Citation Nr: 21027033 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 14-42 928 DATE: May 4, 2021 ORDER Entitlement to service connection for erectile dysfunction is denied. FINDING OF FACT The Veteran's erectile dysfunction is not secondary to service-connected disabilities, and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction due to service or service-connected disabilities, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1962 to September 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is associated with the claims file. This matter was previously remanded by the Board in November 2020. There was substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that either began during service or is at least as likely as not related to an in-service injury, event, or disease, or is proximately due to or the result of, or is aggravated beyond its natural progress by service-connected disability. VA is responsible for determining whether the evidence supports the claim, with the veteran prevailing, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). 1. Entitlement to service connection for erectile dysfunction The Veteran asserts that his erectile dysfunction is related to his military service. Alternatively, the Veteran contends that his erectile dysfunction is caused or aggravated by his service-connected diabetes mellitus and/or posttraumatic stress disorder (PTSD). The Board concludes that, while the Veteran has a current diagnosis of erectile dysfunction, the preponderance of the evidence weighs against finding that the Veteran's diagnosis of erectile dysfunction began during service or is otherwise related to an in-service injury, event, or disease. The Board also concludes that the preponderance of the evidence is against finding that the Veteran's erectile dysfunction is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). Service treatment records are silent for any complaints of, treatment for, or diagnosis of erectile dysfunction. Following a review of post-service medical records, it remains unclear exactly when the Veteran was diagnosed with erectile dysfunction and diabetes mellitus. Treatment notes dated in September 2005 indicate the Veteran was diagnosed with diabetes in 1998, and March 2001 treatment notes show erectile dysfunction was listed as an active problem. The Board notes that at a September 2005 VA genitourinary examination, the Veteran reported that his erectile dysfunction problems began in the 1980s. In remands issued in May 2018 and November 2020, the Board determined that VA medical opinions provided in June 2014 and September 2019 were inadequate. Therefore, new VA medical opinions were obtained in January 2021 and February 2021. The January 2021 and February 2021 VA examiners both confirmed the record was reviewed. They opined that it was less likely than not that the Veteran's erectile dysfunction was incurred in or caused by military service, or proximately due to, the result of, or aggravated by his service-connected diabetes mellitus and/or PTSD. As rationale, the examiners noted that service treatment records are negative for any diagnosis or complaints of erectile dysfunction. Additionally, the examiners discussed VA treatment notes from April 2002, which document that after reporting erectile dysfunction problems, the Veteran was diagnosed with hypogonadism and was assessed as having low testosterone. The examiners concluded that the Veteran's erectile dysfunction is related to his hypogonadism, not his military service or service-connected disabilities. The February 2021 VA examiner also noted that to assign any relative contribution to aggravation from diabetes or PTSD is speculative at best. The examiners' combined opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). (Continued on the next page) The Veteran believes his erectile dysfunction is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue, as it is medically complex, as it requires specialized knowledge training to make such an assessment. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Further, the claims file does not contain any medical opinion with sufficient and adequate rationale that establishes a link between the Veteran's erectile dysfunction and either his active service or service-connected disabilities. Consequently, the Board gives more probative weight to the 2021 VA medical opinions. Accordingly, the claim of entitlement to service connection for erectile dysfunction must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Miller, Associate 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.