated in 2001 and 2002 regarding dermatitis to the glutes. These appear to have been acute in nature, treated conservatively, and resolved. His discharge examination was negative for any skin conditions. There is no evidence in the claims file to show chronicity of continuity of care for dermatitis. A nexus has not been established. Therefore, it is less likely than not that his current skin condition is related to military service. VA treatment records show the Veteran has a diagnosis of dermatitis. However a February 2016 VA skin disease examination did not indicate such diagnosis. On review examination in November 2019, the examiner opined that the Veteran’s dermatitis was less likely than not incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner explained that the service treatment records show no evidence of a diagnosis of, treatment for, or complaints of chronic dermatitis while on active duty or within one year of separation. The Veteran was diagnosed with contact dermatitis (poison ivy) while on active duty, which was acute and temporary, resolved with treatment, and is not histologically related to the earlier-diagnosed dermatitis. The Board finds the preponderance of the evidence shows that the Veteran’s dermatitis is unrelated to his active. The medical opinions of record are thorough and well-reasoned in determining that any current dermatitis is unrelated to the Veteran’s service. There is no evidence or argument to the contrary. As such, service connection is not warranted. The preponderance of the evidence is against this service connection claim, and the benefit of the doubt rule is inapplicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. At 55-57. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.E. Lee 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.