Citation Nr: 21050284 Decision Date: 08/16/21 Archive Date: 08/16/21 DOCKET NO. 16-44 596 DATE: August 16, 2021 ORDER Entitlement to service connection for tinnitus has been withdrawn. Entitlement to a disability rating greater than 10 percent for injury to flexion and lateral motion of the spine has been withdrawn. Entitlement to service connection for erectile dysfunction (ED), as secondary to peripheral neuropathy of the right and left lower extremities is granted. FINDINGS OF FACT 1. In July 2021 correspondence, prior to promulgation of this decision, the Veteran's representative communicated the Veteran's intent to withdraw his claims for service connection for tinnitus and to a disability rating greater than 10 percent for injury to flexion and lateral motion of the spine. 2. The evidence of record is at least in equipoise as to whether the Veteran's erectile dysfunction (ED) is secondary to his service-connected peripheral neuropathy of the right and left lower extremities and back disability. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the claim for entitlement to service connection for tinnitus by the appellant (or his or her authorized representative) have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205 (for AMA) § 19.55 (legacy). 2. The criteria for withdrawal of the claim for entitlement to a disability rating greater than 10 percent for injury to flexion and lateral motion of the spine by the appellant (or his or her authorized representative) have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205 (for AMA) § 19.55 (legacy). 3. The criteria for entitlement to service connection for erectile dysfunction (ED), as secondary to peripheral neuropathy of the right and left lower extremities have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from October 1969 to August 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision of a VA Regional Office (RO). The Board remanded the issues on appeal in December 2018. The Board finds that the RO substantially complied with its remand instructions, and the Board may now proceed with adjudication. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the Veteran or his authorized representative. 38 C.F.R. § 20.205. Except for a withdrawal on the record during a hearing, withdrawal of an issue must be done in writing. 38 C.F.R. § 20.205(b). The Veteran's representative submitted a July 2021 statement indicating his intent to withdraw his appeal for service connection for tinnitus and entitlement to a greater disability rating for his back disability. The Board finds the July 2021 correspondence qualifies as a valid withdrawal of the issues. 38 C.F.R. § 20.205(b). Accordingly, the Board will only consider the claim for entitlement to service connection for ED in this decision. 1. Entitlement to service connection for erectile dysfunction (ED), as secondary to peripheral neuropathy of the right and left lower extremities The Veteran asserts that his current ED is secondary to his service-connected peripheral neuropathy of the lower extremities. Service connection may be awarded for a disability "resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty." 38 U.S.C. § 1110. To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Holton v. Shinseki, 557 F.3d 1362 (2009). Service connection may be established for disability that is proximately due to or aggravated by a service- connected disease or injury. 38 C.F.R. § 3.310. In this case, the Veteran's service treatment records (STR) are negative for complaints, treatment, or diagnosis of ED. In a private medical opinion dated February 2016, the physician opined that the Veteran's sexual dysfunction was likely related to his service-connected disabilities and exposure to herbicides during service. In a July 2016 statement by the Veteran's representative, it was argued that research indicated that peripheral neuropathy could cause ED. Additionally, it was noted that the Veteran was diagnosed with peripheral neuropathy in 1995 and ED in 1998. The Veteran submitted research articles in support of his claim. The VA examiner with whom the Veteran met in August 2019 opined that his ED was less likely than not related to his service-connected peripheral neuropathy. The examiner's rationale was based on his peripheral neuropathy not being linked to herbicide exposure. A November 2019 VA medical opinion held that his ED was less likely than not related to his service-connected peripheral neuropathy. The examiner's rationale was based on the lack of evidence of ED during service. A Veteran's March 2020 VA medical opinion indicated that ED was less likely than not related to his service-connected peripheral neuropathy. The examiner's rationale was based on his ED beginning in 1998, more than 20 years prior to his new diagnosis of IVDS and degenerative joint disease of the spine. In July 2021, the Veteran submitted an addendum medical opinion from the physician who authored the February 2016 opinion. The physician concluded that ED was most likely caused by the Veteran's peripheral neuropathy. The physician noted that the Veteran's medical history noted complaints of peripheral neuropathy in July 1995, and, at that time, the Veteran asserted experiencing peripheral neuropathy symptoms for the past four or five years. ED was noted in a December 1998 treatment record, and the Veteran stated that he had experienced ED for the past years. The physician then offered a detailed review of the Veteran's medical history. The examiner stated that medical research did indicate a strong correlation between peripheral neuropathy and the subsequent development of ED. Additionally, the examiner reviewed the VA examination reports of record, explained his disagreement with their conclusions, and identified deficiencies in the etiology opinions offered by the examiners. Based on these facts, the examiner opined that the Veteran's ED was most likely caused by his peripheral neuropathy and low back disability. The Veteran has consistently asserted that his ED is due to his service-connected peripheral neuropathy. In considering the Veteran's contentions, the Board notes that he is competent to observe lay symptoms but does not have the training or credentials to provide a competent opinion as to etiology, diagnosis, or the onset date of a medical disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds the evidence is at least in equipoise as to whether the Veteran's ED is due to his service-connected peripheral neuropathy. While the various VA examination reports are against the Veteran's claim, the Board finds the VA examination reports are not as detailed as the July 2021 private medical opinion. The July 2021 medical opinion offers a more detailed analysis of the Veteran's medical history and the relevant medical research regarding peripheral neuropathy and ED. As there is significant evidence for and against the Veteran's claim, the benefit of the doubt will be given to the Veteran. Accordingly, the claim for service connection for ED is granted. Z. SAHRAIE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Hicks, 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.