ERECTILE DYSFUNCTION

Summary

The veteran, who served from September 1987 to April 1994, appeals the denial of service connection for erectile dysfunction, hypertension, and sleep apnea. The veteran contended these conditions were related to active service, including toxic exposure and secondary to his service-connected PTSD, noting personal and marital difficulties stemming from these issues. The Board reviewed the evidence, including the veteran's claim, the Notice of Disagreement, and a September 2024 VA examination. The veteran elected Direct Review, meaning the record closed at the time of the RO decision. The VA examination diagnosed erectile dysfunction (onset 2020), hypertension (onset 2000), and obstructive sleep apnea (onset 2004). The examiner opined that all three conditions were less likely than not proximately due to or the result of service-connected PTSD, and also less likely than not caused by indicated toxic exposures, considering the veteran's MOS as an Aviation Boatswain's Mate (Aircraft Handler). The examiner detailed recognized risk factors for each condition, such as age, obesity, tobacco use, and low testosterone, finding these factors outweighed any potential service-related contributions. The Board found the evidence persuasively weighed against service connection, noting that service treatment records lacked complaints or diagnoses for these conditions. The Board gave more probative weight to the competent medical opinions from the VA examiner, finding the veteran's lay testimony outside the scope of his medical competence. The Board concluded that the evidence did not establish a service connection for any of the claimed conditions, and the benefit of the doubt doctrine was not applicable.

Rationale

No complaints, symptoms, treatment, or diagnoses in STRs; VA exam found less likely than not related to service or PTSD; VA exam found less likely than not caused by indicated TERAs; Veteran's risk factors (low testosterone, obesity, tobacco use) outweigh service factors

Full Decision Text

Citation Nr: A26000274
Decision Date: 01/05/26	Archive Date: 01/05/26

DOCKET NO. 250328-532393
DATE:  January 5, 2026

ORDER

Service connection for erectile dysfunction is denied.

Service connection for hypertension is denied.

Service connection for sleep apnea is denied.

FINDINGS OF FACT

1. The Veteran's diagnosed erectile dysfunction is not related to his active service or to a service-connected disability.

2. The Veteran's diagnosed hypertension is not related to his active service or to a service-connected disability.

3. The Veteran's diagnosed sleep apnea is not related to his active service or to a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for erectile dysfunction have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for service connection for hypertension have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for service connection for sleep apnea have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1987 to April 1994.  The Board recognizes the Veteran's service to our country, and the sacrifices it necessarily entailed. 

This case is before the Board of Veterans' Appeals (Board) on appeal from a December 2024 Department of Veterans Affairs (VA) Regional Office (RO) rating decision.  In that decision, the RO denied service connection for erectile dysfunction, hypertension, and sleep apnea. 

In March 2025, VA received the Veteran's 10182 Notice of Disagreement (NOD).  The Veteran elected the Direct Review docket.

The Direct Review docket does not allow submission of any additional evidence in support of an appeal.  Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal.  38 C.F.R. § 20.301.  As this is a Direct Review appeal, the record closed as of the December 2024 rating decision.

Evidence added during an ineligible period will not be considered.  Should the Veteran want VA to consider evidence submitted outside the eligible period, the Veteran should submit a VA Form 20-0995, Supplemental Claim, identifying such evidence.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service.  See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  "To establish a right to compensation for a present disability, 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 for certain chronic diseases may also be established based upon a legal "presumption" by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service.  38 U.S.C. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309.  In addition, service connection may be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected condition.  38 C.F.R. § 3.310.

1. Entitlement to service connection for erectile dysfunction

2. Entitlement to service connection for hypertension

3. Entitlement to service connection for sleep apnea

The Veteran contends that his erectile dysfunction, hypertension, and sleep apnea are related to
1137; 38 C.F.R. §§ 3.307, 3.309.  In addition, service connection may be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected condition.  38 C.F.R. § 3.310.

1. Entitlement to service connection for erectile dysfunction

2. Entitlement to service connection for hypertension

3. Entitlement to service connection for sleep apnea

The Veteran contends that his erectile dysfunction, hypertension, and sleep apnea are related to his active service, to include as due to exposure to toxins and as secondary to his service-connected posttraumatic stress disorder (PTSD). The Veteran asserts that living with PTSD has produced other hurdles in his life, including hypertension, sleep apnea, and erectile dysfunction.  These disabilities have caused the Veteran personal difficulties, including problems with his marriage.  The Veteran has been receiving treatment from VA.  See VA 21-526EZ, Fully Developed Claim, September 6, 2024.

Favorable findings made by the AOJ are binding on the Board unless rebutted by evidence of clear and unmistakable error (CUE).  The RO provided favorable findings that participation in a toxic exposure risk activity (TERA) is conceded based on his service as an aviation boatswains mate handler.  The claimed primary disability (PTSD) is service connected.  Moreover, the Veteran has been diagnosed with erectile dysfunction, hypertension, and obstructive sleep apnea (per September 18, 2024, VA examination).

The question for the Board is whether the Veteran has current disabilities that began during service, are at least as likely as not related to an in-service injury, event, or disease, or are due to, the result of, or aggravated by a service-connected disability.

The Board concludes that, while the Veteran has a current diagnosis of erectile dysfunction, hypertension, and sleep apnea, the evidence of record persuasively weighs against finding that the Veteran's diagnosed erectile dysfunction, hypertension, or sleep apnea began during service, are otherwise related to an in-service injury, event, or disease, or is due to, or the result of, or aggravated by a service-connected disability. 

Service treatment records (STRs) do not contain complaints, symptoms, treatment, or diagnoses related to the claimed conditions. 

The Veteran underwent VA examinations on September 21, 2024, providing diagnoses of erectile dysfunction, hypertension, and sleep apnea.  The Veteran's erectile dysfunction had its onset in 2020; hypertension in 2000; and sleep apnea in 2004, with gradual onset of difficulty sleeping.  A sleep study performed in January 2024 confirmed a diagnosis of obstructive sleep apnea.  See C&P Examination, September 21, 2024.

The September 2024 VA examiner opined that the Veteran's diagnosed erectile dysfunction, hypertension, and sleep apnea are less likely than not proximately due to or the result of the Veteran's service-connected PTSD.  The VA examiner further opined that the Veteran's diagnosed erectile dysfunction, hypertension, and sleep apnea are less likely than not caused by the indicated TERAs, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran.  The VA examiner reviewed the TERA memo of record and noted the Veteran's MOS of Aviation Boatswain's Mate (Aircraft Handler), which suggests probable asbestos exposure.  See C&P Exam, September 2024.

Regarding erectile dysfunction, the examiner explained that medical literature does not support a causative relationship between erectile dysfunction and the indicated toxic exposures.  The pathophysiological mechanisms that cause erectile dysfunction are not shared by toxic exposures.  According to the Mayo Clinic, erectile dysfunction is often caused by physical issues such as heart disease, clogged blood vessels (atherosclerosis), high cholesterol, high blood pressure, diabetes, obesity, metabolic syndrome, Parkinson's disease, multiple sclerosis, certain prescription medications, tobacco use, Peyronie's disease, alcoholism and other forms of substance abuse, sleep disorders, treatments for prostate cancer or enlarged prostate, surgeries or injuries affecting the pelvic area or spinal cord, and low testosterone. Various risk factors can also contribute to the condition, including medical conditions, certain medical treatments and medications; injuries to nerves or arteries that control erections; and psychological conditions such as stress, anxiety, or depression. The Veteran has several significant risk factors for this condition, including low testosterone levels, obesity, and tobacco use, which outweigh any factors identified in the TERA and military service.  The Veteran's significant risk factors are more consistent with these
, obesity, metabolic syndrome, Parkinson's disease, multiple sclerosis, certain prescription medications, tobacco use, Peyronie's disease, alcoholism and other forms of substance abuse, sleep disorders, treatments for prostate cancer or enlarged prostate, surgeries or injuries affecting the pelvic area or spinal cord, and low testosterone. Various risk factors can also contribute to the condition, including medical conditions, certain medical treatments and medications; injuries to nerves or arteries that control erections; and psychological conditions such as stress, anxiety, or depression. The Veteran has several significant risk factors for this condition, including low testosterone levels, obesity, and tobacco use, which outweigh any factors identified in the TERA and military service.  The Veteran's significant risk factors are more consistent with these recognized contributors to erectile dysfunction, and it is more likely than his erectile dysfunction is related to these factors.  Id.  

Regarding hypertension, the examiner explained that medical literature does not support a causative relationship between hypertension and the indicated toxic exposures.  Hypertension and PTSD or the toxic exposures do not share the same pathophysiological mechanisms.  Medical literature does not support a causative relationship between the Veteran's hypertension and PTSD or toxic exposure.  According to the Mayo Clinic, various factors contribute to high blood pressure; these factors include older age, as well as racial predispositions, family history, obesity, lack of exercise, tobacco use or vaping, high salt intake, low potassium levels, excessive alcohol consumption, stress, and certain chronic conditions like kidney disease, diabetes, and sleep apnea.  The Veteran possesses several risk factors for hypertension, such as age, obesity, and tobacco use.  These risk factors outweigh the factors identified in the TERA and military service.  The Veteran's risk factors align more closely with these well-documented contributors to hypertension, and it is more likely that the Veteran's hypertension is attributed to these factors alongside a lack of exercise.  Id.

Regarding sleep apnea, the examiner explained that medical literature does not support a causative relationship between sleep apnea and the indicated toxic exposures.  Sleep apnea is caused by partial or complete mechanical obstruction of the upper airway during sleep, leading to reduced blood oxygen saturation levels, a pathophysiologic mechanism not shared by toxic exposures.  It is caused by physical collapse of oral tissues, which is unrelated to PTSD.  While sleep apnea and PTSD can coexist, sleep apnea is an obstructive process of the oral-pharyngeal airway.  Sleep apnea is separate from PTSD (a mental health condition), and there is no established causal relationship between PTSD and sleep apnea. According to the Mayo Clinic, several factors increase the risk of obstructive sleep apnea, including excess weight (especially fat deposits around the upper airway that can obstruct breathing), older age (with risk leveling off after the 60s and 70s), a naturally narrowed airway or enlarged tonsils/adenoids, high blood pressure, chronic nasal congestion, smoking, diabetes, being male, a family history of sleep apnea, and asthma. The Veteran's risk factors align more closely with these recognized contributors to sleep apnea, including age, male sex, obesity (BMI 32), and tobacco use, which outweigh the factors identified in the TERA and military service.  It is more likely that the Veteran's sleep apnea is related to these factors.  See C&P Examination, September 21, 2024.

The Veteran believes that his claimed disabilities (erectile dysfunction, hypertension, and sleep apnea) are related to his active service, to include exposure to toxins, an in-service injury, event, disease, or a service-connected disability.  The Veteran in this case is not competent to provide a nexus opinion regarding these issues.  The issues are medically complex, as they require knowledge of the interaction between multiple organ systems in the body, anatomical relationships, and the interpretation of complicated diagnostic medical testing.  Therefore, here, it is outside the competence of the Veteran because the record does not show that he has the medical training or credentials to make such a determination.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).  Consequently, the Board gives more probative weight to the competent medical evidence of record, including the September 2024 VA exams and medical opinions.

Competent medical evidence of record is sufficient to decide this claim, and it has been afforded high probative value.  A thorough review of the record does not evidence that the Veteran's diagnosed erectile dysfunction, hypertension, and sleep apnea are related to his active service, to include as due to exposure to toxins during service or as secondary to his service-connected PTSD. 

For the above reasons, the
2, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).  Consequently, the Board gives more probative weight to the competent medical evidence of record, including the September 2024 VA exams and medical opinions.

Competent medical evidence of record is sufficient to decide this claim, and it has been afforded high probative value.  A thorough review of the record does not evidence that the Veteran's diagnosed erectile dysfunction, hypertension, and sleep apnea are related to his active service, to include as due to exposure to toxins during service or as secondary to his service-connected PTSD. 

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for erectile dysfunction, hypertension, or sleep apnea is warranted.  Rather, the evidence persuasively weighs against the claims, and the benefit of the doubt doctrine is not for application.  38 U.S.C. § 5107(b), 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

 

Frederic P. Gallun

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Labi, 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.