Citation Nr: 22014002 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 19-25 817 DATE: March 11, 2022 ORDER The claim for service connection for erectile dysfunction (ED) is denied. REMANDED The claim for an increased disability rating in excess of 30 percent for left knee degenerative joint disease, status post total knee replacement (herein left knee disability) is remanded. FINDING OF FACT The evidence of record persuasively weighs against finding that ED began during active service, is otherwise related to an in-service injury or disease, or is proximately related a service-connected disability. CONCLUSION OF LAW The criteria for service connection for ED are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1972 to April 1974. 1. Entitlement to service connection for ED The Veteran contends that he incurred ED as a result of his service-connected right and left knee disabilities. At the outset, the Board notes that the Veteran has not reported, nor does the Veteran report, that he incurred ED directly during or as a result of an in-service injury or event. Service treatment records are negative for any complaints, treatment, or diagnosis of ED, including upon separation examination, and ED was not diagnosed for many years post-service. As such, the evidence does not demonstrate a connection between current ED and military service. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that is proximately due to or was aggravated by his service-connected right and left knee disabilities. The Board concludes that, while the Veteran has a current ED disability, the evidence of record persuasively weighs against finding that the Veteran's ED is proximately due to or the result of or aggravated beyond its natural progression by his service-connected right and left knee disabilities. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The 2018 VA examiner opined that the Veteran has several comorbidities, to include non-service connected disabilities like hypertension (and medication used to treat it) and cannabis abuse disorder, as well as his age that can cause and aggravate his ED. As a result, the examiner said that it was not possible to determine that his ED is proximately due to his service-connected right and left knee disabilities, to include the medication to treat his knee symptoms, without resort to speculation. The remaining medical evidence, including VA treatment records, do not include any evidence linking ED to the service-connected disabilities. The Board acknowledges that the Veteran believes that his ED is proximately related to his service-connected right and left knee disabilities, to include the medication used to treat the related symptoms. However, he is not competent to provide a nexus opinion regarding this issue as it is medically complex and requires knowledge of the interaction between multiple organ systems in the body. As the Veteran has not been shown to have the requisite skills or medical training, it is outside his competence to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiner's opinion, which is against the finding of proximate service connection for ED. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), Barr v. Nicholson, 21 Vet. App. 303 (2007), Stefl v. Nicholson, 21 Vet. App. 120 (2007), Prejean v. West, 13 Vet. App. 444 (2000). Given the lack of medical evidence in support of the claim, the evidence is against a finding of a proximate connection between the Veteran's current ED and service-connected right and left knee disabilities. Accordingly, the Board must conclude that the weight of the evidence is against the claim, and it is, therefore, denied. In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt rule enunciated in 38 U.S.C. § 5107(b). However, as there is not an approximate balance of evidence, that rule is not applicable in this case. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). REASONS FOR REMAND 1. Entitlement to an increased disability rating in excess of 30 percent for left knee disability During the Board hearing, the Veteran reported that his left knee disability as worsened since his last VA examination in 2018. In light of the Veteran's reports, the Board finds that a new VA examination is necessary to assess the current severity of his left knee disability. See Green v. Derwinski, 1 Vet. App. 121 (1991) (VA has a duty to conduct a thorough and contemporaneous examination of the Veteran in an increased rating claim); Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left knee disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. B., 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.