Citation Nr: 23001026 Decision Date: 01/06/23 Archive Date: 01/06/23 DOCKET NO. 18-00 048A DATE: January 6, 2023 ORDER Entitlement to service connection for low testosterone is denied. FINDING OF FACT The probative evidence of record persuasively weighs against finding that low testosterone began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for low testosterone are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 1993 to July 1999, from January 2005 to June 2006, and from September 2008 to November 2009. This case comes before the Board of Veterans' Appeals (Board) on appeal from a February 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for low testosterone is denied. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The Veteran asserts that he is entitled to service connection for low testosterone due to an in-service vasectomy. The Board concludes that the Veteran does not have a current diagnosis of low testosterone during the period on appeal. Further, the preponderance of the probative evidence persuasively weighs against finding that the Veteran's low testosterone began during service or is otherwise related to an in-service injury, event, or disease. The Veteran's service treatment records document a vasectomy procedure on April 2, 1999, with a follow-up report of pain above the incision site on April 4, 1999. All medical examinations and post-deployment health assessments dated October 2004, April 2008, September 2009, and March 2010, found the Veteran's external genitalia and hormonal systems to be normal. Outside of the April 1999 treatment, the Veteran did not report any symptoms of or treatment for low testosterone. Private medical treatment records include low testosterone readings in April 2013 and February 2014. In May 2013, the Veteran was noted to have an improved testosterone deficiency. In July 2013, the Veteran had a normal testosterone reading. The Veteran was afforded a VA examination in July 2022. See July 2022 VA Examination. The examiner noted that the Veteran's low testosterone had resolved, noting that on July 6, 2022, the Veteran's testosterone was within normal limits. Additionally, at the time of the examination, the Veteran was not on testosterone therapy. While the Veteran had a finding of low testosterone in 2013, this was years after service; therefore, the examiner found that his low testosterone was less likely than not incurred in or was caused during service. In September 2022, an addendum opinion was completed by the same examiner. See September 2022 Addendum Opinion. The examiner noted that the Veteran had a vasectomy in April 1999 with a brief period of low testosterone levels, which occurred in April 2013, which was 4 years after discharge and over 10 years after his vasectomy. The examiner noted that a vasectomy does not affect virility or testosterone level. Additionally, the Veteran's service treatment records are silent for a testosterone condition. Further, the Veteran's current testosterone levels were within normal limits per lab work completed on July 6, 2022, and the Veteran was not on testosterone therapy. While all the VA medical opinions of record provide a negative nexus, the July 2022 medical opinion is inadequate as an adequate rationale was not provided. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Conversely, the Board finds the September 2022 VA medical opinion is competent, credible afforded great probative weight. This opinion was conducted by a health care professional, who reviewed the record and provided an opinion that is well supported by adequate rationale with clear conclusions, supporting data with citations to evidence in the claims files and a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Additionally, the Board gives probative weight to the medical records, which, as noted by the September 2022 VA examiner, indicate that the Veteran did not have low testosterone until 2013, approximately 4 years after service and approximately 14 years after his in-service vasectomy. Further, the Veteran does not have a current diagnosis of low testosterone. Having thoroughly examined the evidence of record, reviewing the medical opinions, and the Veteran's contentions and testimony, overall, the weight of the evidence is against the Veteran's claim for service connection for a testosterone disorder. In reaching this determination, the Board acknowledges that VA is statutorily required to resolve the benefit of the doubt in favor of the Veteran when there is an approximate balance of positive and negative evidence regarding the merits of an outstanding issue. That doctrine, however, is not applicable in this case because the weight of the evidence is against the Veteran's claim. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. The Board carefully considered the Veteran's lay report as to the onset of symptoms. Significantly, however, the Veteran's condition is not one listed under 38 C.F.R. § 3.309. Additionally, although the Veteran is competent to describe the symptoms, he is not competent to provide an etiology or diagnosis of the symptoms. While the Veteran believed there was a current diagnosis of low testosterone, the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. The Veteran does not have a current low testosterone diagnosis for VA purposes. (Continued on the next page) Consequently, the Board gives more probative weight to the September 2022 medical opinion and medical treatment records of record, which establish that the Veteran does not have a current diagnosis of low testosterone and that the Veteran's previous low testosterone readings are not at least as likely as not related to an in-service injury, event, or disease. Nieves-Rodriguez, 22 Vet. App. 295, 304 (2008). Accordingly, entitlement to service connection for low testosterone is denied. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Schmidt 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.