ERECTILE DYSFUNCTION

RAY BARTO SLABBEKORN, JR. · 2026 · Case ID: A26031965

MIXED

Summary

The Veteran, an Army Veteran who served from February 1991 to May 1991 and July 1993 to June 2011, including service in Operation Desert Shield/Desert Storm, appeals the denial of service connection for bruxism and the original denial of service connection for erectile dysfunction. The Veteran also sought special monthly compensation (SMC) for loss of use of a creative organ. The Board granted service connection for erectile dysfunction on a secondary basis to his service-connected hypertension. The Veteran testified that his erectile dysfunction began in service after taking hypertension medication, and a May 2016 treatment record indicated that treating hypertension might benefit his erectile dysfunction. The Board found the evidence in approximate balance, affording the Veteran the benefit of the doubt, and granted service connection for erectile dysfunction. Consequently, SMC for loss of use of a creative organ was also granted. For bruxism, the Veteran submitted service treatment records showing bruxism and treatment with a mouthguard, but the Board found no current clinical diagnosis and that the condition did not cause functional impairment of earning capacity. The Board also considered and rejected presumptive service connection under the PACT Act for bruxism, as it is not a condition presumed to result from burn pit exposure. Service connection for bruxism was denied.

Rationale

Current diagnosis of erectile dysfunction established by treatment records and prescription of Sildenafil.; Veteran is service-connected for hypertension.; Evidence regarding causation/aggravation by hypertension was in approximate balance, leading to benefit of the doubt grant.

Service Branch

ARMY

Special Benefit

SMC

Docket No.

210203-138497

Full Decision Text

Citation Nr: A26031965
Decision Date: 04/07/26 Archive Date: 04/07/26

DOCKET NO. 210203-138497
DATE: April 7, 2026

ORDER

Entitlement to service connection for erectile dysfunction is granted.

Entitlement to special monthly compensation based on loss of use of a creative organ is granted.

Entitlement to service connection for bruxism is denied.

FINDINGS OF FACT

1. The Veteran's service-connected hypertension has caused or aggravated his erectile dysfunction.

2. The Veteran's erectile dysfunction results in the loss of use of a creative organ.

3. The Veteran's grinding of the teeth is not a disability representing functional impairment of earning capacity at any time during or approximate to the pendency of the claim.

CONCLUSIONS OF LAW

1. The criteria for service connection for erectile dysfunction as secondary to service-connected hypertension have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for Special Monthly Compensation based on loss of use of a creative organ have been met. 38 U.S.C. §§ 1114(k), 5107; 38 C.F.R. §§ 3.102, 3.350.

3. The criteria for entitlement to service connection for bruxism have not been met. 38 U.S.C. §§ 1110, 1131, 1712; 38 C.F.R. §§ 3.303, 3.310, 3.381, 4.150, 17.161.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from February 1991 to May 1991 and from July 1993 to June 2011. The Veteran received the Ranger Tab and Special Forces Tab, among other decorations, medals, badges, citations and campaign ribbons.

In December 2014, the Veteran filed a claim for erectile dysfunction and bruxism. A Department of Veterans Affairs (VA) Regional Office (RO) originally denied the Veteran's claims in an October 2015 rating decision (November 2015 decision notice). The Veteran submitted a Notice of Disagreement. In a February 4, 2020 Statement of the Case, the RO denied service connection for erectile dysfunction due to no diagnosis, no evidence of the disability in the service records, and no link between erectile dysfunction and hypertension. The RO denied service connection for bruxism due to no diagnosis. After a February 2020 Statement of the Case, the Veteran opted into the modernized appeals system (AMA) on February 1, 2021. See February 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement).

In the February 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. As an appeal in which the appellant requested, on the Notice of Disagreement, a Board hearing, the Board's decision is based on a review of the evidence of record at the time of the decision on the issues on appeal, evidence submitted by the appellant or his representative at the hearing, to include testimony provided at the hearing, and evidence submitted by the appellant or his representative within 90 days following the hearing. 38 C.F.R. § 20.302(a).

The appellant testified at a hearing before the undersigned Veterans Law Judge in June 2025. This decision reflects the Board's consideration of the testimony, evidence, and information presented at the hearing, and a transcript of the hearing is in the Veteran's claims file.

There is evidence in the Veteran's claims file that arrived there after the decision on appeal, which means the Board may not consider it in deciding this appeal. If the Veteran would like VA to consider any evidence that was added to the claims file 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Factual history

December 1996, March 2007, and August 2008 service treatment records showed that the Veteran had bruxism. July 2010 and April 2011 service treatment records indicated that the Veteran received a bruxism guard. June 2011 service treatment records indicated that all the Veteran's
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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Factual history

May 2016 treatment records indicated that a clinician discussed with the Veteran the benefits of treating diseases like hypertension which the clinician stated might benefit the Veteran with his erectile dysfunction symptoms. The Veteran was prescribed Sildenafil.

In June 2025, the Veteran testified that his erectile dysfunction began in the middle of service. The Veteran testified that he believed it was after he received hypertension medication. The Veteran testified that during service he took Viagra, but it caused his blood pressure to go haywire. He turned blue, he testified. The Veteran testified that he had not had an erection for 20 years (during which time he had been taking hypertension medication).

In June 2025, the Veteran testified that he had bruxism in service. The Veteran testified that in 2010 or 2011 he had work on his teeth before he retired. The Veteran testified that his teeth were capped. However, the caps were only good for a couple of years and have to be replaced, the Veteran testified. The Veteran testified that his teeth problems were due to stress. The Veteran testified that he still grinded his teeth on occasion and woke up with a stiff jaw.

Law

VA grants service connection for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 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).

The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must at least show the appellant has the disability for which benefits are being claimed, else, there can be no valid claim because, for all intents and purposes, there is no present disability to in turn relate or attribute to his military service. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). A current disability means a disability shown by competent and credible (i.e., probative) evidence to exist. Chelte v. Brown, 10 Vet. App. 268 (1997). Pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability if it reaches the level of a functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018).

Service connection may also be granted on a secondary basis for a disability that is due to or aggravated by a service-connected disease or injury. Establishing service connection on a secondary basis requires sufficient evidence to show that (1) a current disability exists and (2) the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead holding "but for" causation or aggravation is enough to show entitlement to secondary service connection).

Under current VA regulations, compensation is only available for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla.
was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead holding "but for" causation or aggravation is enough to show entitlement to secondary service connection).

Under current VA regulations, compensation is only available for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. 38 C.F.R. § 4.150. Compensation is available for loss of teeth only if the loss of the tooth is due to loss of the substance of the body of the maxilla or mandible.

The Veterans Benefits Administration (VBA) Procedures Manual (M21-1) provides guidance for dental and oral conditions in M21-1, Part V, Subpart iii, Chapter 14 - Dental and Oral Conditions (hereinafter "V.iii.14"). See https://vaww.vrm.km.va.gov/system/templates/selfservice/va_kanew/help/agent/locale/en-US/portal/554400000001034/content/554400000180509/M21-1-Part-V-Subpart-iii-Chapter-14-Dental-and-Oral-Conditions?query=bruxism. V.iii.14 contains favorable guidance for the Veteran that "Generally, and unless otherwise contraindicated, any dental/oral condition that may be rated under, or by appropriate analogy to, the diagnostic code (DC) criteria of 38 C.F.R. § 4.150 is potentially subject to service connection for compensation purposes. However, the following are prohibited from being deemed service-connected (SC) for compensation purposes: treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, periodontal disease, dental calculi, third molars, impacted or malposed teeth (and other similar developmental defects), and teeth extracted because of chronic periodontal disease. 38 CFR 4.150, DC 9913, does permit and provide for potential compensation-purpose SC for missing teeth; however, it also requires that such tooth loss be associated with underlying bone (maxilla/mandible) loss acquired as a result of service trauma, as discussed in M21-1, Part XIII, Subpart i, 4.C.1, or non-periodontal disease, such as osteomyelitis." The Board is required to discuss any relevant provisions contained in the M21-1 as part of its duty to provide adequate reasons and bases. See Overton v. Wilkie, 30 Vet. App. 257 (2018); see also Nat'l Org. of Veterans' Advocates, Inc. v. Sec'y of Veterans Affairs, 981 F.3d 1360 (Fed. Cir. 2020). The Board finds that bruxism is a disability for which service connection may be granted.

Service connection may be granted for a Persian Gulf Veteran with a qualifying chronic disability that became manifest to any degree at any time. 38 U.S.C. § 1117(a)(1); 38 C.F.R. § 3.317(a)(1). A qualifying chronic disability is a chronic disability that may result from an undiagnosed illness or a medically unexplained chronic multisymptom illness (MUCMI). 38 C.F.R. § 3.317(a)(2)(i).

Objective indications of a qualifying chronic disability include both signs and symptoms, in the medical sense of objective evidence perceptible to an examining physician, and other non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Non-medical indicators include evidence such as time lost from work, the veteran having sought treatment for such symptoms, and change in the veteran's appearance, physical abilities, and mental or emotional attitude. 60 Fed. Reg. 6661, 6663 (Feb. 3, 1995).

An undiagnosed illness requires that the illness, by history, physical examination, and laboratory tests, cannot be attributed to any known clinical diagnosis. 38 C.F.R. § 3.317(a)(4). There is no burden on a veteran to demonstrate that a medical professional has eliminated all possible diagnoses before the veteran can be compensated for a disability stemming from an undiagnosed illness. Joyner v. McDonald, 766 F.3d 1393, 1395 (Fed. Cir
sought treatment for such symptoms, and change in the veteran's appearance, physical abilities, and mental or emotional attitude. 60 Fed. Reg. 6661, 6663 (Feb. 3, 1995).

A Persian Gulf Veteran is defined as a Veteran who served on active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(e)(1). The Southwest Asia theater of operations refers to Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. Id. § 3.317(e)(2). The period of the Persian Gulf War is from August 2, 1990, through the present. See 38 C.F.R. § 3.2(i). Additionally, for Veterans diagnosed with an infectious disease as defined in 38 C.F.R. § 3.317(c)(2), the qualifying period of service also includes active military, naval, air, or space service in Afghanistan on or after September 19, 2001. 38 C.F.R. § 3.317(c)(3)(ii).

On August 10, 2022, the President signed the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act), which established new presumptions of exposure to toxins for certain Veterans, and service connection on a presumptive basis for certain listed diseases. Section 405 of the PACT Act reduces the threshold for establishing eligibility when considering presumptive service connection for Persian Gulf War Veterans. Presumptive conditions under 38 C.F.R. § 3.317(a) and (b) may now manifest to any degree at any time. There is no longer a requirement for a chronic disability to manifest to a degree of 10 percent or more prior to December 31, 2026. The end date is no longer applicable and will be removed in a forthcoming regulation. Additionally, the PACT expanded the definition of a Persian Gulf Veteran to include those who served in the countries of Afghanistan, Israel, Egypt, Turkey, Syria, and Jordan, along with those who served in the Southwest Asia theater of operations as defined in 38 C.F.R. § 3.317(e).

Pursuant to the PACT Act, exposure to burn pits and other toxins (BPOT) is presumed for "covered veterans," i.e., those who served in specific locations on or after specific dates. 38 U.S.C. § 1119. Any veteran who, on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Bahrain; Iraq; Kuwait; Oman; Qatar; Saudi Arabia; Somalia; the United Arab Emirates; the neutral zone between Iraq and Saudi Arabia; the Gulf of Aden; the Gulf of Oman; the Persian Gulf; the Arabian Sea; or the Red Sea will be presumed BPOT exposed, as will any Veteran who, on or after September 11, 2001, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Afghanistan; Djibouti; Egypt; Jordan; Lebanon; Syria; Yemen; or Uzbekistan. 38 U.S.C. § 1119; VBA Letter 20-22-10 at 7, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). Certain diseases will be presumed resulting from service for Veterans with in-service toxic exposure, including BPOT exposure. 38 U.S.C. § 1120.

38 U.S.C. § 1120 provides that if one of the listed diseases are diagnosed after service in a Veteran described in 38 U.S.C. § 1119(c), the disease shall be considered to have been incurred in or aggravated during active-duty service, even if there is no record of evidence of such disease during the period of active service.

VA must provide a medical
22-10 at 7, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). Certain diseases will be presumed resulting from service for Veterans with in-service toxic exposure, including BPOT exposure. 38 U.S.C. § 1120.

VA must provide a medical examination and/or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file to decide the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see 38 U.S.C. § 5103A (d)(2).

The Federal Circuit described the different evidentiary standards required under different subparagraphs of section 5103A(d)(2), which correspond to different McLendon elements. Waters v. Shinseki, 601 F.3d 1274, 1276-77 (Fed. Cir. 2010); Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010). Regarding section 5103A(d)(2), subparagraph (B), which corresponds to the third McLendon element, the Federal Circuit in Waters rejected the argument that a claimant's "own conclusory statements regarding causation were []sufficient" to meet the evidentiary standard to indicate that a disability may be associated with service. However, in Colantonio, the Federal Circuit cautioned that Waters should not be interpreted as holding that "a veteran's testimony can never be sufficient in itself to satisfy" the McLendon evidentiary standard. The Federal Circuit made clear that, "medically competent evidence is not required in every case to 'indicate' that a claimant's disability [or symptoms] 'may be associated' with the claimant's service." See also 38 U.S.C. § 5103A (d)(2)(B). In other words, the Federal Circuit's decision in Waters is not a blanket prohibition against the use of statements from a claimant to trigger VA's duty to provide an examination. See Colantonio, 606 F.3d at 1381-82. Instead, the Federal Circuit noted that the Board must evaluate those statements, including their factual basis, and determine whether they satisfy the requisite standard or whether they are too general and conclusory. Id. at 1382; Waters, 601 F.3d at 1278.

Section 1168(b) creates an exception to the requirement of providing examinations and medical opinions. The exception applies when the Secretary determines there is no indication of an association between the claimed condition and the TERA for which the Veteran submitted evidence. VA has identified six situations in which this exception applies: non-presumptive claims based on physical trauma, including blunt force trauma, trauma due to repetitive use, and penetrating trauma; mental disorders; conditions determined to have no positive association with herbicide exposure; claims for disabilities that manifested during military service or with an etiology not associated with toxic exposure; the only participation in a TERA that is established is based on an entry in an exposure tracking record system, such as ILER, that does not corroborate or correspond to an activity carried out by the Veteran during active military service that could result in potential exposure to toxic substances, chemicals, or airborne hazards; and the only participation in a TERA that is established is based on an entry in an exposure tracking record system, such as ILER, that is based on the Veteran's self-reports of exposure to toxic substances, chemicals and airborne hazards that cannot be substantiated. VBA Letter 20-24-06 at 12-14, Updated Guidance on Processing Claims Involving Public Law 117-168, PACT Act. For non-presumptive claims based on physical trauma, mental disorders, and conditions determined to have no positive association with herbicide exposure, VBA instructs claims processors to not order a disability examination based upon a TERA if the Veteran claims
potential exposure to toxic substances, chemicals, or airborne hazards; and the only participation in a TERA that is established is based on an entry in an exposure tracking record system, such as ILER, that is based on the Veteran's self-reports of exposure to toxic substances, chemicals and airborne hazards that cannot be substantiated. VBA Letter 20-24-06 at 12-14, Updated Guidance on Processing Claims Involving Public Law 117-168, PACT Act. For non-presumptive claims based on physical trauma, mental disorders, and conditions determined to have no positive association with herbicide exposure, VBA instructs claims processors to not order a disability examination based upon a TERA if the Veteran claims service connection for a non-presumptive disability unless the Veteran submits competent medical or scientific evidence of an association between their disability and the in-service TERA. Id.

"When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C. § 5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001).

1. Entitlement to service connection for erectile dysfunction, including as secondary to hypertension

The Veteran asserts that he has erectile dysfunction that resulted from hypertension medication in service, or was caused or aggravated by his service-connected hypertension. See June 2025 Hearing transcript. For the reasons identified below, the Board finds the evidence is in approximate balance regarding whether the Veteran's erectile dysfunction was caused or aggravated by his service-connected hypertension and as such service connection is granted.

The initial question is whether the Veteran has a current diagnosis. The Veteran's medical treatment records noted that the Veteran had erectile dysfunction, and he was prescribed Sildenafil as treatment. See, e.g., May 2016 Medical treatment records. In light of this evidence, the Board finds the element of a present disability is met.

Regarding the second element of secondary service connection, the Veteran is currently service connected for hypertension.

The third element of secondary service connection is a nexus between the current disability and a service-connected disability. As noted above, that nexus may be established via causation or aggravation. Here, the competent medical evidence of record is in approximate balance with other evidence of record and thus the Board finds that Veteran's erectile dysfunction was caused or aggravated by his hypertension.

Here, the most relevant evidence are the Veteran's June 2025 Hearing testimony and the May 2016 treatment records. The Veteran's testimony suggested a correlation between hypertension medication and erectile dysfunction. As noted above, the May 2016 clinician indicated that treating diseases like hypertension might benefit the Veteran with his erectile dysfunction symptoms. While the May 2016 clinician did not use the specific language of the evidentiary standard used to evaluate Veterans' benefits claims, the Board infers from the context of the medical records that the May 2016 clinician meant that the Veteran's service-connected hypertension has caused or aggravated his erectile dysfunction. As such, treating the hypertension would also alleviate the erectile dysfunction symptoms. While a medical opinion may be inadequate to decide a claim, if the opinion is merely lacking in detail, then it may be given some weight based upon the amount of information and analysis it contains. Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). The Board assigns some probative weight to the May 2016 clinician's opinion regarding the interaction between the Veteran's hypertension and his erectile dysfunction.

Accordingly, the Board finds that the evidence of secondary service connection between the Veteran's current disability and his hypertension is at least in approximate balance. The Board affords the Veteran the benefit of the doubt and finds that the Veteran's service-connected hypertension has caused or aggravated his erectile dysfunction. Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). As such, the criteria for service connection for erectile dysfunction are met.

2. Entitlement to special monthly compensation based on loss of use of creative organ is granted.

The issue of entitlement to special monthly compensation (SMC) based on loss of use of a creative organ is raised by the record. VA has a "
in approximate balance. The Board affords the Veteran the benefit of the doubt and finds that the Veteran's service-connected hypertension has caused or aggravated his erectile dysfunction. Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). As such, the criteria for service connection for erectile dysfunction are met.

2. Entitlement to special monthly compensation based on loss of use of creative organ is granted.

The issue of entitlement to special monthly compensation (SMC) based on loss of use of a creative organ is raised by the record. VA has a "well-established" duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993).

SMC is warranted where there is loss of use of a creative organ. 38 C.F.R. § 3.350. Therefore, the Board also grants entitlement to SMC based on loss of use of a creative organ as an ancillary benefit that is reasonably raised by the record in connection with the Board's award of entitlement to service connection for erectile dysfunction. See 38 U.S.C. § 1114(k); 38 C.F.R. §§ 3.155(d)(2), 3.350(a)(1).

3. Entitlement to service connection for bruxism

The Veteran is seeking service connection for bruxism. See, e.g., June 2025 Hearing Transcript. The Board finds that the Veteran's grinding of the teeth is not a disability representing functional impairment of earning capacity at any time during or approximate to the pendency of the claim. As such, service connection for bruxism is not warranted.

While there are credible complaints of bruxism and treatment with a mouthguard noted during the course of the Veteran's active service, the medical evidence does not reflect a current clinical diagnosis for the Veteran's teeth grinding. The Veteran is competent to describe symptomatology such as pain. However, he is not competent to diagnose the condition because he does not possess the requisite medical training or expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds that the Veteran does not have a current diagnosis of bruxism.

In coming to this conclusion, the Board is mindful that where pain alone results in functional impairment that affects earning capacity, even if there is no identified underlying diagnosis, it can constitute a disability. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Board finds that pain has at no time been so severe as to cause functional impairment affecting earning capacity. The evidence does not show, and the Veteran has not contended, that teeth pain affects his earning capacity. Based on the foregoing, the Board does not find that the Veteran's teeth pain rises to the level of a disability.

The Board further finds that the Veteran does not have a current compensable dental disability that has resulted from bruxism, such as impairment of the mandible, loss of a portion of the ramus, or loss of a portion of the maxilla, or a jaw disability. The Board finds that the Veteran does not have a current dental disability, and the first element of service connection has not been established. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.150; Holton v. Shinseki, 557 F.3d 1363 (Fed. Cir. 2009).

The Board has also considered whether presumptive service connection can be granted pursuant to the PACT Act. Here, the Veteran was ordered to active duty in support of operation Desert Shield/Desert Storm in February 1991. Accordingly, the Veteran is a "covered veteran" with presumed BPOT exposure under 38 U.S.C. § 1119. As such, presumptive service connection will be warranted for diseases enumerated in 38 U.S.C. § 1120. However, the Veteran's teeth grinding is not among those diseases which can be presumed due to BPOT exposure pursuant to 38 U.S.C. § 1119. Therefore, presumptive service connection due to BPOT exposure is not warranted under 38 U.S.C. § 1120.

The Veteran has not been afforded a TERA examination and opinion concerning the nature and origin of his teeth grinding. However, an examination is not warranted as the duty to assist has not been triggered.
Veteran is a "covered veteran" with presumed BPOT exposure under 38 U.S.C. § 1119. As such, presumptive service connection will be warranted for diseases enumerated in 38 U.S.C. § 1120. However, the Veteran's teeth grinding is not among those diseases which can be presumed due to BPOT exposure pursuant to 38 U.S.C. § 1119. Therefore, presumptive service connection due to BPOT exposure is not warranted under 38 U.S.C. § 1120.

The Veteran has not been afforded a TERA examination and opinion concerning the nature and origin of his teeth grinding. However, an examination is not warranted as the duty to assist has not been triggered. The Veteran's grinding of the teeth is not a disability representing functional impairment of earning capacity at any time during or approximate to the pendency of the claim.

The Board has considered whether service connection can be granted as a medically unexplained chronic multisymptom illness (MUCMI). The evidence does not otherwise show that the Veteran's signs and symptoms are attributable to a known clinical diagnosis representing functional impairment of earning capacity by history, physical examination, or laboratory testing. As the Veteran does not have objective indications of a qualifying chronic disability, service connection pursuant to 38 U.S.C. § 1117 and 38 C.F.R. § 3.317 is not warranted.

(Continued on the next page)

As there is no diagnosis, the Veteran's signs and symptoms cannot be considered a MUCMI. See 38 C.F.R. § 3.317(a)(2)(ii). They can potentially qualify as an undiagnosed illness; however, in this instance, a clinician has not identified that the illness, by history, physical examination, and laboratory tests, could not be attributed to any known clinical diagnosis. Accordingly, presumptive service connection as an undiagnosed illness is not warranted.

In reaching these conclusions, the Board has considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C. § 5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In this case, the evidence persuasively favors a finding that the Veteran's grinding of the teeth is not a disability representing functional impairment of earning capacity at any time during or approximate to the pendency of the claim. Thus, the benefit-of-the-doubt rule does not change the outcome on this issue.

RAY BARTO SLABBEKORN, JR.

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Koottappillil, Arun X.

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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