ERECTILE DYSFUNCTION

Summary

The Veteran served on active duty from August 1975 to March 1997. The Veteran sought to readjudicate a claim for service connection for erectile dysfunction, asserting it was secondary to his service-connected lumbar spine degenerative arthritis, depression, obstructive sleep apnea (OSA), and bilateral lower extremity radiculopathy. The Board reviewed new evidence, including a November 2024 VA clinician opinion and a December 2024 VA clinician opinion, along with a medical treatise submitted by the Veteran in April 2025. The service treatment records were silent regarding erectile dysfunction. The VA clinician opinions in November and December 2024 both found no direct causal link or that it was less likely than not that the erectile dysfunction was caused or aggravated by the service-connected conditions. The November opinion cited the multifactorial nature of ED and lack of direct causal link, while the December opinion noted no indication of causation or aggravation by service-connected conditions and no clinical documentation for natural progression. The Board found these opinions definitive and persuasive against the claim. The medical treatise was deemed unhelpful as it lacked specific information about the Veteran. The Board concluded that the evidence persuasively disproved the claim, denying service connection for erectile dysfunction secondary to the listed conditions.

Rationale

Service treatment records silent for erectile dysfunction.; VA clinician opinions found no direct causal link or less likely than not relationship.; Medical treatise lacked specific information about the Veteran.

Full Decision Text

Citation Nr: A25100909
Decision Date: 11/20/25	Archive Date: 11/20/25

DOCKET NO. 250111-507258
DATE: November 20, 2025

ORDER

New and relevant evidence to readjudicate the claim for service connection for erectile dysfunction to include as secondary to lumbar spine degenerative arthritis, depression, obstructive sleep apnea (OSA), and bilateral lower extremity radiculopathy has been received.

Service connection for erectile dysfunction to include as secondary to lumbar spine degenerative arthritis, depression, OSA, and bilateral lower extremity radiculopathy, is denied. 

FINDINGS OF FACT

1. Evidence not of record in conjunction with the Veteran's petition to readjudicate his claim for service connection for erectile dysfunction to include as secondary to lumbar spine degenerative arthritis, depression, OSA, and bilateral lower extremity radiculopathy that was not previously addressed in a final December 2022 rating decision denying service connection for erectile dysfunction as secondary to lumbar spine degenerative arthritis tends to disprove or disprove a matter at issue with respect to the claim for service connection for this disability. 

2. The evidence for consideration is persuasively against the conclusion that the erectile dysfunction was incurred in service or cased or aggravated by lumbar spine degenerative arthritis, depression, OSA, or bilateral lower extremity radiculopathy. 

CONCLUSIONS OF LAW

1. The criteria for readjudication of the previously denied claim for service connection for erectile dysfunction to include as secondary to service-connected disability lumbar are met.  38 U.S.C. §§ 5108, 7104; 38 C.F.R. §§ 3.156(d), 3.2501, 19.2(a).

2. The criteria for service connection for erectile dysfunction to include as secondary to lumbar spine degenerative arthritis, depression, OSA, and bilateral lower extremity radiculopathy are not met.  38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1975 to March 1997.  

The appeal currently before the undersigned Board of Veterans' Appeals (Board) Veterans Law Judge under the Appeals Modernization Act (AMA) was perfected by way of a January 2025 notice of disagreement (VA Form 10182) with respect to a December 2024 rating decision.  The Veteran in his VA Form 10182 selected the Evidence Review docket under the AMA.  Under this review option, the Board may consider the evidence of record at the time of the rating decision which gave rise to this appeal and that received within 90 days of receipt of VA Form 10182, to include a medical treatise received in April 2025 as discussed below.  

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

I. Legal Criteria

When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the U.S.  Court of Appeals for Veterans Claims (Court) held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail.  See also Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021).  Only when the evidence persuasively favors one side, or another is the benefit of the doubt doctrine not for application.  Id. 

Effective February 19, 2019, when a claim has been previously disallowed it may not thereafter be readjudicated and a claim based upon the same factual basis may not be considered, unless the Veteran submits a supplemental claim along with new
53 (1990), the U.S.  Court of Appeals for Veterans Claims (Court) held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail.  See also Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021).  Only when the evidence persuasively favors one side, or another is the benefit of the doubt doctrine not for application.  Id. 

Effective February 19, 2019, when a claim has been previously disallowed it may not thereafter be readjudicated and a claim based upon the same factual basis may not be considered, unless the Veteran submits a supplemental claim along with new and relevant evidence.  38 U.S.C. §§ 5108, 7104; 38 C.F.R. §§ 3.2501, 19.2(a).  If new and relevant evidence is presented or secured with respect to the supplemental claim, the agency of original jurisdiction will readjudicate the claim taking into consideration all of the evidence of record.  38 C.F.R. §§ 3.156(d), 3.2501.

New evidence is evidence that was not previously part of the actual record before agency adjudicators at the time of the prior denial.  38 C.F.R. § 3.2501(a)(1). Relevant evidence is information that tends to prove or disprove a matter at issue in a claim, including evidence that raises a theory of entitlement to benefits that was not previously addressed.  Id.

Service connection will be granted for disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.  Service connection may be granted for any disease diagnosed after discharge from 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).

Service connection on a secondary basis requires (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) evidence establishing that the service-connected disability either (a) caused, or (b) aggravated, the nonservice-connected disability.  38 C.F.R. § 3.310; 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).

II. Analysis

A December 2022 rating decision denied a claim for service connection for erectile dysfunction secondary to lumbar spine degenerative arthritis.  The Veteran did not file a timely appeal with respect to this decision, so it thus became final.  38 U.S.C. § 7105(c); 38 C.F.R. § 3.104, 20.302, 20.1103.  This is the only final rating decision addressing the claim for service connection for erectile dysfunction on any basis. 

In conjunction with the Veteran's petition to readjudicated the claim for service connection for erectile dysfunction, an opinion completed in November 2024 by a VA clinician found that the evidence did not establish a direct causal link between the Veteran's erectile dysfunction and the service-connected condition lumbar spine disability.  Also received was an opinion from a VA clinician completed in December 2024 essentially finding that it was less likely than not that erectile dysfunction was caused or aggravated by the service-connected lumbar spine degenerative arthritis, depression, OSA, or bilateral lower extremity radiculopathy.  Also received was a medical treatise submitted by the Veteran in April 2025 discussing the relationship between lumbar spine disorders and erectile dysfunction.  

The above evidence, not of record at the time of the December 2022 rating decision, clearly tends to disprove or prove a matter at issue with respect to the claim for service connection for erectile dysfunction to include as secondary to service-connected disability.  Under the AMA, relevant evidence is information that tends to prove or disprove a matter at issue in a claim.  38 C.F.R. § 3.2501(a)(1).  As such, new and relevant evidence to readjudicate the claim for service connection for erectile dysfunction has been received.   

Turning to the readjudication of the claim for service connection for erectile dysfunction, the service treatment reports (STRs), to include the reports from the January 1997 separation examination and medical history collected at that time, are silent for erectile dysfunction.  The post service evidence does reflect this diagnosis but, as forth above, the record reflects negative opinions completed in
 for erectile dysfunction to include as secondary to service-connected disability.  Under the AMA, relevant evidence is information that tends to prove or disprove a matter at issue in a claim.  38 C.F.R. § 3.2501(a)(1).  As such, new and relevant evidence to readjudicate the claim for service connection for erectile dysfunction has been received.   

Turning to the readjudication of the claim for service connection for erectile dysfunction, the service treatment reports (STRs), to include the reports from the January 1997 separation examination and medical history collected at that time, are silent for erectile dysfunction.  The post service evidence does reflect this diagnosis but, as forth above, the record reflects negative opinions completed in November 2024 and December 2024 with respect to whether erectile dysfunction is due to service-connected disability.  In this regard, the rationale for the negative opinion rendered in November 2024 as to whether erectile dysfunction is due to service-connected disability was set forth as follows: 

Erectile dysfunction (ED) is a multifactorial condition that can arise from various causes, including psychological factors, hormonal imbalances, and medical conditions such as diabetes or cardiovascular disease.  In this case, the available medical evidence does not establish a direct causal link between the [V]eteran's erectile dysfunction and the[] service-connected condition.

The rationale for the December 2024 opinion was as follows: 

After a thorough review of the medical records and documentation, there is no indication that the current condition in question has been caused or aggravated by a service-connected disease or injury.  The evidence does not support a causal or proximate relationship between the nonservice-connected condition and the service-connected conditions of depression obstructive sleep apnea (OSA) radiculopathy, left lower extremity radiculopathy, [or] right lower extremity. [] Furthermore, there is no clinical documentation to suggest that the increase in severity of the nonservice-connected condition is other than due to its natural progression.

There is otherwise no positive opinion with respect to the matter of secondary service connection for erectile dysfunction, and as the opinions above are documented to have been based on a review of the record and supported by adequate rationale, the undersigned finds these opinions to be definitive as to this matter.  

With respect to the medical treatise submitted by the Veteran in April 2025 discussing the relationship between lumbar spine disorders and erectile dysfunction, as this reference contained no information specific to the Veteran, it cannot be the basis of a grant of service connection for erectile dysfunction as secondary to service-connected disability.  Mattern v. West, 12 Vet. App. 222, 227 (1999); Sacks v. West, 11 Vet. App. 314, 317 (1998).

To the extent the assertions submitted by or on behalf of the Veteran are advanced in an attempt to establish that he has erectile dysfunction due to service or service-connected disability, such complex medical matters are within the province of trained medical professionals.  See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994).  As neither the Veteran nor his representative are shown to have the appropriate training and expertise, they are not competent to render a persuasive opinion as to such matters. 

While the Veteran is competent to describe any lay observable symptoms associated with erectile dysfunction since service, the undersigned finds the lack of any clinical evidence of this condition in the STRs or any competent evidence in the evidentiary windows for consideration linking this condition to service to be more persuasive than any described or implied assertions of continuity made in connection with the claim on appeal, and that these facts weigh against a finding of continuity of relevant symptoms associated with erectile dysfunction since service.  Finally, as there is no objective or persuasive evidence of record indicating that the Veteran has erectile dysfunction due to service, a VA examination or opinion to address the matter of direct service connection for erectile dysfunction is not necessary to fulfill the duty to assist.  

?

In light of all of the above, the Board finds that the evidence is persuasively against the claim for service connection for erectile dysfunction to include as secondary to lumbar spine degenerative arthritis, depression, OSA, and bilateral lower extremity radiculopathy.  As such, this claim must be denied.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, Lynch, supra.

 

 

 

MARJORIE A. AUER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Ahlberg, Andrew

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.