Citation Nr: 21027904 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 17-14 547 DATE: May 7, 2021 ORDER Service connection for erectile dysfunction, to include as secondary to service-connected major depressive disorder with anxious distress, is granted. FINDING OF FACT The probative medical evidence of record is in equipoise as to whether the Veteran's erectile dysfunction was caused or aggravated by his service-connected major depressive disorder with anxious distress. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction as secondary to service-connected disabilities are met. 38 U.S.C. §§ 1110, 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.310 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from October 1961 to August 1962. In September 2017, the Veteran testified at a hearing before a Veterans Law Judge; a transcript of the hearing is associated with the claims file. In February 2021, the Veteran was informed that the Veterans Law Judge who held the September 2017 hearing was no longer employed by the Board and was given an opportunity to appear at another hearing. See 38 C.F.R. § 20.604 (2020). The letter informed the Veteran that, if no response was received in 30 days, the Board would assume she did not want another hearing. The Veteran has not responded to the letter; therefore, no further action concerning a Board hearing in necessary. Service Connection Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Veteran contends that his erectile dysfunction was caused or aggravated by his service-connected major depressive disorder. The Veteran has a current diagnosis of erectile dysfunction as confirmed in a February 2018 male reproductive organ conditions disability benefits questionnaire (DBQ). The Veteran currently service-connected for major depressive disorder with anxious distress. At present, there have been multiple VA medical opinions addressing potential secondary service connection for erectile dysfunction. A February 2018 VA mental disorders DBQ that included a review of the Veteran's claims folder and pertinent medical history found that the Veteran's erectile dysfunction was associated with his service-connected adjustment disorder. The examiner stated: The Veteran's [erectile dysfunction] is more likely than not associated with his anxiety, as well as he physical discomfort. His anxiety, or worry and fear, related to his heart issues, and his anticipatory anxiety that doubts his ability to perform given his high likelihood of pain, contributes to his [erectile dysfunction]. A November 2019 medical opinion stated the Veteran did not have a current diagnosis of erectile dysfunction. The opinion made no reference to the February 2018 male reproductive organ conditions DBQ that diagnosed the Veteran with erectile dysfunction. Moreover, a February 2020 medical opinion determined that it was less likely than not that the Veteran's [erectile dysfunction] was not caused or aggravated by his service-connected adjustment disorder with anxiety and depressed mood. However, the examiner's rationale stated: Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction. Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction. This medical opinion does not contain any rationale for why the Veteran's erectile dysfunction was not caused or worsened by his service-connected mental health disorder. Finally, a November 2020 medical opinion determined that it was more likely than not that the Veteran's erectile dysfunction was not caused or aggravated by his service-connected major depressive disorder with anxious distress. This medical opinion rationalized that the Veteran's erectile dysfunction was more likely than not caused by his nonservice-connected pulmonary vascular disease. Given the conflicting nature of the numerous medical opinions regarding the etiology of the Veteran's erectile dysfunction, and affording all benefit of the doubt to the Veteran, the Board finds that the evidence of record is in equipoise as to whether his erectile dysfunction was caused or aggravated by his service-connected major depressive disorder with anxious distress. A veteran need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. Entitlement need not be established beyond a reasonable doubt, by clear and convincing evidence, or by a fair preponderance of the evidence. When the evidence is in "relative equipoise, the law dictates that the Veteran prevails." Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, entitlement to service connection for erectile dysfunction is warranted. James Springer Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Riordan, 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.