Citation Nr: 22016945 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 18-41 745 DATE: March 23, 2022 ORDER Service connection for erectile dysfunction (ED) is denied. FINDINGS OF FACT 1. The Veteran served on active duty from June 1988 to April 1992, to include service in the Southwest Asia Theater of Operations. 2. ED was not shown in service, is not causally or etiologically related to service, and was not caused by or permanently worsened in severity by a service-connected disability. CONCLUSION OF LAW ED was not incurred in service and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159. 3.303, 3.310 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION In April 2021, the Veteran testified before the undersigned Veterans Law Judge. A copy of the transcript has been associated with the claims file. In June 2021, the Board remanded the appeal for additional development. The case has now been returned to the Board for further appellate action. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran claims that ED is proximately due to, or aggravated beyond its natural progression by, a penile varicocele ligation which was conducted during service, and for which he is separately service connected. Initially, although he complained of ED from approximately ten years prior, he was formally diagnosed with ED at a November 2017 VA examination. Thus, a current diagnosis is shown, and the first element of service connection is met. Next, the service treatment records (STRs) reflect that in April 1990, the Veteran underwent a low ligation of left varicocele. October 1991 follow up notes reflected that he was status/post varicocele repair, and that there was probable infertility. No ED was noted. Nonetheless, as surgery was conducted in service, an in-service incurrence is met. Additionally, with regard to secondary service connection, he has been service connected for postoperative left varicocele, mild left testicular atrophy, and infertility since April 1992. Thus, the second element of secondary service connection is also met. Therefore, the remaining question before the Board is whether there is a medical nexus between the ED, and the service-connected varicocele disability, or whether ED was aggravated by the varicocele surgery. The Board finds that the appeal fails on these final elements. Specifically, in a July 1992 VA examination, the examiner noted that the Veteran had a left varicocele repair in the Army secondary to orchialgia in the left testicle. The examiner noted that there was a sperm analysis prior to surgery which revealed a decreased sperm count and there was no change after surgery. The examiner noted that the Veteran's pain had been relieved after surgery and he had no complaints at that time. Upon examination, his phallus was normal, and he denied any further complications. This evidence suggests that the Veteran was not experiencing ED shortly after discharge. At an April 2017 VA examination, the examiner reviewed the record and examined the Veteran and found that he did not have ED. At a November 2017 VA examination, the Veteran was formally diagnosed with ED. He reported that he had a normal postoperative course following the varicocele repair without complication and that he began to experience ED approximately 10 years prior which was intermittent in nature. This dates the onset of ED to approximately 2007, some 15 years after discharge. After reviewing the records and examining the Veteran, the examiner opined it was less likely than not that the Veteran's ED was related to his in-service surgery or service-connected disability. The examiner reasoned that the two conditions were not medically related and further noted that the claimed disorder was a separate entity entirely from the service-connected condition and unrelated to it. The examiner noted that the medical literature also did not support a medical relationship. After a review of the record, another VA examiner provided a similar opinion in December 2021. Specifically, the examiner opined that it was less likely than not that the Veteran's ED was proximately due to, or aggravated by, his service-connected disability. The examiner reasoned that a varicocele repair was a separate entity entirely from ED and fully unrelated to it. Additionally, the examiner noted that there was no evidence of aggravation of the Veteran's ED in the available records. The examiner also reasoned that the STRs mentioned a varicocele repair in 1990, which was a surgery performed to remove enlarged veins and restore proper blood flow to the reproductive organs. The examiner noted that this was a separate entity entirely from ED and unrelated to it in that way. The Board finds that the examinations were adequate for evaluation purposes. Specifically, the examiners reviewed the claims file, interviewed the Veteran, and conducted a physical examination. There is no indication that the VA examiners were not fully aware of the Veteran's past medical history or that they misstated any relevant fact. Moreover, the examiners have the requisite medical expertise to render medical opinions regarding the etiology of the disorder and had sufficient facts and data on which to base the conclusion. Further, there is no contradicting medical evidence of record. Therefore, the Board finds the VA examiners' opinions to be of great probative value. In this regard, the third element a medical nexus between the two is not met, as no competent medical professional has opined that there is an etiological connection between ED and the Veteran's varicocele repair or disability. The Board has also considered the Veteran's lay statements that his disorder was caused by service or a service connected disability. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Yacoub, 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.