Secondary service connection
Erectile dysfunction secondary to PTSD: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided erectile dysfunction claimed as secondary to PTSD in 1,645 decisions. It granted the issue in 30.3% of them, above the 17.0% grant rate for all erectile dysfunction issues, denied it in 15.0%, and remanded it in 53.6%. Counting only decisions on the merits, 66.9% were granted.
Decisions
1,645
2017–2026
Granted
30.3%
All erectile dysfunction: 17.0%
Granted on the merits
66.9%
Granted ÷ (granted + denied)
Remanded
53.6%
Denied: 15.0%
See all erectile dysfunction decisions, direct and secondary.
Erectile dysfunction secondary to PTSD: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 94 | 20.2% | 23.4% | 50.0% | 6.4% |
| 2018 | 142 | 25.4% | 19.7% | 52.8% | 2.1% |
| 2019 | 191 | 20.9% | 19.4% | 59.2% | 0.5% |
| 2020 | 184 | 28.3% | 15.8% | 55.4% | 0.5% |
| 2021 | 122 | 28.7% | 13.9% | 56.6% | 0.8% |
| 2022 | 163 | 33.1% | 11.0% | 54.6% | 1.2% |
| 2023 | 161 | 31.1% | 11.2% | 57.8% | 0.0% |
| 2024 | 227 | 32.6% | 12.3% | 54.6% | 0.4% |
| 2025 | 269 | 36.8% | 13.0% | 49.4% | 0.7% |
| 2026 | 95 | 42.1% | 14.7% | 40.0% | 3.2% |
Each row counts issues (each condition the Board decided), so the shares add up to 100%. Other: dismissed, withdrawn or no clear outcome. Years with fewer than 20 issues are left out.
Evidence in granted and denied erectile dysfunction decisions
For each kind of supporting evidence: how often the Board granted the erectile dysfunction issue on the merits when the decision mentioned it, compared with decisions that did not. These are associations, not causes, and evidence is recorded per decision, not per issue.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Positive nexus opinion | 385 | 92.4% | 49.4% | +43.0 pts |
| Favorable VA exam | 253 | 86.2% | 60.4% | +25.7 pts |
| Treating physician opinion | 89 | 90.7% | 65.1% | +25.7 pts |
| Private medical opinion | 482 | 78.4% | 59.4% | +19.0 pts |
| Buddy statement | 45 | 77.3% | 66.6% | +10.7 pts |
| Combat service | 217 | 71.2% | 66.1% | +5.1 pts |
| Lay statement | 1,213 | 63.6% | 78.0% | −14.5 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 78.5% of the decisions that granted erectile dysfunction.
- The Board found the veteran's statements credible in 23.5% of grants and 11.4% of denials.
Negative evidence in the record
An unfavorable exam or a negative nexus opinion often sits in the same record as favorable evidence, and the Board weighs them against each other. So these rows show how often erectile dysfunction was still granted when the record contained the negative item, not that the item helped.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Negative nexus opinion | 1,071 | 66.3% | 68.4% | −2.2 pts |
| Unfavorable VA exam | 1,317 | 65.1% | 76.9% | −11.9 pts |
How these claims are argued
A secondary claim says PTSD caused erectile dysfunction or made it worse, and names how. Below: whether the Board's decision discussed aggravation, and the medical link each decision names, with how often those issues were granted.
Aggravation discussed
made worse by the disability, 3.310(b)
17.4%
granted, of 605 issues (36.7% of all)
Causation only
caused by the disability, 3.310(a)
37.8%
granted, of 1,043 issues (63.3% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Medication side effects Granted “Treating physicians noted erectile dysfunction as a side effect of PTSD medication.” 26004175 (2026) Denied “The Veteran claims service connection for erectile dysfunction, and as secondary to PTSD, possibly due to medication.” 24008172 (2024) | 127 | 43.3% |
Weight gain or obesity Granted “Service-connected PTSD/alcohol use disorder and left ankle disability caused obesity” 25008302 (2025) Denied “Veteran's risk factors (low testosterone, obesity, tobacco use) outweigh service factors.” A26000274 (2026) | 35 | 14.3% |
Stress Granted “The Veteran reported symptoms of erectile dysfunction and loss of libido, which he attributes to anxiety and stress from his PTSD.” A26039734 (2026) Denied “Service connection for a penile condition as secondary to high blood pressure, stress, PTSD, serious depression, anxiety, and diabetes was denied.” A25032343 (2025) | 32 | 46.9% |
Nerve involvement Granted “Private medical opinion provided detailed rationale linking ED to PTSD, neuropathy, sleep apnea, and lumbar spine condition.” A22016689 (2022) Denied “The Veteran claims service connection for erectile dysfunction (ED), contending it is secondary to his service-connected PTSD, lumbar strain with bilateral lower extremity radiculopathy, neurogenic bladder, and medications prescribed...” 24024692 (2024) | 14 | 21.4% |
Sleep disruption Granted “Service connection for erectile dysfunction is granted as secondary to PTSD with insomnia disorder.” A25010157 (2025) Denied “Service connection for erectile dysfunction as secondary to PTSD, persistent depressive disorder, insomnia disorder, and alcohol use disorder was denied due to the lack of a current diagnosis of erectile dysfunction in the record.” A25052146 (2025) | 10 | 50.0% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 13.0% of the 1,648 issues name at least one medical link; the rest only say “secondary to” the disability. One issue can name several links. Granted is the share of those issues granted (remands count as not granted). A link named in a denial was often the argument the Board rejected.
Why the Board granted or denied erectile dysfunction
Most common reasons in grants
- Current diagnosis established77
- Caused by the service-connected disability64
- Service connection established50
- Aggravated by the service-connected disability13
- Secondary to PTSD9
- VA examiner: less likely than not related to service8
- Criteria for service connection met7
- Veteran diagnosed with erectile dysfunction6
Most common reasons in denials
- VA examiner: less likely than not related to service42
- No in-service complaints, treatment or diagnosis31
- No current diagnosis26
- Preponderance of the evidence against the claim21
- Service records negative or silent17
- Current diagnosis established12
- Service connection established5
- Continuity of symptomatology since service4
Numbers are decisions that gave the reason. Reasons are short phrases extracted by AI from each decision; common wordings of the same reason are grouped. Benefit of the doubt is reported above.
Recent erectile dysfunction decisions
Granted
Veteran has current diagnosis of erectile dysfunction.; VA examiner opined erectile dysfunction is secondary to PTSD.; Examiner's opinion considered claims file and medical principles.; Negative nexus opinion for TERAs does not preclude secondary service connection for PTSD.
Veteran competent and credible to report symptoms; VA examiner's opinion unclear regarding nexus to PTSD; Board found but/for relationship met for secondary SC
Private medical opinion linked erectile dysfunction to PTSD and treatment.; Nexus established that it is at least as likely as not a result of PTSD.; Benefit of the doubt applied.
Denied
No current diagnosis of ED established; Veteran confirmed no formal diagnosis at hearing; Private opinion assumed diagnosis without confirmation
Evidence persuasively weighs against finding of erectile dysfunction with onset during service or relation to PTSD.; Criteria for service connection for erectile dysfunction not met.
No current diagnosis of erectile dysfunction reflected in VA or service treatment records.; VA examiner did not diagnose erectile dysfunction.; Veteran is competent to describe symptoms but not diagnose complex conditions.
What VA needs to grant a secondary claim
Secondary service connection means VA disability benefits for a condition caused or made worse by a disability that is already service connected (38 CFR 3.310). The claim needs three things:
- A current diagnosis of erectile dysfunction.
- PTSD is already service connected.
- Medical evidence linking them (a nexus opinion): erectile dysfunction was caused by PTSD (3.310(a)), or was made worse beyond its natural progress by it (aggravation, 3.310(b)).
VA's procedures for these claims are in M21-1 V.ii.2.D. When the evidence for and against is about even, VA must decide in the veteran's favor (38 CFR 3.102).
Other conditions secondary to PTSD
- Major depressive disorder secondary to PTSD305 decisions · 62.0% granted
- Migraine secondary to PTSD1,732 decisions · 37.1% granted
- Sleep apnea secondary to PTSD11,479 decisions · 31.7% granted
- Gastroesophageal reflux disease (GERD) secondary to PTSD1,237 decisions · 25.3% granted
- Irritable colon syndrome (spastic colitis mucous colitis) secondary to PTSD380 decisions · 24.2% granted
- Diabetes mellitus secondary to PTSD551 decisions · 20.3% granted
- Hypertension secondary to PTSD3,194 decisions · 16.5% granted
Erectile dysfunction secondary to other conditions
- Erectile dysfunction secondary to hypertension648 decisions · 36.7% granted
- Erectile dysfunction secondary to a psychiatric disorder1,061 decisions · 31.9% granted
- Erectile dysfunction secondary to a back condition619 decisions · 27.6% granted
- Erectile dysfunction secondary to diabetes1,811 decisions · 25.8% granted
See all conditions secondary to PTSD.
Rules that apply to secondary erectile dysfunction claims
- 38 CFR 3.310
Secondary service connection and aggravation
Read it in VA Law Explorer - M21-1 V.ii.2.D
Secondary service connection and aggravation of non-service-connected disabilities
Read it in VA Law Explorer - 38 CFR 3.102
Reasonable doubt (benefit of the doubt)
Read it in VA Law Explorer
Research your erectile dysfunction case
Narrow by year, judge, evidence or secondary condition, read the decisions, and export a research memo.
How these numbers are calculated
- Counts decisions in which the Board decided a erectile dysfunction issue claimed as secondary to PTSD, by the outcome of that issue.
- The primary disability is read from the decision text ("secondary to …") and grouped by name, so spellings such as "PTSD" and "posttraumatic stress disorder" count together.
- Secondary claims also include aggravation of a non-service-connected condition by a service-connected one (38 CFR 3.310(b)).
- The data comes from CaseScribe's AI extraction of public BVA decisions (2017–2026) and can contain errors. It is updated automatically as new decisions are added.