ERECTILE DYSFUNCTION

B.T. KNOPE · 2026 · Case ID: A26004449

MIXED

Summary

The veteran, who served in the United States Air Force from October 1982 to August 1992, appeals the denial of service connection for erectile dysfunction, GERD, and IBS, and the remand of claims for OSA and diabetes mellitus type II. The veteran contended that his acquired psychiatric disorder caused or worsened these conditions, including through weight gain leading to OSA and diabetes. For erectile dysfunction, the Board found no current diagnosis or functional limitation, citing a VA examiner's note of low libido and no functional limitations. For GERD and IBS, the Board acknowledged a 2025 private diagnosis but found the private clinician's opinions inadequate, citing a lack of specific rationale addressing the veteran's history and citing studies that only suggested statistical overlaps rather than direct causation. The Board also noted that the private clinician did not address the potential link between an in-service gastroenteritis and IBS. The Board found no pre-decisional duty to assist errors for these denied claims, advising the veteran to file a Supplemental Claim for any evidence not considered. For OSA and diabetes, the Board remanded the claims due to pre-decisional duty to assist errors. Specifically, the VA examiner provided opinions that the conditions were unrelated to the psychiatric disorder and did not address aggravation or the veteran's contention that the psychiatric disorder caused obesity, which in turn led to OSA and diabetes. The Board also found the private opinions for OSA and diabetes inadequate. The case was remanded for addendum opinions from a VA examiner to address causation and aggravation of OSA and diabetes by the psychiatric disorder, including the role of obesity as an intermediate step.

Rationale

No current diagnosis of erectile dysfunction established.; No functional limitation demonstrated.; VA examiner noted low libido but no functional limitations.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250707-561765

Full Decision Text

Citation Nr: A26004449
Decision Date: 01/16/26 Archive Date: 01/16/26

DOCKET NO. 250707-561765
DATE: January 16, 2026

ORDER

Entitlement to service connection for erectile dysfunction is denied.

Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied.

Entitlement to service connection for irritable bowel syndrome (IBS) is denied.

REMANDED

Entitlement to service connection for obstructive sleep apnea (OSA) is remanded.

Entitlement to service connection for diabetes mellitus type II (diabetes) is remanded.

FINDINGS OF FACT

1. The Veteran's erectile dysfunction is not etiologically related to service.

2. The Veteran's GERD is not etiologically related to service.

3. The Veteran's IBS is not etiologically related to service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

2. The criteria for entitlement to service connection for gastroesophageal reflux disease (GERD) have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

3. The criteria for entitlement to service connection for irritable bowel syndrome (IBS) have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from October 1982 to August 1992.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March May 2023 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In March 2024, the Veteran submitted a request for a Higher-Level Review (HLR) of this decision. The agency of original jurisdiction (AOJ) issued a July 2024 HLR decision.

In the July 2025 VA Form 10182, Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

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

However, because the Board is remanding the claims of entitlement to service connection for OSA and diabetes, any evidence the Board could not consider will be considered by the AOJ in the adjudication of this claim. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Generally, establishing service connection requires medical or, in
could not consider will be considered by the AOJ in the adjudication of this claim. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). Additionally, a showing of continuity of symptoms from separation to the present is a factor to be considered in assessing service connection claims.

In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id.

In 2017, VA's General Counsel issued a precedential opinion which held that obesity can be an "intermediate step" between a service-connected disability and a current disability that may be service-connected on a secondary basis. VAOPGCPREC 1-2017 (Jan. 22, 2017). For obesity to be such an "intermediate step," (1) a service-connected disability must have caused or aggravated the Veteran's obesity, (2) obesity must have been a substantial factor in causing the disability in question and (3) the disability in question must have been one that would not have occurred but for obesity caused or aggravated by the service-connected disability. Id; Marcelino v. Shulkin, 29 Vet. App. 155 (2018); Walsh v. Wilkie, 32 Vet. App. 300 (2020).

1. Entitlement to service connection for erectile dysfunction.

2. Entitlement to service connection for GERD.

3. Entitlement to service connection for IBS.

The Veteran seeks service connection for erectile dysfunction, GERD, and IBS contending his service connected acquired psychiatric disorder caused or worsened his conditions. After a review of the evidence of record, service connection is not warranted.

As an initial matter, the Veteran was diagnosed with GERD and IBS in a 2025 private assessment. As such, the first element of service connection, a current disability, has been established for GERD and IBS. However, the medical evidence of record does not reflect a diagnosis for erectile dysfunction, and therefore a current disability has not been established.

The Board recognizes that service connection is still possible in the absence of a diagnosis when certain factors are shown that limit functional ability. Saunders v. Wilkie, 886 F.3d 1356, 1364 (Fed. Cir. 2018). Here, however, the medical evidence of record does not demonstrate he has erectile dysfunction and therefore reflects no functional limitation. Specifically, the 2023 VA examiner noted that the Veteran has low libido and no functional limitations. Thus, the persuasive weight of the evidence indicates that the Veteran does not have a current diagnosis of erectile dysfunction, and, in the absence of such disabilities, no basis exists for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

Next, the service treatment records (STRs) do not reflect any complaints of, or treatment for GERD, but do include a December 1986 report of an intestinal issue involving watery diarrhea and a hospital admission for acute gastroenteritis. No follow-up was noted after his hospital discharge, and his 1992 separation physical does not note any intestinal issues.

Next, the clinical evidence of record does not reflect any complaints of, or treatment
persuasive weight of the evidence indicates that the Veteran does not have a current diagnosis of erectile dysfunction, and, in the absence of such disabilities, no basis exists for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

Next, the clinical evidence of record does not reflect any complaints of, or treatment for IBS, or GERD. Specifically, April 2023 VA treatment records reflect no side effects other than mild sedation due to his prescribed medications for his acquired psychiatric disorder.

The Veteran was afforded March 2023 VA examinations for his IBS and GERD in which he reported cycles of two days constipation, one day of diarrhea and one to two days of normal bowel movements with onset in 2022, and reflux like symptoms in which he awakens and has to vomit four to six times per year with onset in the 2010s. This VA examiner declined to diagnose IBS or GERD and did not provide opinions as the lack of diagnosed conditions precluded an etiological determination.

The Veteran submitted February 2025 a private examination and opinions in an authorized evidentiary window in which he reported symptoms of alterations to his bowel movement habits, specifically that he experiences constipation alternating with diarrhea and has abdominal pain and that he was treated for 14 days with a proton pump inhibitor for 14 days with positive response. The clinician diagnosed the Veteran with IBS and GERD.

The private clinician opined that it was more likely than not these conditions were caused by the Veteran's acquired psychiatric disorder. The Board finds the opinions inadequate and affords them limited probative value as the clinician supported his conclusion with medical literature that establishes the co-occurrence of the conditions, and studies that suggest that possible pathologic mechanisms for development of peptic ulcer disease and GERD due to mental health problems, that anxiety and depression may increase stomach acid production and can affect functions of the gastrointestinal tract without addressing the specific medical history of this Veteran. Furthermore, specific to GERD, while the clinician cited additional studies which noted statistical overlaps with anxiety and depression and the authors of the study suggested possible reasons, the studies did not assert that anxiety or depression directly causes GERD.

The Board also notes that the 2025 private clinician indicated that a prior intestinal infection can also be associated with IBS. However, the private clinician did not provide an opinion regarding the December 1986 in-service hospital admission for acute gastroenteritis.

The Board acknowledges that while the Veteran was afforded a March 2023 VA examination, no opinions were provided for his claimed conditions as the examiner found the Veteran did not have diagnoses for erectile dysfunction, IBS, and GERD and no functional limitation was shown for his claimed conditions. The Board must remand AMA appeals to the RO to correct pre-decisional duty to assist errors. See 38 C.F.R. 20.802(a). In this case, there is no pre-decisional duty to assist error evident, as no functional limitation was shown prior to the May 2023 rating decision, and his GERD and IBS conditions were not diagnosed until February 2025. Without a pre-decisional duty to assist error, the Board may not remand this appeal for further development. Instructions for filing a Supplemental Claim have been provided with this decision.

The Board acknowledges the Veteran's own firmly held beliefs that he has erectile dysfunction and his IBS, and GERD are caused by active service, to include as secondary to his acquired psychiatric disorder. While lay evidence may be competent on a variety of matters concerning the nature and cause of some disabilities, the diagnosis of erectile dysfunction and the etiology of IBS and GERD are medical determinations and generally must be established by medical findings and opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007. In the present case, the Veteran is a lay person without appropriate medical training and expertise, and thus, is not competent to make a diagnosis or an etiological conclusion regarding the cause of his disabilities.

As such, the Board finds that service connection is not warranted for erectile dysfunction, IBS, or GERD.

REASONS FOR REMAND

1. Entitlement to service connection for obstructive sleep apnea.

2. Entitlement to service connection for diabetes mellitus type II.

The Veteran seeks service
medical determinations and generally must be established by medical findings and opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007. In the present case, the Veteran is a lay person without appropriate medical training and expertise, and thus, is not competent to make a diagnosis or an etiological conclusion regarding the cause of his disabilities.

As such, the Board finds that service connection is not warranted for erectile dysfunction, IBS, or GERD.

REASONS FOR REMAND

1. Entitlement to service connection for obstructive sleep apnea.

2. Entitlement to service connection for diabetes mellitus type II.

The Veteran seeks service connection for obstructive sleep apnea (OSA) and diabetes mellitus type II (diabetes) contending his service connected acquired psychiatric disorder caused or worsened his conditions, including by causing him to gain weight which led to his OSA and diabetes.

The Board finds a remand is necessary to correct pre-decisional duty to assist errors related to the claims.

In this case, the Veteran has asserted that his OSA and diabetes were secondary service to his acquired psychiatric disorder to include due to weight gain. While the RO requested secondary service opinions for the two conditions. While he was afforded May 2023 VA examinations for his OSA and diabetes and the examiner provided secondary opinions and noted that both conditions are unrelated to an acquired psychiatric disorder. However, the examiner did not address aggravation nor address the Veteran's contention that his acquired psychiatric disorder caused his obesity, which led to his OSA and diabetes.

The Board notes that the Veteran submitted February 2025 private opinions for OSA and diabetes during the authorized evidentiary window. Unfortunately, the opinions inadequate as the clinician cited literature that makes a statistical association between depression, weight gain, and the development of diabetes and OSA, failed to address the Veteran's specific medical history, and did not provide a rationale for the conclusion.

The matters are REMANDED for the following action:

Forward the claims file to a VA examiner for addendum opinions. A new examination is not required unless so deemed by the examiner. The examiner should provide opinions as to:

(a) Whether it is at least as likely as not (whether there is a 50 percent or better probability) that the Veteran's obstructive sleep apnea and diabetes mellitus was caused or worsened by his service-connected acquired psychiatric disorder, to include major depressive disorder and probable dysthymia.

(b) Whether it is at least as likely as not (whether there is a 50 percent or better probability) that the Veteran's service-connected acquired psychiatric disorder, to include major depressive disorder and probable dysthymia, caused or worsened his obesity.

(c) Whether it is at least as likely as not (whether there is a 50 percent or better probability) that the Veteran's service-connected acquired psychiatric disorder, to include major depressive disorder and probable dysthymia, caused or worsened his obesity and, if so, whether such obesity is a factor in the Veteran's sleep apnea or his diabetes.

Separate opinions for causation and aggravation are requested. A complete rationale for each opinion should be provided.

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.

B.T. KNOPE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K. Miller, Associate Counsel

Analyze in VA Law Explorer