ERECTILE DYSFUNCTION

Summary

The Veteran served on active duty from January 1967 to January 1971. The Veteran appeals the denial of service connection for erectile dysfunction (ED), claiming it is secondary to his service-connected diabetes mellitus type 2 (DM) and coronary artery disease (CAD). The record includes a current diagnosis of ED, confirmed by the Veteran's testimony and a May 2024 VA examination. While the VA examiner initially opined that ED was less likely due to service-connected conditions, their detailed rationale and supporting medical literature indicated that atherosclerosis and autonomic neuropathy associated with DM and CAD, as well as medication side effects, contribute to ED. The Board found this examiner's opinion effectively confirmed that ED is caused by the service-connected CAD and DM. Applying the benefit of the doubt doctrine, the Board found the evidence in equipoise and granted secondary service connection for ED in relation to CAD and DM. The Board's decision is based on the finding that the Veteran's ED is multifactorial, including contributions from his service-connected conditions.

Rationale

Current diagnosis of ED confirmed by VA exam and Veteran testimony; VA examiner's rationale and cited medical literature confirm ED multifactorial, including CAD and DM; Board applied benefit of doubt doctrine, finding evidence in equipoise

Full Decision Text

Citation Nr: 25000573
Decision Date: 01/15/25	Archive Date: 01/15/25

DOCKET NO. 17-21 089
DATE: January 15, 2025

ORDER

Entitlement to service connection for erectile dysfunction (ED), to include as secondary to diabetes mellitus type 2 (DM) and coronary artery disease (CAD), is granted.

FINDING OF FACT

Resolving reasonable doubt in the Veteran's favor, it is at least as likely as not that the Veteran's ED is due to, a result of, or aggravated by his service-connected DM and CAD.

CONCLUSION OF LAW

The criteria for entitlement to service connection for ED, to include as secondary to DM and CAD, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from January 1967 to January 1971.

The Veteran appeals an August 2014 rating decision issued by the Agency of Original Jurisdiction (AOJ).

The Veteran testified at a hearing in January 2021 and a transcript of the hearing is of record. The Veterans Law Judge (VLJ) who held that hearing is retired from the Board of Veterans' Appeals (Board). In June 2023, the Veteran was notified and offered another hearing before a different VLJ. The Veteran chose to appear at another hearing. Therefore, in October 2023, the Veteran testified before the undersigned VLJ, and a transcript of the hearing is associated with the Veteran's claims file. In May 2021 and May 2024, the Board remanded the claim.   

The case has been returned to the Board for review. The Board finds that there has been substantial compliance with the Board's May 2024 remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). 

The Veteran seeks service connection for ED, as secondary to his service-connected DM and/or CAD.

Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in service injury or disease; and (3) a relationship between the two. See Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in-service. 38 C.F.R. § 3.303(d).

A disability which is due to, or the result of a service-connected disease or injury shall be service-connected. 38 C.F.R. § 3.310(a). Any increase in severity of a nonservice-connected disease or injury that is due to, or the result of a service-connected disease or injury will also be service-connected. 38 C.F.R. § 3.310(b).

Finally, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant.

First, the record reflects a current diagnosis of ED. See August 2024 VA examination. The Veteran has also confirmed this diagnosis in his hearing testimony. See Board Hearing Tr. at 6.

Next, the Board concludes that the evidence is at least in equipoise as to whether his ED is related on a secondary basis to his service-connected CAD and DM. Thus, service connection to ED is warranted.

The Veteran underwent a VA examination in August 2024. Although the examiner opined that the Veteran's ED was less likely due to or the result of the Veteran's service-connected disabilities, the rationale stated otherwise. The VA examiner stated that ED in CAD is due to atherosclerosis, and that results in the hardening of penile arteries and less vasodilation to ED. In addition, the VA examiner stated that ED is also caused by diabetes due to autonomic neuropathy which causes less vascular dilation of penile arteries resulting in ED due
 the Board concludes that the evidence is at least in equipoise as to whether his ED is related on a secondary basis to his service-connected CAD and DM. Thus, service connection to ED is warranted.

The Veteran underwent a VA examination in August 2024. Although the examiner opined that the Veteran's ED was less likely due to or the result of the Veteran's service-connected disabilities, the rationale stated otherwise. The VA examiner stated that ED in CAD is due to atherosclerosis, and that results in the hardening of penile arteries and less vasodilation to ED. In addition, the VA examiner stated that ED is also caused by diabetes due to autonomic neuropathy which causes less vascular dilation of penile arteries resulting in ED due to autonomic neuropathy as well as atherosclerosis of penile arteries in diabetes. The VA examiner also stated that the ED could be due to the side effects of the Veteran's medication for hypertension, Lisinopril, and for mental health conditions, Sertraline. Therefore, the VA examiner concluded that the Veteran's ED is multifactorial, and includes CAD and DM. 

The Board finds that the VA examiner's opinion effectively confirms that the Veteran's ED is caused by the service-connected CAD and DM. The VA examiner further cites medical articles to support such a conclusion. 

Accordingly, a grant of secondary service connection of ED in relation to CAD and DM is warranted. In so reaching that conclusion, the Board has considered and applied the benefit of the doubt doctrine. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990).

 

 

ANTHONY C. SCIRÉ, JR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Fam, 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.