Case A26005131

MICHAEL MARTIN · 2026 · Case ID: A26005131

MIXED

Summary

The Veteran, who served from January 1985 to January 1989 and again from February 1991 to March 1991, appeals the denial of service connection for erectile dysfunction (ED) and seeks an increased rating for his service-connected acquired psychiatric disorder, along with earlier effective dates for TDIU and SMC housebound status. The Board granted service connection for ED, finding it at least as likely as not secondary to his service-connected acquired psychiatric disorder. The Board found the VA medical opinions inadequate as they did not fully address the Veteran's claims regarding medication side effects or aggravation by his psychiatric condition. The Board relied on the Veteran's private medical opinion, which linked ED to depression, anxiety, and stress, and resolved doubt in the Veteran's favor. The claims for an increased rating for the acquired psychiatric disorder and earlier effective dates for TDIU and SMC housebound status were remanded due to the RO's failure to obtain all relevant private treatment records from Integrated Behavioral Center and Dr. Dodds, constituting a duty to assist error.

Special Benefit

SMC - HOUSEBOUND; TDIU

Docket No.

250708-561980

Full Decision Text

Citation Nr: A26005131
Decision Date: 01/21/26 Archive Date: 01/21/26

DOCKET NO. 250708-561980
DATE: January 21, 2026

ORDER

Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected adjustment disorder with mixed anxiety and depressed mood (previously rated as acquired psychiatric disorder), is granted.

REMANDED

Entitlement to a disability rating in excess of 50 percent for adjustment disorder with mixed anxiety and depressed mood (previously rated as acquired psychiatric disorder) prior to August 12, 2024 is remanded.

Entitlement to an effective date prior to August 12, 2024 for the award of the 70 percent rating for adjustment disorder with mixed anxiety and depressed mood (previously rated as acquired psychiatric disorder) is remanded.

Entitlement to an effective date earlier than January 4, 2023 for the award of a total disability rating based on individual unemployability (TDIU) due to the service-connected disabilities is remanded.

Entitlement to an effective date earlier than January 4, 2023 for the award of special monthly compensation (SMC) based on housebound status is remanded.

FINDING OF FACT

Resolving all reasonable doubt in the Veteran's favor, it is at least as likely as not that his erectile dysfunction is causally related to or aggravated by his service-connected acquired psychiatric disorder.

CONCLUSION OF LAW

The criteria for entitlement to service connection for erectile dysfunction, to include as secondary to service-connected adjustment disorder with mixed anxiety and depressed mood (previously rated as acquired psychiatric disorder), have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from January 1985 to January 1989, and from February 1991 to March 1991.

This matter comes before the Board of Veterans' Appeals (Board) from a July 2024 rating decision, an August 2024 rating decision, and a September 2024 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In the July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. The Board may only consider the evidence of record at the time of notice of the July 2024, August 2024, and September 2024 rating decisions on appeal for the respective issues adjudicated in those decisions, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the July 2025 VA Form 10182. 38 C.F.R. § 20.303.

Regarding the issues remanded in this decision, any evidence the Board could not consider will be considered by the RO in the adjudication of those claims. 38 C.F.R. § 3.103 (c)(2)(ii).

Neither the Veteran nor the Veteran's representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issue decided in this appeal. See Scott v. McDonald,?789 F.3d 1375, 1381?(Fed. Cir. 2015) (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 veteran fails to raise them before the Board."); Dickens v. McDonald,?814 F.3d 1359, 1361?(Fed. Cir. 2016) (applying Scott to a duty to assist argument).

The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issue decided in this appeal. The Veteran should not assume that evidence that is not explicitly discussed in the decision has been overlooked. See Timberlake v. Gober,?14?Vet. App.?122?(2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed).

The Veteran seeks entitlement to service connection for erectile dysfunction. He contends that his erectile dysfunction is causally related to his service-connected acquired psychiatric disorder and/or its treatment.

Generally, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R
. Gober,?14?Vet. App.?122?(2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed).

Generally, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. Secondary service connection requires: (1) a service-connected disability; (2) a nonservice-connected disability; and (3) evidence that the nonservice-connected disability is either (a) proximately due to or the result of the service-connected disability or (b) aggravated (increased in severity) by the service-connected disability and not due to the natural progress of the nonservice-connected disability. Id.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt should be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt should be resolved in favor of the claimant. See 38 C.F.R. § 3.102.

In the August 2024 rating decision on appeal, the RO made the following favorable findings: (1) the Veteran has a currently diagnosed of erectile dysfunction, (2) the claimed primary disability - depressive disorder - is service connected, and (3) the Veteran's exposure to toxic chemicals while in service was conceded. These favorable findings are binding on the Board. See 38 C.F.R. § 3.104(c). Therefore, the question before the Board is whether the Veteran's diagnosed erectile dysfunction is causally related to an in-service injury, event, or disease; or is proximately due to or aggravated by his service-connected acquired psychiatric disorder.

In May 2023, the Veteran underwent a VA examination for male reproductive organ conditions. The Veteran reported that his erectile dysfunction began in 1992 after struggling with depression, anxiety, and panic attacks. A diagnosis of erectile dysfunction was confirmed. The examiner noted that the Veteran was not taking any medication for erectile dysfunction at the time of the examination. The Veteran reported that he had tried medications in the past.

The examiner opined that it was less likely than not that the Veteran's erectile dysfunction was incurred in or caused by an in-service injury, event, or illness. The examiner's opinion was based on the Veteran having never deployed, and the examiner concluded that the Veteran's erectile dysfunction was due to low testosterone. The examiner also provided a secondary service connection opinion that it was less likely than not that the Veteran's erectile dysfunction was proximately due to or the result of his service-connected acquired psychiatric disorder. The examiner stated, "erectile dysfunction is a neurovascular disorder or an endocrine disorder. Mental health conditions may effect libido but has no effect on the neurovascular genital system. This is supported by the literature."

Following the denial of the Veteran's claim for service connection for erectile dysfunction in an August 2023 rating decision, the Veteran requested a higher-level review. See August 2023 VA Form 20-0996 Request for Higher-Level Review. During the higher-level review, the Veteran reported that his erectile dysfunction was due to medications taken for his service-connected acquired psychiatric disorder. Additionally, the RO determined that erectile dysfunction was not on the exceptions list for conditions that required toxic exposure risk activity (TERA) examinations. As a result of the higher-level review, the RO requested medical opinions to address TERA and aggravation.

In January 2024, medical opinions for secondary service connection, aggravation, and TERA were added to the Veteran's claims file. Regarding secondary service connection, the examiner opined that it was
an August 2023 rating decision, the Veteran requested a higher-level review. See August 2023 VA Form 20-0996 Request for Higher-Level Review. During the higher-level review, the Veteran reported that his erectile dysfunction was due to medications taken for his service-connected acquired psychiatric disorder. Additionally, the RO determined that erectile dysfunction was not on the exceptions list for conditions that required toxic exposure risk activity (TERA) examinations. As a result of the higher-level review, the RO requested medical opinions to address TERA and aggravation.

In January 2024, medical opinions for secondary service connection, aggravation, and TERA were added to the Veteran's claims file. Regarding secondary service connection, the examiner opined that it was less likely than not that the Veteran's erectile dysfunction was proximately due to or the result of his service-connected acquired psychiatric disorder based on lack of evidence in the Veteran's service treatment records (STRs) documenting significant risk factors related to erectile dysfunction. The examiner added that although depression is a risk factor for erectile dysfunction, the Veteran's age and metabolic syndrome far outweighed "any risk of ED from a mental health disorder."

Regarding aggravation, the examiner opined that it was less likely than not that the Veteran's erectile dysfunction was aggravated beyond its natural progression by his service-connected acquired psychiatric disorder. The supporting rationale was a duplicate of the rationale provided for the secondary service connection opinion.

The January 2024 VA examiner also opined that it was less likely than not that the Veteran's erectile dysfunction was 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. As supporting rationale, the examiner stated that medical literature did not reflect that there was a causal relationship between the Veteran's TERA participation and erectile dysfunction. The stated that the Veteran's age and metabolic syndrome outweighed other risk factors.

In support of his claim, the Veteran' submitted a private medical opinion authored by Kapil Gulati, MD. See January 2025 Medical Treatment Record - Non-Government Facility. Dr. stated that depression and anxiety are two common health problems that can lead to or worsen erectile dysfunction and explained that stress decreases the amount of testosterone produced by the body. He cited studies that documented a correlation between anxiety and depression and erectile dysfunction. Dr. Gulati opined that it was more likely than not that the Veteran's ED was a direct result of his acquired psychiatric disorder, hypertension, and diabetes.

The Board finds that the VA medical opinions are inadequate. Neither the May 2023 VA examiner nor the January 2024 VA examiner addressed whether the Veteran's statement that his erectile dysfunction was caused by medication taken for his service-connected acquired psychiatric disorder or whether the Veteran's erectile dysfunction was aggravated by his service-connected acquired psychiatric disorder.

The Board notes that military service need not be the exclusive and only cause of the disability for service connection to be warranted. Based on the January 2024 VA examiner's statement that depression is a risk factor for erectile dysfunction and the private medical opinion submitted by the Veteran, and resolving all reasonable doubt in the Veteran's favor, the Board finds that it is at least as likely as not that the Veteran's diagnosed erectile dysfunction was caused or aggravated by his service-connected acquired psychiatric disorder.

Therefore, entitlement to service connection for erectile dysfunction, to include as secondary to service-connected adjustment disorder with mixed anxiety and depressed mood (previously rated as acquired psychiatric disorder), is granted.

REASONS FOR REMAND

1. Entitlement to a disability rating in excess of 50 percent for adjustment disorder with mixed anxiety and depressed mood (previously rated as acquired psychiatric disorder) prior to August 12, 2024 is remanded.

2. Entitlement to an effective date prior to August 12, 2024 for the award of the 70 percent rating for adjustment disorder with mixed anxiety and depressed mood (previously rated as acquired psychiatric disorder) is remanded.

The Veteran seeks a rating in excess of 50 percent for his service-connected acquired psychiatric disorder prior to August 12, 2024 and an earlier effective date for the award of the 70 percent rating for his service-connected acquired psychiatric disorder.

During an August 2016 VA examination for mental disorders, the Veteran reported that he was receiving mental health care from Integrated Behavioral Center. The Veteran's claim file only contains progress notes for visits in February 2016, March 2016, and May 2016. In January 2023, a document containing an active problem list and a current medication list from Integrated Behavioral Center was added to the Veteran's claim file. The record does not reflect that efforts were made to obtain all of the Veteran's treatment records from Integrated Behavioral Center.

During a February 2023 VA examination for mental disorders, the Veteran reported that he had been receiving treatment with Dr. Dodds, through a community-based
percent rating for his service-connected acquired psychiatric disorder.

During a February 2023 VA examination for mental disorders, the Veteran reported that he had been receiving treatment with Dr. Dodds, through a community-based private practice. Additionally, in the December 2023, higher-level review, the RO noted that development was not completed to obtain treatment records. The claims file does not reflect that efforts were made to obtain the Veteran's treatment records from Dr. Dodds.

VA is required to make reasonable efforts to assist claimants in obtaining relevant private records. 38 U.S.C. § 5103A(b). Failure to make reasonable efforts to assist the Veteran in obtaining relevant private records is a pre-decisional duty to assist error that requires that the claim be remanded.

3. Entitlement to an effective date earlier than January 4, 2023 for the award of a total disability rating based on individual unemployability (TDIU) due to the service-connected disabilities is remanded.

4. Entitlement to an effective date earlier than January 4, 2023 for the award of special monthly compensation (SMC) based on housebound status is remanded.

The Veteran asserts that he is entitled to earlier effective dates for the awards of TDIU and SMC based on housebound status. The Board finds that the issues of entitlement earlier effective dates for the awards of TDIU and SMC based on housebound status are inextricably intertwined with the Veteran's claims for an increased rating and an earlier effective date for his service-connected acquired psychiatric disorder which are being remanded. Therefore, entitlement to an earlier effective date for the award of TDIU and entitlement to an earlier effective date for the award of SMC based on housebound status are remanded.

(Continued on the next page)

The matters are REMANDED for the following action:

Ask the Veteran to complete a VA Form 21-4142 for any private providers of treatment for any acquired psychiatric conditions. Make two requests for the authorized records from any identified providers unless it is clear after the first request that a second request would be futile. If any identified and authorized records cannot be obtained, then such should be noted in the record and the Veteran and his representative should be notified of such in a manner consistent with 38 C.F.R. § 3.159(e).

MICHAEL MARTIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C. R. G., 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.

Analyze in VA Law Explorer