Citation Nr: A26019331 Decision Date: 03/04/26 Archive Date: 03/04/26 DOCKET NO. 210413-152322 DATE: March 4, 2026 ORDER Entitlement to service connection for erectile dysfunction (ED), as secondary to posttraumatic stress disorder with cannabis use disorder, in remission (PTSD), is denied. FINDING OF FACT The Veteran's erectile dysfunction (ED) is not proximately due to, or the result of, his service connected posttraumatic stress disorder with cannabis use disorder, in remission (PTSD). CONCLUSION OF LAW The criteria for entitlement to service connection for erectile dysfunction (ED) as secondary to posttraumatic stress disorder with cannabis use disorder, in remission (PTSD), have not been met. 38 U.S.C. §§ 1131, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from November 1973 to March 1975. The present matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2021 rating decision issued by VA Agency of Original Jurisdiction (AOJ). Accordingly, this decision is subject to the AMA. In a September 2016 rating decision, the Veteran's claim for erectile dysfunction (ED) as secondary to posttraumatic stress disorder with cannabis use disorder, in remission was denied. The Veteran did not appeal this rating decision within one year, and it became final. In December 2020, the Veteran submitted a VA Form 20-0995, Supplemental Claim Application. In February 2021, the AOJ issued the supplemental claim rating decision, finding that new and relevant evidence had been received, and denied the claim. Next, the Veteran timely appealed the February 2021 rating decision to the Board in an April 2021, VA Form 10182 Notice of Disagreement and requested the hearing docket. Next, the appeal was added to the hearing docket and was scheduled to be held on January 15, 2025. However, on December 23, 2024, the Veteran expressly withdrew his request for a hearing, and the hearing was cancelled. Accordingly, the Board may consider evidence of record at the time of the February 2021 rating decision and any evidence submitted by the Veteran or his representative within 90 days from the date of his withdrawal of his hearing request. 38 C.F.R. §?20.302(b). Service Connection?? Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (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 or aggravated during service-the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 38 F.3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in a denial of service connection.??????? The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence").???? Service connection may also be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).???? Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a).??? Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. See 38?C.F.R. § 3.310(b); Allen v. Brown, 8?Vet. App.?374 (1995).???? In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11?Vet. App.?509, 512 (1998); see also Allen, supra.???? Service connection must be considered on the basis of the places, types, and circumstances of a Veteran's service as shown by his or her service records, the official history of each organization in which he or she served, his or her medical records, and all pertinent medical and lay evidence. See 38 C.F.R. § 3.303(a); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); and see Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006).??????? When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §?3.102.?? Entitlement to service connection for erectile dysfunction (ED), as secondary to posttraumatic stress disorder with cannabis use disorder, in remission (PTSD) The Veteran only seeks service connection for his ED condition on a secondary basis. As such, the Board finds that the theory of entitlement to service connection on a direct basis has not been raised by the Veteran or the record, so this theory of entitlement will not be addressed. Turning to the existence of a current disability, the AOJ made a favorable finding in the February 2021 rating decision that the Veteran has a disability with the diagnosis of ED, which was confirmed at the February 2021 VA examination. The Board is bound by this finding. 38 C.F.R. § 3.104(c). As such, the current disability element is established. With respect to evidence of a service-connected disability, the Veteran is service connected for PTSD. Thus, second element of secondary service connection is satisfied. Regarding a nexus between the service-connected disability and the current disability, the Veteran was afforded VA examinations in August 2016 and February 2021, conducted by the same examiner, who provided negative nexus opinions across both examinations. The examiner considered the Veteran's lay statements, reviewed the claim file, and concluded that the Veteran's ED condition was less likely than not proximately due to or the result of PTSD. As to rationale, the examiner stated in the February 2021 opinion that it was the same as that given in the August 2016 opinion. The examiner stated that the Veteran had an intact libido and that it was more likely that the Veteran's non-service connected hyperlipidemia or hypertension caused his ED condition. From this explanation by the examiner, one can reasonably infer that if a mental health condition was causing ED, loss of libido or low libido would be the result. Moreover, the examiner points to a more likely physical cause versus a psychological one based on the Veteran having an intact libido. Thus, the conclusion is supported by adequate rationale, and the Board finds the August 2016 and February 2021 VA opinions highly probative. Furthermore, the Board has also considered the March 2020 private mental health records. Although these records were provided in support of the Veteran's service connection claim for PTSD, there are no reports of symptoms of ED during these visits for his treatment of his mental health. The Board finds this evidence highly probative. Additionally, the Board has also considered the September 2019 private clinical assessment for the Veteran's PTSD. In this assessment, the Veteran reported a long list of symptoms of his PTSD, which notably did not include ED, loss of libido or low libido. The Boards finds this evidence highly probative. Based on the most probative evidence, the Board finds that a nexus is not established between the Veteran's ED condition and his PTSD. Based on the foregoing, the most persuasive evidence is against the claim, and the benefit-of-the-doubt rule is not for application. In sum, service connection is not warranted for the Veteran's ED condition, and the claim is denied. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jeffreys, J. 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.