ERECTILE DYSFUNCTION

Summary

The Veteran, an Army Veteran who served from June 2012 to December 2015, appeals the denial of service connection for erectile dysfunction (ED). The Veteran claims ED is secondary to his service-connected back disability, citing chronic pain and medication side effects. The Board reviewed evidence including a September 2024 private medical opinion from a nurse practitioner, P.D., who opined that the Veteran's ED was more likely than not due to chronic pain from musculoskeletal conditions, citing studies correlating chronic pain with sexual dysfunction. The Board also considered an October 2024 VA examination which diagnosed ED and found it less likely than not related to the service-connected right knee disability, but acknowledged the Veteran's back disability, including a history of disc herniation and surgery, presented risk factors attributable to his ED. The Board found both the private opinion and the VA examination had probative value. Applying the benefit-of-the-doubt rule, the Board determined the evidence was in approximate balance regarding the nexus between ED and the service-connected back disability, thus granting service connection for ED. The Board noted that while further development was possible, the balance of evidence warranted granting the claim under the benefit-of-the-doubt doctrine.

Rationale

Private opinion found ED more likely than not due to chronic pain from musculoskeletal conditions.; VA examiner noted back disability presented risk factors attributable to ED.; Evidence found in approximate balance, warranting benefit of the doubt.

Full Decision Text

Citation Nr: A26025525
Decision Date: 03/23/26	Archive Date: 03/23/26

DOCKET NO. 251215-615401
DATE: March 23, 2026

ORDER

Service connection for erectile dysfunction (ED) is granted.

FINDING OF FACT

The evidence is in approximate balance on whether the Veteran's ED is proximately due to his service-connected lumbar spine with intervertebral disc syndrome (IVDS) and degenerative disc disease (DDD) with L5-S1 discectomy and degenerative arthritis ("back disability").

CONCLUSION OF LAW

The criteria for service connection for ED as secondary to the service-connected back disability have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the Army from June 2012 to December 2015.

In the December 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 January 2025 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.

1. Service connection for ED.

The Veteran contends that the claimed ED is due to his service-connected right knee disability.  He states that despite taking various medications for his service-connected disabilities, he continues to struggle with ED.  See the September 2024 statement.

To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability.  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  

A disability may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated beyond its natural progress by a service-connected disease or injury.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b).

An October 2024 VA examination reports clearly indicates that the Veteran was diagnosed with ED.  Thus, the current diagnosis element has been established.  

In addition, the Veteran's service-connected disabilities include, in relevant part, a back disability and a right knee disability.  

The remaining question is whether there is a link between the currently diagnosed ED and a service-connected disability.

In September 2024, the Veteran submitted a medical opinion by a private nurse practitioner, P.D., who opined that that based on her knowledge, training, clinical experience, and review of documentation of an August 2024 appointment, the Veteran's ED more likely than not was due to chronic pain from musculoskeletal conditions.  She include a chart showing that a chronic painful condition "can cause" sexual dysfunction, which over time leads to chronic ED; or alternatively, a chronic painful condition "often causes" mental health disorders, which lead to chronic ED.  P.D. also cited two studies showing correlation between sexual difficulty/dysfunction and chronic pain.

In an October 2024 VA male reproductive organ conditions examination, the Veteran reported that his ED started in 2022, and he had not been treated for the condition.  The examiner diagnosed ED and opined that it was less likely than not proximately due to or the result of the service-connected right knee disability.  The examiner explained that there is no evidence in medical literature that supports knee joint dysfunction causing ED.  The Veteran had significant history, including disc herniation with surgical correction at L5-S1, which is the nerve bundle that supplies innervation to the penis, meaning that "he has risk factors that would be attributable to his ED."

The Board finds that the private opinion from P.D. and the VA examiner's opinion both have at least some probative value.  P.D. provided a rationale for her opinion, and the Board finds nothing in the record that challenges her qualifications to provide competent medical evidence.  The VA examiner's opinion was based on interview and clinical examination
imately due to or the result of the service-connected right knee disability.  The examiner explained that there is no evidence in medical literature that supports knee joint dysfunction causing ED.  The Veteran had significant history, including disc herniation with surgical correction at L5-S1, which is the nerve bundle that supplies innervation to the penis, meaning that "he has risk factors that would be attributable to his ED."

The Board finds that the private opinion from P.D. and the VA examiner's opinion both have at least some probative value.  P.D. provided a rationale for her opinion, and the Board finds nothing in the record that challenges her qualifications to provide competent medical evidence.  The VA examiner's opinion was based on interview and clinical examination of the Veteran, and a rationale was also provided for the opinion.  See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (noting that the credibility and weight to be attached to medical opinions are within the province of the Board).

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?

There can be no doubt that further medical inquiry could be undertaken with a view towards development of the claim.  However, under the "benefit-of-the- doubt" rule, where there exists "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter," the Veteran shall prevail upon the issue.  Ashley v. Brown, 6 Vet. App. 52, 59 (1993).  In this case, the Board finds that the evidence is in approximate balance on the issue of whether the Veteran's ED is due to, or aggravated by, his service-back disability.  See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2022).  As such, service connection for ED is warranted.

 

H. SEESEL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	N. Nelson

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.