HYPERTENSION

MICHAEL A. PAPPAS · 2026 · Case ID: A26005740

DENIED

Summary

The veteran, who served from August 1989 to August 1992, appeals the denial of service connection for hypertension, dry eye syndrome, and erectile dysfunction. The veteran claimed hypertension was related to noise exposure and family history, dry eye syndrome to artillery gun smoke, and erectile dysfunction as secondary to hypertension. The Board reviewed the evidence, including private medical records and VA compensation and pension examinations from November 2024. For hypertension, the VA examiner found it less likely than not service-related, citing the absence of in-service complaints and a family history as more probable causes. The Board found the VA opinion well-reasoned and denied service connection for hypertension. For dry eye syndrome, the VA examiner found no current diagnosable eye condition beyond refractive error, which is not a service-connectable disability. The Board denied service connection for dry eye syndrome, noting the lack of proof of a current disability. For erectile dysfunction, the VA examiner found it less likely than not service-related, attributing it to medications for hypertension, which itself was not service-connected. The Board denied service connection for erectile dysfunction, both directly and secondarily, due to lack of nexus to service or a service-connected condition. All claims were denied.

Rationale

No in-service complaints or diagnosis of hypertension.; Earliest diagnosis in July 2024 private medical records.; VA examiner provided negative opinion, citing family history and lifestyle factors.; Lack of contemporaneous medical evidence linking hypertension to service.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250928-591376

Full Decision Text

Citation Nr: A26005740
Decision Date: 01/22/26 Archive Date: 01/22/26

DOCKET NO. 250928-591376
DATE: January 22, 2026

ISSUES

Entitlement to service connection for hypertension.

Entitlement to service connection for dry eye syndrome.

Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disability.

ORDER

Entitlement to service connection for hypertension is denied.

Entitlement to service connection for dry eye syndrome is denied.

Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disability, is denied.

FINDINGS OF FACT

1. A hypertension disability was not manifest during active service, or until many years after service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease.

2. A dry eye disability was not manifest during active service, or until many years after service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease.

3. An erectile dysfunction disability was not manifest during active service, or until many years after service, and is not shown to be causally or etiologically related to an in-service event, injury, or disease, or is otherwise aggravated by a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for a hypertension disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309.

2. The criteria for service connection for a dry eye disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309.

3. The criteria for service connection for an erectile dysfunction disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1989 to August 1992.

This matter comes before the Board of Veterans' Appeals (Board) from a December 2024 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina, which is the Agency of Original Jurisdiction (AOJ) in this appeal.

In the September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the December 2024 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 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[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

As the Veteran is unrepresented in this case, VA has a duty to construe his claims liberally. See Moody v. Principi, 360 F.3d 1306, 1310 (Fed. Cir. 2004); Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 2004).

Veterans Claims Assistance Act of 2000 (VCAA)

The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102,
duty to construe his claims liberally. See Moody v. Principi, 360 F.3d 1306, 1310 (Fed. Cir. 2004); Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 2004).

Veterans Claims Assistance Act of 2000 (VCAA)

The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert. denied, U.S.C. Oct. 3, 2016) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board....to search the record and address procedural arguments when the [appellant] fails to raise them before the Board"); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant's failure to raise a duty to assist argument before the Board).

The Board has reviewed all of the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000).

Service Connection

Legal Criteria for Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, 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. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Service connection may also be granted for disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection). Secondary service connection under 38 C.F.R. § 3.310(a) is warranted where a non-service-connected disability would have been less severe but for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. See Spicer, 61 F.4th at 1364.

The Veteran has not claimed and the record does not indicate that the Veteran is eligible for any possible presumptive methods of service connection pursuant to herbicide agent exposure or any other presumptive possibility for service connection based on the record, timing, and location of his active service. The
show entitlement to secondary service connection). Secondary service connection under 38 C.F.R. § 3.310(a) is warranted where a non-service-connected disability would have been less severe but for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. See Spicer, 61 F.4th at 1364.

Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases, to include hypertension, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). For hypertension, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3).

Service connection for certain chronic diseases can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. For chronic diseases shown as such in service or within the applicable presumptive period, subsequent manifestations of the same chronic disease at any later date are service-connected unless attributable to an intercurrent cause. 38 C.F.R. § 3.303(b). For a chronic disease to be considered to have been "shown in service," there must be a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. Id. When the condition noted in service or within the presumptive period is not a chronic disease, a showing of continuity of symptomatology after discharge is required. Id.

VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay 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).

Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran's lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000).

Proof of a current disability is a threshold to establishing service-connection for any claimed disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). To be present as a current disability, there must be evidence of the condition at some time during the appeals period. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998).

After the evidence is assembled, it is the Board's responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3.

If the evidence for and against a claim is in approximate balance, the claim will be
condition at some time during the appeals period. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998).

If the evidence for and against a claim is in approximate balance, the claim will be granted. 38 C.F.R. § 4.3. A claim will be denied only if the approximate balance of the evidence is against the claim. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Evidence and Analysis - Hypertension

The Veteran filed an original claim for service connection for hypertension in July 2024. On that VA 21-526EZ claim form, the Veteran contended that his presence as a soldier assigned to artillery units involved exposure to loud noises which raised his blood pressure. The Veteran also cited that he had a family history of high blood pressure to include his father and his brother.

The Veteran submitted private medical records in July 2024 which indicated a current diagnosis of essential hypertension, and for which he was prescribed daily prescription medications. The submitted private records made no mention of the origin or etiology of the Veteran's hypertension.

VA provided a compensation and pension examination for the Veteran's claimed hypertension in November 2024. The examiner made a diagnosis of hypertension and noted that continuous medications were required. This examiner provided a negative opinion for service connection, saying it was less likely than not that the Veteran's diagnosed hypertension was incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran separated from service in August 1992 with no mention of high blood pressure, hypertension, or any related condition in his service treatment records. The earliest mention of a diagnosis of hypertension in the Veteran comes in the July 2024 private medical record, and that a lack of any mention in any record in between 1992 and 2024 made it more likely that the Veteran's hypertension did not have an etiological cause from active service. The examiner considered the hypertension to be related to his family history, male gender, African American ethnicity, and his tobacco smoking.

The Board finds the November 2024 VA examination report and opinion to be of great probative value. Indeed, the examiner considered the Veteran's contention, the claims file, and clinical medical evidence before providing a negative opinion for direct service connection. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). This VA examiner noted both entrance and exit examinations were silent for hypertension, and there was no other related condition noted in service records. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiner's negative opinion was supported by a sufficiently clear and well-reasoned medical rationale and was consistent with the verifiable facts regarding the Veteran's contentions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005).

The Board acknowledges that the Veteran is competent to testify as to his beliefs that his disabilities are related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; "[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge." Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran is competent to testify about his symptoms relating to his claimed hypertension. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise
beliefs that his disabilities are related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; "[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge." Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran is competent to testify about his symptoms relating to his claimed hypertension. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of any type of a high blood pressure condition beyond a description of symptoms. See 38 C.F.R. § 3.159(a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Accordingly, his assertions to that effect are of no probative value.

There are no competent medical opinions of probative value in favor of a positive nexus to active service from any VA examiner or medical treatment provider from any source.

1. Entitlement to service connection for hypertension is denied.

Upon review of the record, the Board concludes that entitlement to service connection for a hypertension disability is not warranted. The Board notes a current diagnosis of hypertension based on a July 2024 private medical treatment report, and thus the requirement for a current disability is shown. The Board acknowledges the Veteran's contentions, and the Veteran's post-service statements are noted. However, the service treatment records through the end of active service are silent for any existing diagnosed hypertension condition or related disability at the time of separation from active service, and, and there is no competent evidence to tie the current assertions to any in-service disease or injury. The Board thus finds the Veteran fails the third prong of the test for entitlement to direct service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. §§ 3.303, 3.310.

Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran's claimed hypertension disability was not incurred in service. For these reasons, the Board finds that an approximate balance of the evidence is persuasively against the claim of service connection for a hypertension disability, and the claim must be denied. Because the approximate balance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

Evidence and Analysis - Dry Eye Syndrome

The Veteran filed an original claim for service connection for dry eye syndrome in July 2024. On that VA 21-526EZ claim form, the Veteran contended that his presence as a soldier assigned to artillery units involved exposure to bright orange and red explosions while firing the M109 howitzer, and that the gun smoke burned his eyes and dried them out, causing him to wear prescription glasses.

VA provided a VA compensation and pension examination for the Veteran's claimed dry eye syndrome in November 2024. The examiner declined to make a diagnosis of dry eye syndrome and found no other diagnosable condition related to the eyes on this examination.

This November 2024 VA examiner provided a negative opinion for service connection, saying it was less likely than not
an original claim for service connection for dry eye syndrome in July 2024. On that VA 21-526EZ claim form, the Veteran contended that his presence as a soldier assigned to artillery units involved exposure to bright orange and red explosions while firing the M109 howitzer, and that the gun smoke burned his eyes and dried them out, causing him to wear prescription glasses.

This November 2024 VA examiner provided a negative opinion for service connection, saying it was less likely than not that any dry eye disability for which VA service connection is possible was incurred in or the result of active military service. The examiner noted the Veteran had no evidence of any diagnosable eye condition beyond visual acuity for which the Veteran had been prescribed eyeglasses by a local provider. As such, the examiner opined, the Veteran had no current eye disability for which service connection could be awarded.

2. Entitlement to service connection for dry eye syndrome is denied.

A claim for service connection requires medical evidence showing that the veteran currently has the claimed disability. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) [service connection may not be granted unless a current disability exists]. Under 38 U.S.C. § 1110, it is essential that there be a current disability in order to establish service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). Absent proof of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992).

Refractive errors of the eye are not considered diseases or injuries for which service connection is available. 38 C.F.R. §§ 3.303(c), 4.9, 4.127. VBA's Adjudication Manual defines "refractive errors" as conditions "due to anomalies in the shape and conformation of the eye structures, and generally of congenital or developmental origin." M21-1 III.iv.4.B.1.d. Examples include: astigmatism, myopia (nearsighted), hyperopia (farsighted), and presbyopia (due to aging). Id.

Service connection may be granted for additional disability on top of underlying refractive error or personality disorder that results from a superimposed disease or injury during service. See VAOPGCPREC 82-90 (July 18, 1990). However, in the absence of a superimposed disease or injury, service connection may not be granted for refractive error of the eyes, even if symptoms increased in severity in service, as refractive error is not a disease or injury eligible for service connection.

In the absence of a current diagnosis of any eye disability for which VA service connection is possible, service connection for a dry eye disability is not warranted. 38 C.F.R. § 3.303. The Board notes there is no additional evidence in the Veteran's favor, beyond his own statements. In the absence of proof of a current disability, there is no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Under these circumstances, the Veteran has failed to state a claim of entitlement to service connection for a dry eye disorder for compensation purposes upon which relief could be granted. As such, the claim lacks legal merit and must be denied. Sabonis v. Brown, 6 Vet. App. 426 (1994).

Evidence and Analysis - Erectile Dysfunction

The Veteran filed an original claim for service connection for erectile dysfunction in July 2024. On that VA 21-526EZ claim form, the Veteran contended a theory of secondary service connection, that his erectile dysfunction was due to the medications he took for his diagnosed hypertension. The Board notes that service connection for hypertension is denied in this decision and the Veteran has no other service-connected disabilities at the time of this decision.

The Veteran submitted private medical records in July 2024 which indicated a current diagnosis of essential hypertension, and for which he was prescribed daily prescription medications. The submitted private records made no mention of erectile dysfunction or any other effect of the Veteran's hypertension.

VA provided
426 (1994).

Evidence and Analysis - Erectile Dysfunction

The Veteran submitted private medical records in July 2024 which indicated a current diagnosis of essential hypertension, and for which he was prescribed daily prescription medications. The submitted private records made no mention of erectile dysfunction or any other effect of the Veteran's hypertension.

VA provided a compensation and pension examination for the Veteran's claimed erectile dysfunction in November 2024. The examiner made a diagnosis of erectile dysfunction with no other condition related to the male reproductive organs observed or diagnosed. The Veteran declined physical examination of any of his male reproductive organs and the examiner accepted the Veteran's complaints of erectile dysfunction as sufficient for diagnosis. This examiner provided a negative opinion for service connection, saying it was less likely than not that the Veteran's diagnosed erectile dysfunction was incurred in or caused by the claimed in-service injury, event, or illness. The examiner continued, noting that the Veteran's erectile dysfunction was more likely than not related to the Veteran's medications for his diagnosed but non-service connected hypertension. The examiner noted that the Veteran separated from service in August 1992 with no mention of erectile dysfunction, hypertension, or any related condition in his service treatment records. The earliest mention of a diagnosis of erectile dysfunction in the Veteran comes in the Novemer 2024 VA examination, and that a lack of any mention in any record in between 1992 and 2024 made it more likely that the Veteran's erectile dysfunction did not have an etiological cause from active service.

The Board finds the November 2024 VA examination report and opinion to be of great probative value. Indeed, the examiner considered the Veteran's contention, the claims file, and clinical medical evidence before providing a negative opinion for direct and secondary service connection. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). This VA examiner noted both entrance and exit examinations were silent for erectile dysfunction, and there was no other related condition noted in service records. The VA examiner did note it was medically possible that the Veteran's hypertensive medications led to or aggravated the Veteran's erectile dysfunction, but in the absence of service connection for hypertension, no affirmative opinion for service connection of erectile dysfunction, direct or secondary, could be made. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiner's negative opinion was supported by a sufficiently clear and well-reasoned medical rationale and was consistent with the verifiable facts regarding the Veteran's contentions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005).

The Board acknowledges that the Veteran is competent to testify as to his beliefs that his disabilities are related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; "[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge." Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran is competent to testify about his symptoms relating to his claimed erectile dysfunction. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of any type of an erectile dysfunction condition beyond a description of symptoms. See 38 C.F.R. § 3.159(a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v.
testify about his symptoms relating to his claimed erectile dysfunction. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of any type of an erectile dysfunction condition beyond a description of symptoms. See 38 C.F.R. § 3.159(a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Accordingly, his assertions to that effect are of no probative value.

There are no competent medical opinions of probative value in favor of a positive nexus to active service from any VA examiner or medical treatment provider from any source.

3. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disability, is denied.

Upon review of the record, the Board concludes that entitlement to service connection for a erectile dysfunction disability is not warranted, to include with a theory of secondary service connection. The Board notes a current diagnosis of erectile dysfunction based on a November 2024 VA examination, and thus the requirement for a current disability is shown. The Board acknowledges the Veteran's contentions, and the Veteran's post-service statements are noted. However, the service treatment records through the end of active service are silent for any existing diagnosed erectile dysfunction condition or related disability at the time of separation from active service, and, and there is no competent evidence to tie the current assertions to any in-service disease or injury. Further, VA found no evidence that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. The Board thus finds the Veteran fails the third prong of the test for entitlement to direct and secondary service connection. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023); 38 C.F.R. §§ 3.303, 3.310.

Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran's claimed erectile dysfunction disability was not incurred in service, or was caused by or aggravated by service-connected disability. For these reasons, the Board finds that an approximate balance of the evidence is persuasively against the claim of service connection for an erectile dysfunction disability, and the claim must be denied. Because the approximate balance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

MICHAEL A. PAPPAS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. Setter, 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.

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