Citation Nr: 21025200 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 13-35 143 DATE: April 27, 2021 ORDER Entitlement to service connection for erectile dysfunction is granted. Special monthly compensation (SMC) based on loss of use of a creative organ is granted. FINDING OF FACT 1. The evidence is at least in equipoise that the Veteran’s erectile dysfunction was related to service. 2. The grant of service connection for erectile dysfunction supports entitlement to SMC based on loss of use of a creative organ. CONCLUSION OF LAW 1. The criteria for entitlement to service connection for erectile dysfunction have been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. § 3.102, 3.303, 3.310. 2. The criteria for SMC based on loss of use of a creative organ have been met. 38 U.S.C. § 1114(k); 38 C.F.R. § 3.350(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1961 to October 1966. He served in the U.S. Marine Corps, including service in the Republic of Vietnam during the Vietnam era. The Board is thankful for the Veteran’s service to our country. The Veteran testified before the undersigned at a Board videoconference hearing in February 2017. A transcript of the hearing is of record. The Board previously remanded this case in January 2018 for additional development. Upon consideration of additional evidence obtained pursuant to the January 2018 Board remand, an interim August 2020 rating decision granted a total disability rating based on individual unemployability (TDIU) from May 20, 2009, the date of claim. As this represents a complete grant of the Veteran’s TDIU claim, this issue is no longer on appeal before the Board. See generally Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997); Barrera v. Gober, 122 F.3d 1030 (Fed. Cir. 1997). The case has now returned to the Board for further appellate review. Unfortunately, the Veteran died in February 2019, during the pendency of his appeal. The Agency of Original Jurisdiction (AOJ) has recognized his surviving spouse as the substitute claimant for the purposes of processing these claims to completion. Entitlement to service connection for erectile dysfunction is granted. The Board finds that service connection for erectile dysfunction is warranted. Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may also 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. To substantiate a claim of service connection, there must be evidence of: (1) a current disability; (2) a disease, injury, or event in service; and (3) a nexus or causal relationship between the claimed disability and the disease, injury, or event in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection is also warranted for a disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). To establish secondary service connection there must be evidence: (1) of a current disability (for which secondary service connection is sought); (2) of an already service-connected disability; and (3) that the current disability for which service connection is sought was either (a) caused or (b) aggravated by the service-connected disability. 38 C.F.R. § 3.310(a); see Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). As an initial matter, the Board observes that the Veteran was service connected for posttraumatic stress disorder (PTSD). In a June 2008 VA examination report, the examiner noted that PTSD manifested in intrusive thoughts, perceptions, and vivid memories service in the Republic of Vietnam and flashbacks triggered by stimuli rooted in Vietnam. In a February 2009 VA examination report, the Veteran reported that his psychiatric symptoms began immediately after returning to the United States and that when he first arrived back in the U.S. he wanted to go back to Vietnam. The examiner also noted recurrent thoughts and nightmares were symptoms of his PTSD. In an April 2018 VA PTSD examination report, the examiner noted that the Veteran’s traumatic event was persistently reexperienced in recurrent and distressing recollections of the event, recurrent distressing dreams of the event, acting or feeling as if the traumatic event were recurring, and intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. In an October 2018 VA examination report, the Veteran reported that he could not recall when erectile dysfunction had its onset but that the disorder began with difficulty with erections since approximately 1970. The examiner concluded that the etiology of the disorder was multifactorial, including age, stress, hormone levels, small vessel disease, and medication side effects. The Board finds that the evidence is at least in equipoise that erectile dysfunction was related to service-connected PTSD. The October 2018 examiner concluded that the etiology of the disorder was multifactorial, including as due to stress. The Board observes that there is no legal requirement that PTSD be the sole cause of the disorder for which service connection is being sought. As a result of his PTSD, he persistently reexperienced the traumatic stressor events from his service in the Republic of Vietnam. Accordingly, service connection for erectile dysfunction is granted. SMC for loss of use of a creative organ is granted. VA provides special monthly compensation (SMC) if a veteran, as a result of a service-connected disability, sustains the anatomical loss or loss of use of one or more creative organs. 38 U.S.C. § 1114(k); 38 C.F.R. § 3.350(a). Entitlement to SMC based on loss of use of a creative organ can be granted based on erectile dysfunction. In light of the grant of service connection for erectile dysfunction, the Board finds that entitlement to SMC based on loss of use of a creative organ is warranted. Thus, the appeal is granted. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Vashaw, Monica 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.