Citation Nr: A22006319 Decision Date: 04/08/22 Archive Date: 04/08/22 DOCKET NO. 200318-77709 DATE: April 8, 2022 ORDER Entitlement to service connection for erectile dysfunction (ED), as secondary to posttraumatic stress disorder (PTSD) with obsessive compulsive disorder, neurocognitive disorder, and traumatic brain injury (TBI), is granted. Entitlement to special monthly compensation (SMC) based on loss of use of a creative organ is granted. FINDINGS OF FACT 1. The Veteran's ED is proximately due to his PTSD with TBI. 2. The Veteran's ED results in inability to achieve an erection sufficient for penetration and ejaculation. CONCLUSIONS OF LAW 1. The criteria entitlement to service connection for ED, as secondary to PTSD with TBI, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310 2. The criteria for entitlement to SMC based on loss of use of a creative organ are met. 38 U.S.C. §§ 1114(k), 5107; 38 C.F.R. §§ 3.102, 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from December 1965 to December 1967, including service in the Republic of Vietnam. His decorations include the Combat Infantryman Badge. In May 2017, an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA) issued a rating decision that denied entitlement to service connection for ED and entitlement to SMC based on loss of use. The Veteran filed a timely Notice of Disagreement (NOD) with that decision and in January 2020 the AOJ issued a Statement of the Case (SOC). In March 2020, the Veteran filed a VA Form 10182, thus opting into VA's modernized appeals system. The Veteran requested a hearing before the Board of Veterans' Appeals (Board). The Veteran's NOD identifies the issues on appeal as service connection for ED and SMC. Although the January 2020 SOC only addresses ED, SMC is reasonably raised in connection with the benefits granted in this appeal. In January 2022, the Veteran testified at a videoconference hearing before the undersigned. The Veteran's representative was unable to attend the hearing and the Veteran acknowledged that he wished to proceed without his representative present. Separately, the Board is issuing a decision governed by VA's legacy appeals system addressing entitlement to service connection for sleep apnea and entitlement to an earlier effective date of service connection for migraine headaches. 1. Entitlement to service connection for ED, as secondary to PTSD with TBI, is granted. The Veteran asserts that his ED is due to his PTSD and/or TBI, and that while he had experienced sexual dysfunction for many years he was fully unable to achieve erection or ejaculate once he began taking medication for those disabilities. See, e.g., Board Hearing Transcript; March 2018 VA Form 21-4138. Secondary service connection may be granted for a disability that is proximately due to or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310. The Veteran has been diagnosed with ED and he is in receipt of service connection for TBI and PTSD, among other disabilities. Thus, the key question in this appeal is whether there is an etiological relationship between his current ED and his TBI. The evidence against the claim includes the opinion of a VA-contracted examiner. The evidence in favor of the claim includes medical opinions and supplemental opinions that the Veteran submitted. In February 2017, a VA-contracted examiner diagnosed the Veteran with ED. The examiner opined that ED was less likely than not proximately due to or the result of the Veteran's PTSD with TBI. The examiner explained that the Veteran inconsistently reported the onset of his ED, as records showed that he reported to a private examiner the onset of symptoms in 1967 and reported to the VA-contracted examiner that ED began in 2012 when he started sertraline. The examiner stated that because of this inconsistency the examiner could not provide an opinion without resorting to speculation. The opinion of the February 2017 examiner is not entitled to probative value. In this regard, the examiner declined to provide an opinion due to a perceived inconsistency in the Veteran's reports of his symptoms. However, it is the role of the Board, not an examiner, to adjudicate questions of credibility. Moreover, and as discussed below, the Veteran explained the reason for this perceived discrepancy. Remand is not necessary to correct this deficiency as the record establishes that the Veteran is entitled to service connection for ED. The Veteran submitted the opinions of Dr H.G.B., who opined that ED is more likely than not directly caused by depression and PTSD that were in turned caused by TBI, and Dr H.W.L, who opined that ED is due to depression, obsessive compulsive disorder and PTSD. However, these opinions are not entitled to probative value as they do not include rationales. See March 2014 H.G.B. Opinion; March 2014 Dr. H.W.L. Report. The Veteran also submitted the opinion of Dr. C.N.B., who noted that the Veteran had had persistent problems with penile erections and ejaculation ever since his TBI (which was sustained in 1967). Dr. C.N.B. opined that ED was most likely due to the Veteran's TBI as TBI is known to cause "ED problems" and as the Veteran's medical records do not include another more likely cause for ED. See December 2013 Dr. C.N.B. Opinion. In March 2018, the Veteran submitted a statement in response to the February 2017 examiner's opinion. The Veteran explained that from his perspective, ED means inability to achieve erection or ejaculate and this level of impairment began when he first began taking sertraline for his PTSD. He further explained that Dr. C.N.B.'s definition of ED was when sexual dysfunction first began, and the Veteran did not consider any issues with sexual performance to be ED. The Veteran also submitted an addendum opinion from Dr. C.N.B., who explained that the Veteran's sexual performance lessened after his TBI, although sexual performance was only totally precluded after the Veteran began taking medication for his PTSD. Thus, the apparent inconsistency as to the onset of ED was due to the Veteran's layman's understanding of ED when he reported the onset of the disorder. Dr. C.N.B. then cited additional medical studies that linked ED to antidepressant medications (such as sertraline). See January 2018 Dr. C.N.B. Addendum Opinion. Dr. C.N.B.'s opinion is probative. As a physician, he is competent to provide a medical opinion. Critically, his opinion is based on an accurate history of the Veteran's ED. Moreover, his opinion includes an adequate rationale. Thus, as all the probative evidence of record weighs in favor of the claim, the evidence establishes that ED is proximately due to PTSD with TBI and the appeal as to this issue is granted. 2. Entitlement to SMC based on loss of use of a creative organ is granted. Entitlement to SMC based of loss of use of a creative organ is an ancillary benefit that is reasonably raised by the record in connection with the Board's award of entitlement to service connection for ED. See, e.g., 38 C.F.R. § 4.115b, Diagnostic Code 7522 (explaining that SMC should be considered where there is erectile dysfunction, with or without deformity of the penis). SMC is warranted where there is loss of use of a creative organ. 38 C.F.R. § 3.350. Here, the evidence shows that the Veteran is unable to achieve and erection sufficient for penetration and ejaculation. See February 2017 Male Reproductive System Disability Benefits Questionnaire (DBQ). The DBQ indicates that the Veteran is unable to achieve an erection without medication and also indicates that even with medication the Veteran is unable to achieve an erection sufficient for penetration and ejaculation. Compare DBQ at Section II (Medical History), Section IV (Erectile Dysfunction). The Board notes that these statements are not necessarily contradictory and resolves this reasonable doubt in favor of the Veteran. VA regulations do not define what level of ED warrants SMC. However, examples noted in the regulation indicate that SMC is warranted when a creative organ is sufficiently impaired to preclude procreation. See 38 C.F.R. § 3.350. That is consistent with the examiner's indication that the Veteran cannot achieve an erection sufficient for penetration and ejaculation, even with medication. Accordingly, SMC based on loss of use of a creative organ is granted. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.M. Badaczewski, 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.