ERECTILE DYSFUNCTION

Summary

The Veteran, who served from January 1986 to January 2006, appeals the denial of service connection for erectile dysfunction, including as secondary to his service-connected hypertension and hypertensive heart disease/left ventricular hypertrophy. The Board reviewed the evidence of record at the time of the March 2021 agency of original jurisdiction decision. The Veteran reported erectile dysfunction onset two to three years prior to an October 2017 VA examination, attributing it to multiple risk factors including age, obesity, and mood disorder. The October 2017 VA opinion was found inadequate because it did not adequately address the impact of hypertension medications on erectile dysfunction. A March 2021 VA examination opined that the erectile dysfunction was less likely than not proximately due to or the result of the Veteran's service-connected hypertension, citing the Veteran's obesity, sedentary lifestyle, and well-controlled blood pressure as primary factors. The Board found this March 2021 opinion to be adequate and assigned it significant probative weight. The Board conceded the Veteran's current erectile dysfunction and service-connected hypertension. However, based on the adequate March 2021 VA opinion, the Board concluded that the criteria for secondary service connection were not met, as the erectile dysfunction was not found to be caused or aggravated by the service-connected hypertension. Therefore, service connection for erectile dysfunction was denied.

Rationale

AOJ conceded current erectile dysfunction and service-connected hypertension/hypertensive heart disease/left ventricular hypertrophy.; October 2017 VA opinion found inadequate for failing to address impact of hypertension medications on erectile dysfunction.; March 2021 VA opinion found adequate, assigning significant probative weight.; March 2021 opinion concluded erectile dysfunction was less likely than not due to service-connected hypertension, citing multiple non-service-connected risk factors.; No aggravation of erectile dysfunction beyond natural progression found.

Full Decision Text

Citation Nr: A24039950
Decision Date: 07/23/24	Archive Date: 07/23/24

DOCKET NO. 210422-155722
DATE: July 23, 2024

ORDER

Service connection for erectile dysfunction (including as due to hypertension and hypertensive heart disease/left ventricular hypertrophy) is denied.

FINDING OF FACT

The Veteran's erectile dysfunction is not secondary to service-connected hypertension and hypertensive heart disease/left ventricular hypertrophy and is not otherwise related to an in-service injury or disease. [this is a conclusion, not a finding of fact - please take out the conclusion and add the key facts]

CONCLUSION OF LAW

The criteria are not met for service connection for erectile dysfunction due to service or hypertension and hypertensive heart disease/left ventricular hypertrophy. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from January 1986 to January 2006.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2021 rating decision by the Department of Veterans Affairs (VA). This case was remanded in February 2021 for further development; it has since been re-assigned to the undersigned.

In the April 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

By law, for claims appealed in this docket, the Board may only consider the evidence of record at the time of the March 2021 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. If there was any evidence submitted after the AOJ decision on appeal, then, by law, the Board was not permitted to consider that evidence in this decision. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service connection for erectile dysfunction (including as due to hypertension and hypertensive heart disease/left ventricular hypertrophy) is denied.

Legal Criteria

Establishing secondary service connection requires evidence: (1) of a current disability (for which secondary service connection is sought); (2) of a service-connected disability; and (3) that the current disability was either caused or aggravated by the service-connected disability. 38 C.F.R. § 3.310(a); see also Allen v. Brown, 7 Vet. App. 439 (1995).

When VA provides a medical examination and opinion, it must ensure that these are legally adequate to rely on to adjudicate the claim. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). An adequate medical opinion must be "accurate and fully descriptive ..., with emphasis upon the limitation of activity imposed by the disabling condition." 38 C.F.R. § 4.1 (2015). It must be based on an accurate factual premise and on a consideration of the veteran's prior medical history and examinations and must describe the disability in sufficient detail so that the Board's "evaluation of the claimed disability will be a fully informed one." Ardison v. Brown, 6 Vet. App. 405, 407 (1994) (quoting Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (internal quotation marks omitted); see also Floyd v. Brown, 9 Vet. App. 88, 93 (1996). In addition, the medical opinion "must support its conclusions with an analysis that the Board can consider and weigh against contrary opinions." Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); see Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("most of the probative value of a medical opinion comes from its reasoning").

Factual Background

In the October 2017 VA examination, the Veteran reported that he experiences erectile dysfunction, and the onset of the condition was two or three years prior to the examination. See October 2017 VA examination. The Veteran
 Vet. App. 88, 93 (1996). In addition, the medical opinion "must support its conclusions with an analysis that the Board can consider and weigh against contrary opinions." Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); see Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("most of the probative value of a medical opinion comes from its reasoning").

Factual Background

In the October 2017 VA examination, the Veteran reported that he experiences erectile dysfunction, and the onset of the condition was two or three years prior to the examination. See October 2017 VA examination. The Veteran reported taking Viagra. Id. The VA examiner stated the erectile dysfunction was caused by several risk factors, for example: increasing age, obesity, hypertension, mixed hyperlipidemia, mood disorder with treatment with selective serotonin reuptake inhibitors (SSRIs). Id. The VA examiner, therefore, opined that it was less likely than not that the Veteran's erectile dysfunction was due to hypertension. This opinion was inadequate because it conflicted with a statement from the VA examiner that the erectile dysfunction was as likely as not attributable to one of the diagnoses in Section 1, to which the VA examiner named erectile dysfunction. This is a circular argument that renders the opinion inadequate. [don't put analysis in the facts section - move it to the analysis section please]

In January 2021, the Veteran was being treated with HCTZ for hypertension. 

In March 2021, a VA examiner opined that the Veteran's erectile dysfunction was less likely as not proximately due to or the result of the Veteran's service-connected condition. See March 2021 VA examination. While the VA examiner did not directly provide an analysis regarding the Veteran's risk factor of aging, she did provide reasons for the conclusion that were specific to the Veteran. Id. The VA examiner addressed the Veteran's obesity and body mass index of 41 and his sedentary lifestyle as risk factors. Id. The VA examiner also reasoned that, because the Veteran's blood pressure was well controlled with oral medication, this risk factor was reduced. Id. Furthermore, the Veteran was being treated with angiotensin receptor blockers (ARBs) and HCTZ, which improved sexual function and did not have an impact on sexual function, respectively. Id. The VA examiner ultimately concluded that the Veteran's erectile dysfunction disability was highly likely due to his multiple, nonservice-connected risk factors rather than his well-controlled hypertension/hypertensive heart disease and treatment. Id. The VA examiner also concluded there was no aggravation of the erectile dysfunction beyond the expected, natural progression of the disability.

In the March 2021 rating decision, the AOJ conceded that the Veteran had been diagnosed with the disability of erectile dysfunction. The AOJ also conceded that the primary disability, hypertension and hypertensive heart disease/left ventricular hypertrophy, was service connected. 

Analysis

Because the AOJ conceded the first two elements of secondary service connection ((1) a current disability (for which secondary service connection is sought) and (2) a service-connected disability), the issue is whether the current disability was either caused or aggravated by the service-connected disability.

The Board found the October 2017 VA opinion to be inadequate because the examiner did not address whether the Veteran's prescribed medication used to treat the hypertension and hypertensive heart disease/left ventricular hypertrophy would have an impact on the erectile dysfunction disability. This issue had been specifically raised by the Veteran in his NOD. Therefore, the Board cannot assign significant probative weight to that opinion.

The Board assigns significant probative weight to the March 2021 VA opinion. The opinion is accompanied by a sufficient explanation as to why the Veteran's erectile dysfunction disability is neither secondary to nor aggravated by his service-connected disability of hypertension and hypertensive heart disease/left ventricular hypertrophy, which is discussed above.

Therefore, the criteria are not met for service connection and the appeal must be denied. 

 

VICTORIA MOSHIASHWILI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Lisa N. Linney, 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.