Citation Nr: 21027041 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 16-52 183 DATE: May 4, 2021 ORDER Service connection for an acquired psychiatric disability, diagnosed as major depressive disorder, is granted. Service connection for erectile dysfunction is granted. FINDINGS OF FACT 1. The Veteran has been diagnosed with major depressive disorder; it is at least as likely as not that the disorder has a secondary relationship to his service-connected coronary artery disease (CAD). 2. The Veteran has been diagnosed with erectile dysfunction; it is at least as likely as not that his erectile dysfunction also has a secondary relationship to his service-connected CAD. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for an acquired psychiatric disability, diagnosed as major depressive disorder, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for erectile dysfunction have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from November 1970 to October 1972, to include service in the Republic of Vietnam. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Boston, Massachusetts. In November 2020, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Under applicable law, disability which is proximately due to or the result of a service-connected disease or injury shall also be service connected. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. See also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Service connection for major depressive disorder as secondary to CAD In March 2014, the Veteran underwent coronary artery bypass surgery. He contends that he suffers from psychiatric disability as secondary to his service-connected CAD with atrial fibrillation, supraventricular arrhythmia, and coronary artery bypass graft. VA treatment records beginning in September 2014 reflect that the Veteran's mood was mildly depressed. Beginning in June 2016, it was noted that his mood was mildly anxious. In September 2017, it was noted that he had a depressed mood that had worsened over the past three years. The clinical assessment was major depressive disorder. It was noted that there were a number of health factors likely contributing to his low mood. In January 2020, the Veteran was treated for pain management. The pain clinic provider stated that the Veteran's lung disease likely contributed to the swelling in his legs, his impaired exercise tolerance, and possibly his depressed mood. See January 2020 pain clinic assessment by L.W., LCSW. In November 2020, the Veteran and his representative appeared at a Board hearing before the undersigned Veterans Law Judge. During the hearing, the undersigned agreed to hold the record open for a period of time to afford the Veteran an opportunity to submit additional evidence in support of his claim. While the record was open, the Veteran submitted an opinion authored by B.L., DO, a VA psychiatrist. Dr. B.L. endorsed the Veteran's feeling that his quadruple bypass surgery in 2014 and the medical sequelae that followed were major contributors to his depression, noting that "[t]his is a reasonable conclusion to draw." See November 2020 opinion of Dr. B.L. Later that month, another VA care provider, a physician's assistant, noted the Veteran's bypass surgery and subsequent sequelae of CAD. He stated, "all of the above have directly contributed to [the Veteran's] anxiety and depressive symptoms." In reviewing the evidence of record, the Board affords significant weight to the medical opinions from Dr. B.L. and the physician's assistant. Their opinions were based on their personal treatment of the Veteran, and a working knowledge of his medical history, and were sufficiently supported by rationale so as to be probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303-304 (2008). There is no requirement under the law that a primary service-connected disability be the sole cause of a secondary disability. All that is required is a secondary relationship. The evidence as a whole is sufficient to support a finding in the Veteran's favor. Service connection for major depressive disorder is granted. 2. Service connection for erectile dysfunction as secondary to CAD The Veteran also claims that his service-connected CAD has caused or aggravated his erectile dysfunction. See August 2017 VA disability compensation application. The record reflects that he was diagnosed and began treatment for erectile dysfunction in October 2004. See October 2004 VA urology consult. As noted above, during the November 2020 Board hearing, the undersigned agreed to hold the record open for a period of time to afford the Veteran an opportunity to submit additional evidence in support of his claim. While the record was open, the Veteran submitted a November 2020 statement authored by J.H., PA-C. The physician's assistant opined that the Veteran's erectile dysfunction was likely due, at least in part, to the sequelae of his CAD. See November 2020 VA telephone encounter note. In reviewing the evidence of record, the Board affords significant weight to the medical opinion from the physician's assistant. His opinion was based on his personal treatment of the Veteran, and a working knowledge of his medical history, and was sufficiently supported by rationale so as to be probative. See Nieves-Rodriguez, supra. As noted, there is no requirement under the law that a primary disability be the sole cause of a secondary disability. All that is required is a secondary relationship. The evidence as a whole is sufficient to support finding in the Veteran's favor. Service connection for erectile dysfunction is granted. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board F. Lanton, 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.