ERECTILE DYSFUNCTION

Summary

The veteran, who served in the U.S. Army from October 1986 to April 1993, appeals the denial of service connection for erectile dysfunction and the remand of claims for bilateral hip osteoarthritis and an increased rating for lumbosacral strain. The Board denied service connection for erectile dysfunction, finding that no service-connected mental health condition existed to serve as a predicate for the secondary claim. The Board noted that if service connection for a psychiatric disorder is granted on remand, the veteran may pursue a new claim for erectile dysfunction. The Board remanded the claims for bilateral hip osteoarthritis, finding the December 2020 VA examination inadequate because it did not address aggravation and failed to comply with the Spicer standard for secondary service connection. The Board also remanded the claim for an increased rating for lumbosacral strain, deeming the December 2020 VA examination inadequate for failing to discount the beneficial effects of the veteran's pain medications, as required by Ingram v. Collins. New examinations are ordered for the hip and lumbosacral strain claims.

Rationale

No service-connected mental health condition established; Secondary claim fails as a matter of law without predicate disability; No factual or legal basis for secondary service connection

Full Decision Text

Citation Nr: A26027205
Decision Date: 03/25/26	Archive Date: 03/25/26

DOCKET NO. 210203-138581
DATE: March 25, 2026

ORDER

Entitlement to service connection for erectile dysfunction is denied.

REMANDED

Entitlement to service connection for left hip osteoarthritis, secondary to service-connected bilateral knee arthritis, is remanded.

Entitlement to service connection for right hip osteoarthritis, secondary to service-connected bilateral knee arthritis is remanded.

Entitlement to an initial increased disability rating in excess of 10 percent for service-connected lumbosacral strain is remanded.

FINDING OF FACT

The Veteran's erectile dysfunction is not caused or aggravated by a service-connected disability.

CONCLUSION OF LAW

The criteria for entitlement to service connection for erectile dysfunction are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the United States Army from October 1986 to April 1993. 

These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2021 Rating Decision issued by a Department of Veterans Affairs (VA) regional office, which is the agency of original jurisdiction (AOJ). 

In the February 2021 Notice of Disagreement, the Veteran elected the Hearing docket. A Board hearing was held on November 15, 2024. A transcript of the hearing is associated with the claims folder.  Therefore, the Board may only consider the evidence of record at the time of the January 2021 AOJ decision on appeal, as well as any evidence submitted by the Veteran or their representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. Evidence of record specifically identified by the Veteran or his representative in his November 15, 2024, hearing is likewise considered "submitted" during the evidence submission window.  See Cash v. Collins, 2026 U.S. App. LEXIS 3596, 2026 LX 94368, __ F.4th __, 2026 WL 302984, (Fed. Cir., Feb. 5, 2026). 

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

The Board notes that the undersigned VLJ did not conduct the November 2024 hearing.? Unlike the legacy appeal system, under the AMA the VLJ who conducts a Board hearing is not required to decide an AMA appeal.? Frantzis v. McDonough, 35?Vet. App.?354 (2022).???

1. Entitlement to service connection for erectile dysfunction secondary to a mental health condition.

The Veteran seeks service connection for his erectile dysfunction secondary to his mental health condition. See September 2020 Supplemental Claim Application. 

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected disability was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability.
 show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected disability was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id at 1364. 

The Veteran is competent to diagnose erectile dysfunction as it is a simple diagnosis capable of lay observation. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). However, the erectile dysfunction must be caused or aggravated by the primary service-connected disability to be awarded secondary service connection. Service connection has not been established for any mental health and/or psychiatric disorder.  That disability cannot serve as a predicate service-connected disability upon which to base the Veteran's claims for service connection for erectile dysfunction, and any claim based on secondary service connection therefore fail as a matter of law. See 38 C.F.R. § 3.310; Sabonis v. Brown, 6 Vet. App. 426 (1994).  There is simply no factual or legal basis upon which to award service connection for a disability that is claimed as secondary to a disability that is not service connected. See 38 C.F.R. § 3.310, Sabonis, supra. Therefore, the claim for service connection for erectile dysfunction must be denied.

The Board understands that an appeal seeking service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder and depression, was remanded in February 2026.  In that regard, if service connection for an acquired psychiatric disorder is ultimately granted, the Veteran is reminded that he may still pursue a claim for service connection for erectile dysfunction by filing a Supplemental Claim (VA Form 20-0995).  

REASONS FOR REMAND

1. Entitlement to service connection for left hip osteoarthritis.

2. Entitlement to service connection for right hip osteoarthritis.

The Veteran seeks service connection for his bilateral hip osteoarthritis. See September 2020 VA21-526EZ. 

The Veteran was provided a VA examination and opinion in December 2020. The examiner found a nexus had not been established. The rationale provided was that without significantly altered gait that causes pelvic tilt a relation could not be concluded between the two conditions. See December 2020 Medical Opinion. 

The Board finds the examination inadequate for rating purposes. A medical opinion is inadequate when it does not consider all raised theories of entitlement. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). A secondary opinion which addresses a causal relationship, but which does not address the question of aggravation, is inadequate. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Furthermore, the U.S. Court of Appeals for the Federal Circuit has recently clarified the applicable standard for secondary service connection and a new adequate opinion must be obtained to comply with the standard. See Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023). The failure to obtain an adequate examination and opinion with regard to the Veteran's claim constitutes a pre-decisional error in the duty to assist. 38 U.S.C. § 5103A.

On remand, another opinion should be obtained as to whether the Veteran's current bilateral hip osteoarthritis is secondary to his service-connected bilateral knee arthritis under the holding in Spicer.

3. Entitlement to an initial increased disability rating for lumbosacral strain.

The Veteran seeks entitlement to an increased initial disability rating in excess of 10 percent for his now service-connected lumbosacral strain. See February 2021 Notice of Disagreement.

The Veteran was provided with a December 2020 VA examination for his lumbosacral strain. At that time, the examiner documented the Veteran's use of pain medications for his various conditions, to include diclofenac, gabapentin, acetaminophen, and cyclobenzaprine. See December 2020 C&P Exam. 

VA is required to discount the beneficial effects of medication when the relevant rating criteria do not explicitly contemplate medication use. Ingram v. Collins, 38 Vet. App. 130, 139 (202
 seeks entitlement to an increased initial disability rating in excess of 10 percent for his now service-connected lumbosacral strain. See February 2021 Notice of Disagreement.

The Veteran was provided with a December 2020 VA examination for his lumbosacral strain. At that time, the examiner documented the Veteran's use of pain medications for his various conditions, to include diclofenac, gabapentin, acetaminophen, and cyclobenzaprine. See December 2020 C&P Exam. 

VA is required to discount the beneficial effects of medication when the relevant rating criteria do not explicitly contemplate medication use. Ingram v. Collins, 38 Vet. App. 130, 139 (2025). This includes musculoskeletal disabilities as the applicable diagnostic codes and special regulations do not explicitly contemplate medication use. Id. As such, the Board must discount the beneficial effects of medication when assigning an evaluation of a musculoskeletal disability, which includes the Veteran's lumbosacral strain. As such, the VA exam is inadequate because it does not discount the beneficial effects of the Veteran's pain medications on his disabilities.

Therefore, a remand is required for the Board obtain an adequate VA exam for the record that provides competent medical evidence for the period on appeal that comply with the recent holding in Ingram. Ingram v. Collins, No. 23-1798 (Vet. App. 2025); 38 U.S.C. § 5103A.

The Board by this remand makes no determination, expressed or implied, concerning the credibility of any statements on file.

?

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination with an adequate examiner to provide an opinion on:

(i) Whether, but for the Veteran's service-connected bilateral knee arthritis, he would not have bilateral hip osteoarthritis.

(ii) Whether the Veteran's bilateral hip osteoarthritis would be less severe and result in less functional impairment but for the Veteran's service-connected bilateral knee arthritis.

If the examiner opines that the bilateral hip osteoarthritis would result in less functional impairment but for the bilateral knee arthritis, the examiner must attempt to establish a baseline level of severity of the diagnosed bilateral hip osteoarthritis prior to aggravation by the service-connected bilateral knee arthritis. 

2. Schedule the Veteran for a VA examination for the Veteran's lumbosacral strain.

The examiner must establish what medications the Veteran is taking and establish a baseline severity level for his lumbosacral strain that discounts their alleviating effects.

If this is not feasible, the clinician must provide a detailed explanation and rationale for why this could not be accomplished. Specifically, if the clinician cannot provide an opinion without resorting to mere speculation, he or she must provide a complete explanation for why an opinion cannot be rendered. If an opinion cannot be given without resorting to speculation, the clinician should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training).

If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion.

The claims file should be made available for review, and the examination report should reflect that such review occurred.

 

 

MICHAEL A. HERMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Pulaski, Michael F.

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. 


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