Citation Nr: 21030955 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 16-31 594 DATE: May 20, 2021 ORDER Entitlement to service connection for erectile dysfunction, to include as due to a service-connected disability, is denied. FINDING OF FACT The objective medical evidence does not show that erectile dysfunction was a result of service or was a result of or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Navy from August 1990 to August 1995. A hearing was conducted by video conference in September 2019 before the undersigned Veteran's Law Judge, at which the Veteran testified; a transcript is of record. The Board previously remanded this case for additional development in January 2020 and again in December 2020. The matter has now returned to the Board for appellate review. Entitlement to service connection for erectile dysfunction, to include as due to a service-connected disability The Veteran contends that his current erectile dysfunction is related to his active military service and he seeks service connection. Alternatively, the Veteran contends that his current erectile dysfunction is due to a service-connected disability. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131. Establishing service connection generally requires competent evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after separation when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection may be granted for any disability that is proximately due to or the result of a service connected disability. 38 C.F.R. § 3.310 (a). Additionally, secondary service connection is also warranted for any permanent increase in severity (aggravation) of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310 (b). VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310 (b) (2017); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Turning to the record, the Veteran's service treatment records (STRs) are silent as to any diagnosis or treatment for erectile dysfunction during active service. The Veteran's September 1989 entrance examination was normal. The Veteran was treated on several occasions during service for blood in his urine. Antibiotic treatment was rendered for urinary tract infections which resolved. No complaints or findings related to erectile dysfunction were noted in service or on the separation physical examination. At the September 2019 Board hearing, the Veteran testified that his erectile dysfunction began sometime between 2010 and 2011 after he had surgery on his hip. Further, at the time of the Board hearing, the Veteran's representative suggested that the Veteran's erectile dysfunction was related to the urinary problems identified during the Veteran's active military service. Pursuant to the Board's January 2020 remand, in March 2020, the Veteran was afforded a VA examination in connection with his claim. A diagnosis of erectile dysfunction was confirmed. The Veteran reported that the onset of the erectile dysfunction was in or around 2000. The examination was negative for a voiding dysfunction and the physical examination was normal. The examiner opined that the Veteran's claimed erectile dysfunction was less likely than not incurred in or caused by the Veteran's active military service. In support of this conclusion, the examiner explained that there are no medical records to substantiate the Veteran being seen for erectile dysfunction during active military service. In an addendum opinion from April 2020, the examiner considered the Veteran's lay assertion that his erectile dysfunction was related to the hematuria the Veteran had while in service. However, the examiner explained that there was no literature or scientific report to support this assertion. In February 2021, another VA medical opinion was obtained. The examiner opined that the Veteran's claimed erectile dysfunction was less likely than not incurred in or caused by the Veteran's active military service. In support of this conclusion the examiner explained that the Veteran's service treatment records do not support any nexus between the Veteran's claimed erectile dysfunction and his military service. Additionally, the examiner determined that the Veteran's claimed erectile dysfunction was less likely than not proximately due to or the result of a service-connected disability. Specifically, the examiner observed that there was no support in the file that erectile dysfunction was caused by the Veteran's hip replacement as the examiner noted that medical research does not support that erectile dysfunction is related to a hip replacement. In light of the evidence as discussed above, the Board finds that service connection for erectile dysfunction, to include as secondary to a service-connected disability, it not warranted. In particular, the Veteran testified that his erectile dysfunction did not begin during his active military service and reported in the March 2020 VA examination that it had its onset in 2000. Additionally, the March 2020 VA examiner explained that there was no support in science that would relate the Veteran's hematuria to erectile dysfunction. Likewise, the February 2021 VA examiner also explained that there is no support in medical literature that erectile dysfunction is at all related to hip replacement surgery. The Board acknowledges that the Veteran himself has claimed his erectile dysfunction is directly related to his active service. However, while the Veteran is competent to report (1) symptoms observable to a layperson, e.g., difficulty maintaining an erection; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis, he is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Consequently, the Veteran's lay assertions of medical diagnosis or etiology are afforded little probative value and cannot constitute evidence upon which to grant the claim for service connection. Latham v. Brown, 7 Vet. App. 359, 365 (1995). As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). MICHAEL D. LYON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Scanlan, 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.