ERECTILE DYSFUNCTION

Summary

The veteran, who served in the U.S. Navy from November 1987 to July 2010, appealed the denial of a compensable rating for erectile dysfunction (ED), the dismissal of an increased rating for coronary artery disease (CAD), and the remand of claims for secondary service connection for diabetes mellitus (DM) and an acquired mental health disorder, both allegedly secondary to ED. The Board denied the ED claim, finding the veteran did not meet the criteria for a compensable rating, as the evidence did not show both deformity and loss of erectile power. The Board dismissed the CAD claim as moot because the veteran had already been granted a 100 percent rating for CAD, the highest possible. For the secondary claims of DM and acquired mental health disorder, the Board found that the veteran had a diagnosis of DM and an acquired mental health condition, was service-connected for ED, and had an indication that ED could be a cause. However, the Board determined there was insufficient competent medical evidence to decide these claims and that the RO committed a duty-to-assist error by failing to obtain a VA medical opinion. Therefore, these claims were remanded for a VA examination to determine if ED was a "but-for cause" of the DM or acquired mental health disorder.

Rationale

No evidence of penile deformity; No evidence of loss of erectile power with deformity; Veteran's lay statements did not establish criteria for compensable rating

Full Decision Text

Citation Nr: A26039530
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 250803-572978
DATE: April 28, 2026

ISSUES

Entitlement to a compensable rating for erectile dysfunction (ED).

Entitlement to an increased rating for service-connected coronary artery disease (CAD).

Entitlement to service connection of diabetes mellitus (DM), as secondary to service-connected ED.

Entitlement to service connection for an acquired mental health disorder, as secondary to service-connected ED.

ORDERS

Entitlement to a compensable rating for ED is DENIED.

Entitlement to an increased rating for service-connected CAD is DISMISSED.

REMAND ORDERS

Entitlement to service connection of DM, as secondary to service-connected ED is REMANDED.

Entitlement to service connection of an acquired mental health disorder, as secondary to service-connected ED is REMANDED.

FINDINGS OF FACT

1. The evidence of record does not establish the Veteran's service-connected ED manifested with loss of erectile power with deformity of the penis.

2. The Veteran's CAD is service connected at a 100 percent rating throughout the appeal period.

CONCLUSIONS OF LAW

1. The criteria for a compensable rating for ED have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.115B, Diagnostic Code (DC) 7522.

2. The assigned 100 percent rating for the Veteran's CAD renders moot the issue on appeal.  38 U.S.C. §§ 7104, 7105(d)(3); 38 C.F.R. § 20.101.

FACTUAL AND PROCEDURAL HISTORY

The Veteran served on active duty in the United States Navy from November 1987 to July 2010.

In May 2024, the Veteran filed a disability application for entitlement to an increased rating for his service-connected for ED, along with claims of secondary service connection, with the Department of Veterans Affairs (VA).  In September 2024, the VA Regional Office (RO) issued a rating decision denying an increased rating for service-connected ED.

In August 2025, the Veteran appealed to the Board of Veterans' Appeals (Board).  The Veteran elected the Direct Review docket.  

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Although the Board has an obligation to provide adequate reasons and bases supporting this Decision, there is no requirement that every piece of evidence submitted by the Veteran or obtained on his behalf be discussed in detail.  Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim.  Gonzales v. West,?218 F.3d 1378, 1380-81?(Fed. Cir. 2000); Timberlake v. Gober,?14 Vet. App. 122, 128-130?(2000). 

Increased Rating

Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4.  

The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations.  38?U.S.C. §?1155; 38?C.F.R. §§?3.321(a), 4.1. 

Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition.  Esteban v. Brown,?6 Vet. App. 259, 262?(1994).? 

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating will be assigned.  38?C.F.R. §?4.7. 

In evaluating the severity of a particular disability, it is essential to consider its history.  38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991).  Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance.  Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  That said, higher evaluations may
 will be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating will be assigned.  38?C.F.R. §?4.7. 

In evaluating the severity of a particular disability, it is essential to consider its history.  38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991).  Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance.  Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  That said, higher evaluations may be assigned for separate periods based on the facts found during the appeal period.  Fenderson v. West, 12 Vet. App. 119, 126 (1999).  This practice is known as staged ratings.  Id. 

VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits.  38 U.S.C. § 1154(a).  Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall give the benefit of the doubt to the claimant.  38?U.S.C. §?5107(b); 38?C.F.R. §?4.3. 

In accordance with sections 4.1 and 4.2 of Title 38 of the Code of Federal Regulations and Schafrath v. Derwinski, 1?Vet. App.?589 (1991), the Board has reviewed all evidence of record pertaining to the history of the Veteran's service-connected disability. 

1. ED

The Veteran contends his service-connected ED is more severe than is reflected by the currently assigned noncompensable rating.  See August 2025, VA Form 10182.  

The Veteran was granted service connection for ED and assigned a noncompensable rating under DC 7522.  The Veteran was also granted special monthly compensation for loss of use of a creative organ.  The effective date for both grants was August 2010.

The old rating schedule did not provide a DC for rating ED (as the term applies in the instant case, i.e., the inability to maintain an erection).  However, a compensable evaluation was available under DC 7522, which provides for a 20 percent rating when both deformity and loss of erectile power are present.  Having only one or the other is insufficient for a 20 percent rating.  VA has not expressly defined this term.  The Board notes that "deformity" is a "distortion of any part or general disfigurement of the body."  Williams v. Wilkie, 30 Vet. App. 134, 138 (2019); Dorland's Illustrated Medical Dictionary 478 (32d ed. 2012).   

DC 7522 was changed and the effective date was November 14, 2021.  86 Fed. Reg. 54,081 (2022).  The change was not favorable or liberalizing.  If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question.  38 U.S.C. § 5110(g).  If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change.  38 U.S.C. § 5110.  Therefore, the Board will consider the Veteran's claim under the old criteria prior to November 2021.

The Veteran was afforded a VA examination in June 2024.  The examiner found the Veteran had a diagnosis of ED.  The examiner did not examine the Veteran's penis, testes, epididymis, or prostate, per the Veteran's request.

The examiner found the Veteran had not had an orchiectomy, did not have renal or voiding dysfunction, did not have retrograde ejaculation, and did not have a history of chronic prostatitis, urethritis, epididymitis, orchitis, or urinary tract infections.  The examiner did not find the Veteran's
 U.S.C. § 5110.  Therefore, the Board will consider the Veteran's claim under the old criteria prior to November 2021.

The Veteran was afforded a VA examination in June 2024.  The examiner found the Veteran had a diagnosis of ED.  The examiner did not examine the Veteran's penis, testes, epididymis, or prostate, per the Veteran's request.

The examiner found the Veteran had not had an orchiectomy, did not have renal or voiding dysfunction, did not have retrograde ejaculation, and did not have a history of chronic prostatitis, urethritis, epididymitis, orchitis, or urinary tract infections.  The examiner did not find the Veteran's ED caused a functional impact in his ability to perform any occupational task.

The Veteran is competent to report lay observable symptoms.  Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  However, the evidence does not show that he has the medical training or credentials to determine the current nature, extent, and/or severity of his ED and how they relate to the criteria for a compensable rating.  Additionally, the Veteran has not made any lay statements of a penile deformity.

The Veteran's medical treatment records were reviewed.  However, the medical treatment records do not show that the Veteran experiences both deformity and loss of erectile power, as required for a compensable rating.

The Board has considered whether an initial compensable rating is warranted under any DCs other than DC 7522.  As removal of the glans or half or more of the penis has not been shown, a compensable rating under alternative provisions is not warranted.  38 C.F.R. § 4.115b, DCs 7520, 7521.  Further, the Board has considered the application of staged ratings, however the evidence of record shows that the disability has remained consistent throughout the appeal period.

The Board finds the competent and credible evidence of record is not in approximate balance.  The Veteran has not met his burden to establish a compensable rating of his ED.  The appeal is denied.

2. CAD

In May 2024, the Veteran filed a disability application with the RO stating "Secondary to Erectile Dysfunction," "This issue has affected my life in many ways...had heart surgery."  See May 2024, VA Form 21-526.  In September 2024, the RO issued a decision on the Veteran's disability application.  Therefore, the period of review before the Board is May 2024 to September 2024.

In June 2025, the RO issued a rating decision granting service connection for CAD at 100 percent disabling, effective January 12, 2022.  This is the highest possible rating under the schedular criteria.  The Veteran has a full grant of the benefits sought for his service-connected CAD.  

There is no further relief that the Board can provide to the Veteran.  The matter is moot.  A case is moot if "an event occurs while a case is pending on appeal that makes it impossible for the court to grant any effectual relief whatever to a prevailing party."  Church of Scientology v. United States, 506 U.S. 9, 12 (1992)

There is no further relief the Board can provide to the Veteran.  Accordingly, the appeal is dismissed as moot.  Church of Scientology, 506 U.S. at 12.

REASONS FOR REMAND

Under the modernized review system, the Board must remand appeals to the RO to correct pre-decision duty-to-assist errors.  38 C.F.R. § 20.802(a).  Here, the record reveals duty-to-assist errors that occurred prior to the rating decision; therefore, a remand is required to correct the errors.  Id.  

Secondary Service Connection

To establish entitlement to service connection on a secondary basis, there must be (1) a current disability; (2) a service-connected disability; and (3) a nexus between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998), superseded by statute, 38 U.S.C. § 5107(a).    

Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation.  See 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303; Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d. 1331 (Fed. Cir. 
 the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998), superseded by statute, 38 U.S.C. § 5107(a).    

Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation.  See 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303; Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d. 1331 (Fed. Cir. 2006).  Although lay persons are competent to provide opinions on some medical issues, some medical issues fall outside the realm of common knowledge of a lay person.  Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011).  

Because the legal landscape has shifted appreciably on the question of secondary service connection, the Board believes the following explanation will be of some small service to the cause of justice and judicial economy and efficiency-the avoidance of remands.

The United States Court of Appeals for the Federal Circuit (Federal Circuit) had recent occasion to consider matters relevant to the instant case and their holding illuminates the Board's way (and the RO's on remand). 

In Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023), the Federal Circuit held that under the causation standard of section 1110 of Title 38 of the United States Code, secondary service connection is warranted where a nonservice-connected disability would have been less severe "but-for"  a service connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.  Id. at 1365.

In the same case, the Federal Circuit expressly held that section 3.310(b) of Title 38 of Code of Federal Regulations, the regulation that would otherwise control the outcome here, is unlawful because it is inconsistent with section 1110 of Title 38 of the United States Code.  Id. at 1366.

3. DM & Acquired Mental Health Disorder

The Veteran stated in his application to the RO "Secondary to Erectile Dysfunction," "this issue has affected my life in many ways, I developed Diabetes...I also experienced relationship issues with my spouse."  See June 2024, C&P Exam.

The Veteran has a diagnosis of DM.  See May 2024, CAPRI.

The Veteran is currently service-connected for depression, anxiety attacks, sleep disorder, and mild/long memory loss, for treatment purposes only.

The Veteran was not provided with a VA medical opinion to address secondary service connection.  Because the Veteran was not provided with a VA examination for service connection by the RO the Board will consider whether this pre-decisional error for which it must remand the claim to cure. 38 C.F.R. § 20.802(a).  

In McLendon?v. Nicholson,?20?Vet. App.?79?(2006), the Court of Appeals for Veterans Claims (Court) set forth the criteria considered when determining whether a VA examination is necessary to assist in establishing service connection on a direct basis.  

 

The Court held that a VA examination is warranted when there is:  

(1) competent evidence of a current disorder or persistent or recurrent symptoms of a disorder; (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 disorder, or persistent or recurrent symptoms of a disorder, may be associated with the Veteran's active military service, but that (4) insufficient competent medical evidence is on file for the VA Secretary to make a decision on the claim.? 

Id. at 81. 

The Court further explained that: 

The types of evidence that indicate that a current disability may be associated with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. 

Id. at 83 (internal quotation marks and citation omitted). The threshold for finding a link between current disability and service is low.  Id.; Locklear v. Nicholson, 20?Vet. App.?410 (2006).  

The question for the Board is whether deciding the claim without scheduling a medical examination of the Veteran constitutes a pre-decisional duty-to-assist error, for which the
The types of evidence that indicate that a current disability may be associated with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. 

Id. at 83 (internal quotation marks and citation omitted). The threshold for finding a link between current disability and service is low.  Id.; Locklear v. Nicholson, 20?Vet. App.?410 (2006).  

The question for the Board is whether deciding the claim without scheduling a medical examination of the Veteran constitutes a pre-decisional duty-to-assist error, for which the Board must remand the claim to cure.  Accordingly, the locus of the inquiry is on what was before the RO at the time of the decision on appeal and if that evidence met the low threshold to indicate an association triggering the duty to assist.   McLendon, 20 Vet. App. at 81, 83.

Applying this legal framework to the facts of the Veteran's case, the Board finds that there was competent evidence of a diagnosis of DM and an acquired mental health; the Veteran is currently service connected for ED; there is an indication the Veteran's ED could be a cause of his DM and acquired mental health condition; but there is insufficient competent medical evidence to decide the claim.? Id. 

The Board finds each of the elements has been met and concludes that the Veteran should have been afforded a VA medical opinion obtained to determine the cause of the claimed condition prior to the RO's decision made on his claim.  

The Board finds the RO committed a pre-decisional duty to assist error in failing to obtain a VA examination necessary to decide the claim.  38?U.S.C. §?5103A(d); 38?C.F.R. §§?3.159(c)(4), 20.802(a). As such, a remand is necessary to cure the error and fulfill the duty to assist. 

The matter is REMANDED for the following action:

Schedule the Veteran for a VA examination, if deemed necessary, and obtain a medical opinion from an appropriate VA clinician regarding the etiology of the Veteran's conditions.  The evidentiary record, including a copy of this remand decision, must be made available to, and reviewed by, the clinician.  The reviewing clinician must opine on:

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?

Whether it is approximately at least as likely as not that the service-connected ED, is a "but-for cause" of (caused an increase in the severity of, or an inability to treat) the Veteran's DM or acquired mental health disorder?  

A complete rationale, including citation to appropriate medical principles, for the opinion reached must be provided.

 

 

STEVEN V. ADLER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	H.E. Toole, Associate Counsel

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.