Citation Nr: 21025339 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 16-30 607 DATE: April 27, 2021 ORDER Entitlement to service connection for erectile dysfunction is granted. FINDING OF FACT The Veteran’s erectile dysfunction is proximately due to medication used to treat his service-connected right thumb disability. CONCLUSION OF LAW Resolving doubt in the Veteran’s favor, the criteria for service connection for erectile dysfunction are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1986 to March 1988. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, the Board remanded the claim for further development, to specifically include obtaining a VA opinion regarding the etiology of the Veteran’s erectile dysfunction, specifically in light of his contentions that it is secondary to medication used to treat his service-connected right thumb disability. A review of the record shows that there has not been substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). However, as the Board is granting the full benefits sought on appeal, there is no prejudice in adjudicating the claim. See Scott v. McDonald, 789 F.3rd 1375 (Fed. Cir. 2015). The Veteran seeks service connection for erectile dysfunction, to include as secondary to medication used to treat his service-connected right thumb disability. 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. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection is also warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. The Federal Circuit has rejected the view that competent medical evidence is required when the determinative issue in a claim for benefits involves either medical etiology or a medical diagnosis. Under 38 U.S.C. § 1154(a), lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d. 1313 (Fed. Cir. 2009). Turning to the evidence, the Veteran’s service treatment records are absent of any complaint, treatment, or diagnosis of erectile dysfunction. The Veteran’s January 1986 enlistment examination and February 1988 separation examination do not indicate any findings for erectile dysfunction. (Continued on the next page)   In February 2015, the Veteran underwent a VA examination to determine the etiology of his erectile dysfunction. The examiner noted that the Veteran had a diagnosis of erectile dysfunction since 2011. The examiner opined that it was less likely than not that the Veteran’s erectile dysfunction was proximately due to, or the result of, Naproxen taken for his service-connected right thumb. The examiner noted that the Veteran developed erectile dysfunction approximately 4 years ago, but had been taking the anti-inflammatory medication Naproxen, since 1987-88. He determined that the most likely etiology for erectile dysfunction is the multiple medications that the Veteran takes daily. The Board notes that the Veteran takes Naproxen daily, as well as other medications for non-service-connected disabilities. The Board considered remanding this case again; however, given that the evidence of record, namely the February 2015 VA examiner’s implication that the Veteran’s prescribed nonsteroidal anti-inflammatory drugs (NSAID) medication for his service-connected right thumb disability may be a contributing factor, and the referenced medical literature that erectile dysfunction is associated with long term use of NSAIDs, the Board finds that the evidence is in at least a state of equipoise as to whether the Veteran’s erectile dysfunction is secondary to a service-connected disability. 38 U.S.C. § 5107(b); 38 C.F.R. § § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990) (holding that “a veteran need only demonstrate that there is an ‘approximate balance of positive and negative evidence’ in order to prevail.”). As such, there is a reasonable basis to conclude that the Veteran’s disability is secondary to his prolonged NSAID treatment; therefore, service connection for erectile dysfunction is warranted. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Hemphill 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.