Citation Nr: 22014182 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 16-59 238 DATE: March 11, 2022 ORDER Entitlement to service connection for erectile dysfunction is granted. Entitlement to service connection for a right upper extremity carpal tunnel syndrome is granted. Entitlement to service connection for right shoulder disability (other than right upper extremity radiculopathy) is granted. REMANDED ISSUE Entitlement to service connection for sinus disability is remanded. INTRODUCTION The Veteran served on active duty in the United States Navy from March 1973 to June 1993. There matters come before the Board of Veterans' Appeals (Board) on appeal from rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2022, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of this hearing has been associated with the claims file. FINDINGS OF FACT 1. The Veteran's erectile dysfunction onset during active service. 2. The Veteran's right upper extremity carpal tunnel syndrome began during active service. 3. The Veteran's right shoulder disability (other than right upper extremity radiculopathy) began during active service. CONCLUSIONS OF LAW 1. The criteria for service connection for erectile dysfunction are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for right upper extremity carpal tunnel syndrome are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for right shoulder disability (other than right upper extremity radiculopathy) are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran submitted claims of entitlement to service connection for erectile dysfunction, right upper extremity carpal tunnel syndrome, and a right shoulder disability in September 2012. He has perfected an appeal of the RO's determinations. During the pendency of this appeal, the Veteran submitted a separate claim of entitlement to service connection for right upper extremity radiculopathy, to include as a neurological abnormality associated with a cervical spine disability. Ultimately, in an April 2018 rating decision, service connection for right upper extremity radiculopathy was granted and a 20 percent rating was assigned thereto. Herein, the Veteran's right upper extremity carpal tunnel syndrome and right shoulder disability will be considered as separate and apart from his right upper extremity radiculopathy for service connection purposes. In general, service connection may be granted for a disability or injury incurred in or aggravated by active military service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be established by credible lay evidence and medical evidence provided by the Veteran or otherwise. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be found on a secondary basis where the following criteria is met: (1) a current disability that is not already service-connected; (2) at least one service-connected disability; and (3) evidence that the non-service-connected current disability is either proximately due to or as the result of a service-connected disability; or, aggravated beyond its natural progress by a service-connected disability. 38 C.F.R. § 3.310; see also El-Amin v. Shinseki, 26 Vet. App. 136 (2013); Allen v. Brown, 7 Vet. App. 439 (1995). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. See Alemany v. Brown, 9 Vet. App. 518 (1996). The evidence of record includes current diagnoses of erectile dysfunction, right upper extremity carpal tunnel syndrome, and right shoulder disability. See Degmetich v. Brown, 104 F.3d 1328, 1333 (1997) (holding that the existence of a current disability is the cornerstone of a claim for VA disability compensation). As such, this aspect of service connection has been established for each claim. Erectile Dysfunction The Veteran was not provided a VA examination with respect to his claim of entitlement to service connection for erectile dysfunction. In denying this claim, the RO determined that the Veteran's service treatment records were negative for complaints of or treatment for erectile dysfunction during his active service. During the January 2022 hearing, the Veteran testified that his current erectile dysfunction had its onset during his active service, to include as due prescribed medication. He further testified that, since initial onset, he experienced episodes where erectile function was normal, but, overall, he has experienced erectile dysfunction since his active service. The evidence of record demonstrates that he was eventually prescribed a medication to treat erectile dysfunction in November 2009. During the January 2022 hearing, the Veteran's spouse also testified. She stated that she and the Veteran had been married for 43 years, to include during the Veteran's active service. She further stated that, during his active service, the Veteran experienced erectile dysfunction, and this disability continued until the present. The Board finds the testimony proffered by the Veteran and his spouse to competent and credible. Despite the absence of in-service treatment, the Board finds that the evidence is in approximate balance and, thus, with the application of the reasonable doubt doctrine, service connection for erectile dysfunction is warranted. Right Upper Extremity Carpal Tunnel Syndrome The Veteran underwent a VA examination in October 2016 that was primarily intended to evaluate his left upper extremity carpal tunnel, but incidentally assess his right upper extremity as well. Ultimately, the examiner diagnosed bilateral carpal tunnel syndrome "being suspected as far back as an [sic] [service treatment record] note dated [October 13, 1981]." Further, the examiner's positive etiological opinion included a determined that the Veteran's left carpal tunnel syndrome was due to in-service "overuse [versus] early [carpal tunnel syndrome]." Given that the Veteran was found to be ambidextrous, it is reasonable to extrapolate that the Veteran used his right hand as much as his left hand during his active service, to include "overuse." Given the Veteran's current and ongoing diagnosis of right upper extremity carpal tunnel syndrome, as well as his credible January 2022 testimony as to in-service and post-service symptoms, the Board finds there is, at least, an approximate balance of evidence in support of the Veteran's claim. As such, with application of the doctrine of reasonable doubt, the Board finds that service connection for right upper extremity carpal tunnel syndrome is warranted. Right Shoulder As mentioned above, service connection has been granted for the Veteran's right upper extremity radiculopathy. Additionally, herein, service connection has been granted for the Veteran's right upper extremity carpal tunnel syndrome. The evidence demonstrates that, beyond these already service-connected disabilities, the Veteran also experiences a right shoulder disability that has been alternatively diagnosed as adhesive capsulitis or tendonitis. The Veteran was not provided a VA examination that specifically pertained to his right shoulder adhesive capsulitis or tendonitis. During the January 2020 Board hearing, the Veteran testified that observable symptoms of right shoulder disability, such as pain, onset during his active service. He further testified that he did not seek in-service treatment for his right shoulder symptoms/disability for a variety of reason, including concern that he would receive a profile that would negatively affect his evaluation. He also alluded to military culture being against a service member going to "sick bay" for every ache or pain. The Board finds the Veteran's testimony as to his right shoulder disability to be both competent and credible. Despite the absence of in-service treatment, the Board finds that the evidence is in approximate balance and, thus, with the application of the reasonable doubt doctrine, service connection for right shoulder disability, other than right upper extremity carpal tunnel syndrome and radiculopathy, is warranted. REASONS FOR REMAND The evidence of record is unclear as to the presence and nature of the Veteran's claimed sinus disability. The Board finds that a remand is warranted in order to provide the Veteran with a VA examination to obtain current findings and to obtain an etiological opinion from a VA examination. This matter is REMANDED for the following action: 1. Obtain the Veteran's relevant VA treatment records dated in and after April 2018. If no records are available, the claims folder must indicate this fact. Any additional records identified by the Veteran during the course of the remand should also be obtained, following the receipt of any necessary authorizations from the Veteran, and associated with the claims file. 2. Schedule the Veteran for a VA examination to address his claimed sinus disability. All appropriate testing should be conducted, and all findings reported in detail. The examiner is asked to respond to the following: (a) Identify all sinus disabilities present OR that were present during the pendency of this appeal (since September 2012). (b) For every sinus disability present on examination and every sinus disability present since September 2012 (even if it has since resolved), opine as to whether it is at least as likely as not that each such disability was incurred in or due to the Veteran's active duty; AND (c) For every sinus disability present on examination, opine whether is it is at least as likely as not that each such disability was caused or aggravated by a service-connected disability. A full explanation must be provided to support all rendered opinions. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sean G. Pflugner, 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.