Citation Nr: 21040666 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 16-21 606 DATE: July 6, 2021 ORDER A compensable rating for erectile dysfunction (ED) is denied. Service connection for peripheral neuropathy of the lower extremities is denied. Service connection for prolapsed colon, to include secondary to service-connected prostate cancer, is denied. REMANDED Service connection for ischemic heart disease is remanded. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran's ED does not present with any deformity. 2. The preponderance of the evidence is against finding that the Veteran's peripheral neuropathy of the lower extremities began during active service or is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence is against finding that the Veteran's prolapsed colon is related to active service or is otherwise due to or aggravated by his service-connected prostate cancer. CONCLUSIONS OF LAW 1. The criteria for a compensable rating for ED have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.20, 4.31, 4.115b, Diagnostic Code (DC) 7599-7522. 2. The criteria for service connection for peripheral neuropathy of the lower extremities have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a prolapsed colon, to include secondary to service-connected prostate cancer, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 1967 to March 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2013 rating decision. Increased Rating Disability ratings are determined by the application of VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4. The determination of whether an increased rating is warranted is based on review of the entire evidence of record and the application of all pertinent regulations. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999). ED The Veteran's ED is evaluated as noncompensable under 38 C.F.R. § 4.115b, DC 7599-7522 for penis, deformity, with loss of erectile power. The Veteran claims he is entitled to an increased rating. Diagnostic Code 7522 provides a single 20 percent rating where the evidence shows deformity of the penis with loss of erectile power. 38 C.F.R. § 4.115b, DC 7522. When the requirements for a compensable rating of a diagnostic code are not shown, a 0 percent rating is assigned. 38 C.F.R. § 4.31. The Veteran underwent a VA examination in November 2013. The examiner noted that although the Veteran has a diagnosis of ED, there is no deformity of the penis. Further, there is no evidence in the record that establishes any penile deformity. Absent evidence of any penile deformity related to service, even though there is ED, a compensable rating is not warranted under DC 7522. As the requirements for a compensable rating under DC 7522 are not met, a noncompensable (0 percent) rating is proper pursuant to 38 C.F.R. § 4.31. The Board does, however, note that the Veteran has been in receipt of special monthly compensation on account of the loss of use of a creative organ effective from March 22, 2006. Service Connection 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, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection is warranted for a disability which is proximately due to, aggravated by, or the result of a service-connected disability. 38 C.F.R. § 3.310. A finding of secondary service connection requires competent medical evidence to connect the asserted secondary disability to the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Velez v. West, 10 Vet. App. 432 (1997). Peripheral Neuropathy of the Lower Extremities The Veteran contends that he has peripheral neuropathy of the lower extremities. The Veteran underwent a VA examination in November 2013 where he was diagnosed with idiopathic peripheral neuropathy. Therefore, the first element of a service connection claim has been met. However, the preponderance of the evidence weighs against finding that the Veteran's current peripheral neuropathy began during service or is otherwise related to an in-service injury, event, or disease. The Veteran underwent a VA examination in November 2013 when the VA examiner stated that it was less likely than not that the Veteran's peripheral neuropathy was incurred in or caused by the claimed in-service injury, event, or illness. Specifically, the examiner stated that the Veteran developed an idiopathic peripheral neuropathy just in 2008. Additionally, the Veteran underwent another VA examination in March 2016 that confirmed the opinion of the November 2013 exam. The March 2016 examiner stated that there is nothing in the medical literature which supports a nexus between prostate cancer and peripheral neuropathy. Therefore, based on the above, both VA examiners found that the diagnosed peripheral neuropathy is less likely than not related to the Veteran's service. To the extent that the Veteran has asserted such a connection, he is not competent to provide a competent medical opinion because the issue is medically complex and requires knowledge of the nervous system and associated medical conditions. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, the Veteran's claim for service connection is denied. Prolapsed Colon The Veteran contends that his prolapsed is due to his service-connected prostate cancer. VA medical records show the Veteran has a prolapsed as noted in July 2013. In November 2013, the Veteran underwent a VA examination which confirmed this diagnosis. The examiner in the November 2013 examination was also asked to determine the etiology of this disability. The examiner found that the diagnosed prolapsed colon is less likely than not proximately due to or aggravated beyond its natural progression by the Veteran's service-connected prostate cancer. Specifically, the examiner noted that after review of the Veteran's medical records and relevant medical literature it was more likely that the Veteran's complaints of chronic constipation were more likely to be the cause of the prolapsed colon. Further, the examiner noted nothing in the record to show that there was no complication associated with the Veteran's prostate surgery and therefore would not be the cause for any injury to the colon. Therefore, service connection on a secondary basis is not warranted. This denial on the basis of secondary service connection does not preclude the Veteran from service connection on a direct basis. As stated previously, VA medical records and the November 2013 VA examination establish a current diagnosis of a prolapsed colon. Therefore, the first element of a direct service connection claim has been met. In November 2013, the Veteran underwent a VA examination in order to determine the etiology of this disability. The examiner found that the Veteran's prolapsed colon was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner, as stated previously, that the Veteran has a history of chronic constipation. This increased pressure and firm stool over time with straining, could increase the chances of developing an internal prolapse. These findings were confirmed in a subsequent March 2016 VA examination that noted chronic constipation was the likely cause of the prolapsed colon, not the Veteran's service. The Board acknowledges the Veteran's own assertions in support of his claim. However, as a layperson without the appropriate medical training and expertise, the Veteran has not demonstrated the competency to opine as to the etiologies in this matter. Furthermore, neither the Veteran nor his representative has presented or identified any additional medical opinion or other competent evidence that supports the Veteran's claim. Therefore, the Board finds that the preponderance of the evidence is against the claim on both a direct and secondary basis. As such, the benefit of the doubt rule is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND Heart Disability The Veteran underwent a VA examination in November 2013 regarding his claimed heart disability. The examiner found the Veteran to have a current diagnosis of valvular heart disease, however, the examiner failed to opine regarding whether or not this disability is related to the Veteran's active duty service. As such, a remand is necessary to obtain an opinion for direct service connection. (Continued on the next page) The matter is REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any heart disability, to include the diagnosed valvular heart disability. The examiner must opine whether it is at least as likely as not that the Veteran's heart disability had its onset during active service or is otherwise related to any in-service injury, event, or disease. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jorge Barroso, 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.