ERECTILE DYSFUNCTION

Summary

The Veteran served on active duty for training from June 1993 to November 1993 and on active duty from March 1994 to October 1999. The Veteran appeals the denial of service connection for erectile dysfunction, claiming it is secondary to his service-connected degenerative joint disease of the lumbar spine with bulging of the annular disc at L5-S1, left lower extremity radiculopathy, and/or right lower extremity radiculopathy. The Board reviewed evidence including VA treatment records, service treatment records, and military personnel records. The case was previously remanded in October 2017 for further development. The Board considered two VA medical opinions. An August 2008 VA examination opined that the Veteran's erectile dysfunction was caused by his service-connected lumbar spine disorder, finding the opinion highly probative due to its rationale and clear conclusions. A June 2020 VA examination opined that the erectile dysfunction was not related to the lumbar spine disorder, attributing it to obesity and finding the spinal evaluations did not correlate with erectile dysfunction, and that the pudendal nerve, not the deep peroneal nerve, affects penile function. The Board found the June 2020 opinion incomplete because it failed to address aggravation and the intermediate step of obesity caused by the service-connected lumbar spine disorder. Given the probative August 2008 opinion supporting service connection and the inadequacy of the June 2020 opinion, the Board found service connection warranted. Service connection for erectile dysfunction as secondary to degenerative joint disease of the lumbar spine is granted.

Rationale

August 2008 VA opinion found erectile dysfunction caused by service-connected lumbar spine disorder; June 2020 VA opinion found erectile dysfunction not related to lumbar spine disorder, attributed to obesity; June 2020 opinion found inadequate as it failed to address aggravation and intermediate step of obesity caused by service-connected lumbar spine disorder

Full Decision Text

Citation Nr: 25007244
Decision Date: 05/28/25	Archive Date: 05/28/25

DOCKET NO. 20-29 586
DATE: May 28, 2025

ORDER

Entitlement to service connection for erectile dysfunction as secondary to service connected degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1 is granted. 

FINDING OF FACT

The Veteran's erectile dysfunction is caused by his service connected degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1.

CONCLUSION OF LAW

The criteria for service connection for erectile dysfunction as secondary to service connected degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1 have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty for training from June 1993 to November 1993 and on active duty from March 1994 to October 1999. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). 

This matter was most recently before the Board in October 2017, at which time the Veteran's erectile dysfunction claim was remanded to the Agency of Original Jurisdiction (AOJ) for further development, to include issuing a statement of the case (SOC). An SOC was issued in July 2020 and the Veteran timely perfected his appeal to the Board. The Board therefore finds that there has been substantial compliance with its previous remand.

Further, the Board notes that the Veteran's appointed representative is no longer accredited with the VA and is no longer authorized to prepare, present, and prosecute claims for VA benefits. The Veteran was notified in March 2025 and April 2025 letters that his prior representative was no longer recognized as a representative that is authorized to prepare, present or prosecute claims for VA benefits and informed him that he may appoint a new representative by completing an Appointment of Veterans Service Organization (VA Form 21-22) or Appointment of Individual as Claimant's Representative (VA Form 21-22a). The Veteran has not appointed a new representative and is therefore considered to be proceeding pro se. The Board notes that a Privacy Act request from the Veteran's former representative was fulfilled in June 2024 and sent to the former representative's last known address of record. 

The Board notes that additional evidence, namely VA treatment records, service treatment records and military personnel records were added to the record after the issuance of the July 2020 SOC. The Veteran has not waived initial AOJ consideration of this evidence. However, the Board's grant of service connection for erectile dysfunction as secondary to service connected degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1 is a full grant of the benefit and hence the Veteran will suffer no prejudice from the Board's consideration of such evidence. Therefore, such an evidence waiver is not required. See 38 C.F.R. § 20.1305(c). The Board may properly decide the instant claim.

Entitlement to service connection for erectile dysfunction as secondary to service connected degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1 is granted.

The Veteran seeks service connection for erectile dysfunction as etiologically related to service. See September 2012 Statement in Support of Claim (VA Form 21-4138). Specifically, the Veteran asserts that his erectile dysfunction is due to his service connected degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1, left lower extremity radiculopathy associated with degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1, and/or right lower extremity radiculopathy. See August 2020 Appeal to Board of Veterans' Appeals (VA Form 9).  

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may be granted based on evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present
 August 2020 Appeal to Board of Veterans' Appeals (VA Form 9).  

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may be granted based on evidence of (1) a current 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. 38 C.F.R. § 3.304. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). 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. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995). VA has amended 38 C.F.R. § 3.310 to explicitly incorporate the holding in Allen, except that it will not concede aggravation unless a baseline for the claimed disability can be established with evidence created prior to any aggravation. 38 C.F.R.                         § 3.310(b).

When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

The Veteran's service treatment records are negative for complaints, treatment, or a diagnosis of erectile dysfunction. Post-service treatment records show a diagnosis of erectile dysfunction. See e.g., VA examination, June 25, 2020. 

Turning to the question of whether there is an etiological relationship between the Veteran's erectile dysfunction and service connected disabilities, the Board notes that the record contains the below etiology opinions which must be considered and weighed. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993). When faced with conflicting medical opinions, the Board may favor one medical opinion over the other. See Evans v. West, 12 Vet. App. 22, 30 (1998). The Board will consider each opinion below.

The Veteran was afforded a VA examination in August 2008. The examiner noted the Veteran's contentions and conducted a physical examination. The examiner diagnosed the Veteran with degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1, intervertebral disc syndrome with erectile dysfunction. The examiner indicated that the most likely involved nerve was the deep peroneal nerve. The rationale provided was that there is numbness related to the Veteran's lumbar spine disorder and objective pain with limited range of motion. Therefore, the examiner opined that the Veteran's erectile dysfunction was caused by his service connected degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1. 

The Board finds the August 2008 VA medical opinion to be highly probative. In this regard, the clinician examined the Veteran and provided supporting rationale for the conclusions reached. In addition, the examiner adequately considered the statements and contentions of the Veteran and the onset and continuity of his symptoms. The opinion also has clear conclusions and supporting data, as well as reasoned medical explanations connecting the Veteran's erectile dysfunction to his service connected degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Accordingly, the opinion is afforded great probative weight. 

Subsequently, the Veteran was afforded a VA examination in June 2020. The examiner diagnosed erectile dysfunction. The examiner opined that the Veteran's erectile dysfunction was not related to his degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1. The rationale provided was that the Veteran's obesity was the more likely cause of his erectile
 as reasoned medical explanations connecting the Veteran's erectile dysfunction to his service connected degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Accordingly, the opinion is afforded great probative weight. 

Subsequently, the Veteran was afforded a VA examination in June 2020. The examiner diagnosed erectile dysfunction. The examiner opined that the Veteran's erectile dysfunction was not related to his degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1. The rationale provided was that the Veteran's obesity was the more likely cause of his erectile dysfunction. The examiner indicated that the spinal evaluations did not correlate with an individual having erectile dysfunction. The examiner noted that the deep peroneal nerve mentioned by the August 2008 VA examiner would not affect penile function. Rather, the examiner determined, the pudendal nerve would affect penile function. Therefore, the examiner concluded that the record did not connect the Veteran's lumbar spine disorder with his erectile dysfunction. 

The Board finds the June 2020 VA medical opinion incomplete to decide the claim. In this regard, the VA examiner failed to provide an opinion as to whether erectile dysfunction was aggravated by the Veteran's service connected degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013). Furthermore, the examiner did not consider the theory of obesity as an intermediate step, specifically, whether the Veteran's service connected degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1 led to his obesity which, in turn, led to his diagnosis of erectile dysfunction. Walsh v. Wilkie, 32 Vet. App. 300, 303-04 (2020). Regarding this, the VA examiner noted obesity as the likely cause of the Veteran's erectile dysfunction. This opinion is therefore inadequate to decide the claim.  

In sum, the Veteran has a current diagnosis of erectile dysfunction. The only probative opinion of record is in support of the Veteran's claim for entitlement to service connection on a secondary basis. Moreover, there is no sufficient basis for the Board to reject this supportive opinion and to further develop the claim. Cf. Mariano v. Principi, 17 Vet. App. 305, 312 (2003) (holding that, because it is not permissible for VA to undertake additional development to obtain evidence against a Veteran's case, VA must provide an adequate statement of reasons or bases for its decision to pursue such development where such development could be reasonably construed as obtaining additional evidence for that purpose). 

Accordingly, the Board finds that entitlement to service connection for erectile dysfunction as secondary to service connected degenerative joint disease, lumbar spine, with bulging of annular disc, L5-S1 is warranted. The appeal is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

 

 

KRISTY L. ZADORA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Kuhn, 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.