Citation Nr: 21032381 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 10-00 176A DATE: May 26, 2021 ORDER Service connection for erectile dysfunction is denied. Service connection for benign prostatic hypertrophy is denied. FINDINGS OF FACT 1. The Veteran does not have erectile dysfunction that was caused by, or is related to, his service. 2. The Veteran does not have benign prostatic hypertrophy that was caused by, or is related to, his service. CONCLUSIONS OF LAW 1. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 2. The criteria for service connection for benign prostatic hypertrophy have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1968 to December 1991. In February 2012 and September 2018, the Board remanded these claims for additional development. Service Connection The Veteran asserts that service connection is warranted for erectile dysfunction, and benign prostatic hypertrophy (BPH), to include urinary frequency. In a letter, received in June 2007, the Veteran indicated that he has "silently been suffering" from symptoms that include erectile dysfunction since his service "because I always have the paranoia when it comes to hospitals and doctors," and that he tended not to seek medical treatment unless it is "extremely necessary." Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303 (d). It appears that the majority of the Veteran's service treatment records are not of record. In a memorandum, dated in May 2009, the RO determined that the Veteran's service treatment records are unavailable, that all procedures to obtain them have been followed, and that further attempts would be futile. See also memorandum addendum, dated in October 2009. Dental records, to include a dental health questionnaire, dated in August 1991, were subsequently obtained which do not contain any complaints or findings that are relevant to the issues on appeal. As for the post-service medical evidence, the claims file includes treatment records from the Garcia Medical Center, dated between 2000 and 2001, which show treatment for a wide variety of symptoms. This evidence includes a November 2000 report of a computerized tomography (CT) scan of the abdomen from St. Luke's Medical Center, which contained the medical conclusion that the Veteran's urinary bladder and prostate gland were normal. The diagnosis was sarcoma (lumbar) status post radiation therapy (20 days). A private ultrasound report for the prostate, dated in January 2001, notes that the urinary bladder was unremarkable. The impression notes an essentially normal prostate gland. Private treatment reports show that in August 2006, the Veteran's scrotal contents, penis, and a digital rectal examination of the prostate gland, were within normal limits. Private treatment reports, dated in 2007, show treatment for low back pain, to include a herniated disc and degenerative joint disease. This evidence includes a June CT scan noting a normal urinary bladder. Reports dated in July note a seven-month history (since December 2006) of constant urination and voiding, an overactive and hypercontractile bladder, and urge incontinence. A July ultrasound report notes a normal urinary bladder. The diagnosis was urinary frequency caused by an overactive bladder, urge incontinence, and a hypocontractile bladder. VA progress notes include a May 2011 report which shows that the Veteran denied any flank pain, urgency, frequency, dribbling, hesitancy or nocturia. A March 2012 private ultrasound report notes that there was a fairly distended urinary bladder, but no evidence of solid mass or intraluminal acoustic shadowing, and no evidence of pen-urethral calcification. The relevant impression was Grade I prostate gland enlargement. VA progress notes show that between 2017 and 2018, urinalysis testing was normal. In 2018 there are complaints of urinary dribbling, and a notation of an enlarged prostate based on a May ultrasound. In 2019, there are notations of BPH with LUTS (lower urinary tract symptoms). A VA male reproductive organ disability benefits questionnaire (DBQ), dated in March 2021, shows the following: The Veteran has a history that includes Grade I and Grade II prostate gland enlargement beginning in 2003, and urinary frequency beginning in 2007. The diagnoses were erectile dysfunction, with no date provided (but referencing the RO's original denial of the claim in April 2008), and prostate gland injuries, infections, hypertrophy, post-operative residuals, with a date of 2006. His prostate symptoms had their onset in 2006 and his erectile dysfunction had its onset in 2015. The Veteran does not take medication for either of the claimed conditions. He has prostate hypertrophy, increased urinary frequency, and obstructed voiding. The etiology of his erectile dysfunction is unknown. On examination, the penis, testes, and epididymis, were normal. The prostate was moderately enlarged. The examiner concluded that the Veteran's BPH/urinary frequency, and erectile dysfunction, are less likely than not incurred in, or caused by, his service. The examiner explained that there is no evidence of inservice treatment, and that erectile dysfunction is first shown many years after separation from service. With regard to BPH and urinary frequency, they had their onset in 2006, many years after separation from service. There is no evidence to show that the Veteran was treated for prostate, urinary, or erectile symptoms during service. The majority of the Veteran's service treatment records are unavailable and are not currently of record. To the extent that some service treatment records may remain outstanding, the Court has rejected the argument that there should be an "adverse presumption" against VA where service medical records have been lost or destroyed while in the Government's control. Cromer v. Nicholson, 19 Vet. App. 215 (2005). Accordingly, a chronic condition is not shown during service. See 38 C.F.R. § 3.303. Following separation from service, the earliest medical evidence of either of the claimed disabilities is dated in 2006. This is about 15 years after separation from service. To the extent that a July 2007 letter from Dr. R.Y.S. states, "His history, letters from his colleagues suggested that [he] had this problem while assigned to the U.S. Coast Guard," that is not an etiological opinion, nor is it an accurate summary of the lay statements, none of which specifically discuss either erectile dysfunction or urinary symptoms. There is no competent evidence of record in favor of either of the claims on any basis, to include on a secondary basis. See 38 C.F.R. §§ 3.303, 3.310. The only competent opinions of record are the March 2021 VA opinions, and they weigh against the claims. Accordingly, the claims must be denied. The issues on appeal are based on the contentions that service connection is warranted for BPH (to include urinary frequency) and erectile dysfunction. The Veteran's available service treatment reports, and the post-service medical records, have been discussed. Although lay persons are competent to report the presence of urinary and reproductive symptoms, the Veteran has not clearly asserted that he had prostate symptoms during service. See e.g., Veteran's June 2007 letter, October 2009 notice of disagreement. He has alleged experiencing erectile dysfunction since his service. However, there were negative medical findings in 2000, 2001 and 2006, with no evidence of complaints of any relevant symptoms. This evidence contradicts his claims of ongoing symptoms since his service and they have therefore been afforded reduced probative value. AZ v. Shinseki, 731 F.3d 1303 (Fed. Cir. 2013). There is no medical evidence of either of the claimed conditions during service, or for many years following service. The Veteran is not competent to provide an etiological opinion on these issues. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board therefore finds that the medical evidence outweighs the Veteran's contentions to the effect that he has the claimed conditions due to his service. Madden v. Gober, 125 F. 3d 1477, 1481 (Fed. Cir. 1997). MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T.S.E., 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.