Citation Nr: 21031167 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 15-33 214 DATE: May 20, 2021 ORDER Service connection for erectile dysfunction secondary to medications taken for service-connected degenerative arthritis of the spine with lumbar degenerative disc disease is denied. FINDING OF FACT The preponderance of the evidence shows that the Veteran's erectile dysfunction is not proximately due to or aggravated beyond the natural progression by the medications the Veteran has taken for his service-connected back condition. CONCLUSION OF LAW The criteria for service connection for erectile dysfunction as secondary to the medication taken for a service-connected back condition have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1977 to March 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In October 2020 the Board remanded the matter for an addendum opinion. As there was compliance with the directive of the prior decision, the Board may now adjudicate the claim on the merits. Dyment v. West, 13 Vet. App. 141, 14647 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran contends that he has erectile dysfunction secondary to the medication taken for his service-connected back condition. Generally, service connection is warranted for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Additionally, service connection may be granted for a disability which is proximately due to or aggravated in severity beyond its natural progression by a service-connected condition or the treatment for it, to include medication. 38 U.S.C. § 1110; 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995). Turning to the evidence, at an October 2018 Board hearing before the undersigned Veterans Law Judge the Veteran testified that the erectile dysfunction first began in 2008, around the time when he began taking pain medication for his service-connected back disability. Of record is a VA treatment record from February 2008 noting complaint of erectile dysfunction. Under "active outpatient medications" the record noted "no medications found." In a June 2015 statement, the Veteran wrote that he took Baclofen, Tramadol, Gabapentin, and Tylenol for his back condition, and that in the past he had taken Motrin, Vicodin, and Meloxicam. A VA examination was provided in December 2019. The examination report noted the history of the condition was unclear, as the Veteran and his wife were not certain if the onset was sudden or gradual. They recalled the Veteran had been given an oral steroid, at about which time he began to notice erectile problems. Regarding a relation to the medication the Veteran was taking for his back, the examiner noted that at the time of the onset of erectile dysfunction in February 2008 the Veteran was not on any medications at all, and therefore the examiner concluded the erectile dysfunction was not caused by medications. Regarding any aggravation by the medication the Veteran was taking at that time, to include Baclofen, Gabapentin, and periodic Tramadol, the examiner noted that while Tramadol may temporarily affect sexual function, and the Veteran did not report any worsening of his erectile dysfunction since he began taking Tramadol. In October 2020, the Board remanded the matter for consideration of whether the Veteran's other medications, to include Vicodin, Meloxicam, and Motrin, aggravated the Veteran's erectile dysfunction. An addendum opinion was provided in November 2020 based upon review of the Veteran's entire medical history and claims file. The clinician stated that "Vicodin, Meloxicam, and Motrin do not cause ED or exert any influences on erections. [These medications] are not known to cause ED based on our pharmacological understanding of these medications as described in the medical literature." The clinician noted that, as an additional point, there was no evidence that the Veteran's erectile dysfunction had ever worsened beyond the natural progression. In the clinician's opinion, the etiology of the Veteran's condition "is likely his hypertension and hyperlipidemia." Based on all the evidence of record, the Board finds that service connection is not warranted. The preponderance of the evidence of record supports that the Veteran's erectile dysfunction is neither proximately due to nor aggravated by the medications he takes for his service-connected back disability. As noted by the December 2019 examiner, the evidence shows the Veteran's erectile dysfunction began at a time when he was not yet on any medications. As stated by the December 2019 and October 2020 clinicians, the medications the Veteran took throughout the appeal period, including those that he had discontinued taking, are not known to affect erectile dysfunction. While it was noted that Tramadol could potentially affect sexual function, the December 2019 examiner noted that the Veteran did not regularly use Tramadol, and in turn the evidence did not reflect that the Veteran's use of Tramadol aggravated his erectile dysfunction beyond the normal course of the condition. The October 2020 examiner likewise noted that the evidence did not show that the Veteran's erectile dysfunction had worsened beyond the natural progression. The Board acknowledges the observation from the Veteran and his wife that the erectile dysfunction began around the time he started taking medication for his back. However, the Board finds the preponderance of the evidence supports that the medications the Veteran took for his service-connected back condition did not cause or aggravate his erectile dysfunction. Accordingly, service connection for erectile dysfunction as secondary to medications taken for service-connected degenerative arthritis of the spine with lumbar degenerative disc disease is not warranted. 38 U.S.C. § 1110; 38 C.F.R. § 3.310(a). K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Davis, 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.