Citation Nr: 21031000 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 16-30 238 DATE: May 20, 2021 ORDER Entitlement to service connection for erectile dysfunction is granted. REMANDED Entitlement to service connection for scrotal sebaceous cysts is remanded. FINDING OF FACT The Veteran's erectile dysfunction is proximately due to his service-connected type II diabetes mellitus (diabetes). CONCLUSION OF LAW The criteria for service connection for erectile dysfunction have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from August 1965 to August 1967, including service in the Republic of Vietnam. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision from the Lincoln, Nebraska Department of Veterans Affairs (VA) Regional Office (RO). In June 2016 correspondence, the Veteran requested a hearing before a Veterans Law Judge. In April 2019 correspondence, the Veteran withdrew his request for a hearing. His request for a hearing before the Board is accordingly deemed to be effectively withdrawn. See 38 C.F.R. § 20.704(e). During the pendency of the appeal, the RO issued rating decisions in April 2016 and October 2016 that granted service connection for type 2 diabetes mellitus and peripheral neuropathy of the bilateral upper and lower extremities. As these awards of service connection constitute full grants of the benefits sought on appeal, these issues are no longer before the Board. Service Connection 1. Entitlement to service connection for erectile dysfunction. Service connection may be established for a disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310; El-Amin v. Shinseki, 26 Vet. App. 136 (2013); Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran contends that erectile dysfunction is secondary to his service-connected diabetes. Initially, the Board notes the Veteran has established service connection for diabetes. See April 2016 rating decision. The evidence of record reflects a diagnosis of erectile dysfunction. See March 2016 VA examination. In March 2015, the Veteran's treating urologist indicated the Veteran's erectile dysfunction was associated with diabetes. In August 2016, the Veteran's private treating physician opined that the Veteran's genitourinary symptoms are the result of his service-connected diabetes. The Board acknowledges the March and April 2016 VA examiner's negative nexus opinion regarding secondary service connection for erectile dysfunction. However, the VA examiner failed to address the positive nexus opinions provided by the Veteran's treating urologist and private physician. Thus, the Board accords little probative value to the March and April 2016 negative nexus opinions. Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (medical opinions based on an incomplete or inaccurate factual premise are not probative). After a review of the evidence of record, the Board finds that the preponderance of the evidence supports awarding service connection for erectile dysfunction as being of service origin as secondary to service-connected diabetes. See 38 C.F.R. § 3.310. Thus, service connection for erectile dysfunction is warranted. REASONS FOR REMAND 2. Entitlement to service connection for scrotal sebaceous cysts is remanded. The Veteran contends scrotal sebaceous cysts are secondary to service-connected diabetes. The Veteran was afforded a VA examination in March 2016. It was opined that it was less likely than not the Veteran's scrotal sebaceous cysts were proximately due to or caused by his service-connected diabetes. The rationale provided does not reveal aggravation was adequately addressed and considered by the examiner. Therefore, this opinion is inadequate as it does not sufficiently address the aggravation aspect of the Veteran's scrotal sebaceous cysts claim. See El-Amin v. Shinseki, 26 Vet. App. 136, 138 (2013). Thus, a new examination is needed on remand. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records since August 2016 and associate them with the claims file. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of any in-service and post-service symptomatology regarding his scrotal sebaceous cysts. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the nature and etiology of scrotal sebaceous cysts. After conducting any necessary testing and taking into account the Veteran's history, the examiner should opine as to whether it is at least as likely as not that any scrotal sebaceous cysts were caused or aggravated by a service-connected disability, to include diabetes. Please note that separate opinions addressing proximate cause and aggravation are needed. It is not necessary that diabetes be service-connected, or even diagnosed, at the time his scrotal sebaceous cysts were incurred, and reliance on this fact in support of a negative opinion will render it inadequate. Jarrette A. Marley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Straughn, 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.