ERECTILE DYSFUNCTION

Summary

The Veteran, an Army Veteran who served from August 2013 to September 2018, including deployments to the Persian Gulf and Afghanistan, appeals the denial of service connection for erectile dysfunction. The Veteran claims this condition is secondary to his service-connected PTSD or lumbar spine disability. The Board reviewed the evidence, including two VA examinations. The June 2021 VA examiner diagnosed erectile dysfunction but opined it was less likely than not related to service, citing a lack of diagnosis in the record and noting general medical articles linking stress and depression to erectile dysfunction. The July 2024 VA examiner noted the same symptoms but found no objective evidence of neurogenic sexual dysfunction. The Board found the Veteran competent and credible in reporting his symptoms of anxiety and stress impacting his libido and causing erectile dysfunction, noting these are personally observable. The Board also found the June 2021 examiner's opinion unclear, as it noted the association between erectile dysfunction and psychological symptoms but did not fully rule out a connection to the Veteran's PTSD. Applying the "but for" standard for secondary service connection and resolving all reasonable doubt in the Veteran's favor, the Board found the necessary relationship met. Service connection for erectile dysfunction was granted.

Rationale

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

Full Decision Text

Citation Nr: A26039734
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 250805-574260
DATE: April 28, 2026

ORDER

Service connection for erectile dysfunction is granted. 

FINDING OF FACT

The Veteran's erectile dysfunction is caused by his service-connected posttraumatic stress disorder (PTSD). 

CONCLUSION OF LAW

The criteria for service connection for erectile dysfunction as secondary to service-connected PTSD are met.  38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the United States Army from August 2013 to September 2018, including service in the Persian Gulf and in Afghanistan.  The Veteran had two tours of service in the Persian Gulf and served in Afghanistan from May 2015 to February 2016 and from October 2016 to July 2017.  The Veteran's decorations include the Combat Infantryman Badge, the Afghanistan Campaign Medal with and the Air Assault Badge.

On his August 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Board's Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of notice of the March 2025 agency of original jurisdiction (AOJ) decision on appeal.  38 C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board.  38 C.F.R. §§ 20.300, 20.301, 20.801. 

The Board has combined the Veteran's two claims into one, as both the claim for service connection for erectile dysfunction and for neurogenic sexual dysfunction relate to the same diagnostic code, Diagnostic Code 7522, which pertains to erectile dysfunction.  In that respect, both claims are the same - claims for service connection for erectile dysfunction.  Because the Board is granting the appeal, it would be duplicative to keep these two issues separate, and it is more cohesive to combine them into one issue/claim as they are the same disability with simply differing causes.

The Board interprets the Veteran's statements as reflecting an intent to have this matter reviewed in an expeditious manner, which the Board finds to be an implicit waiver of the Veteran's right to change Board dockets under Williams v. McDonough, 37?Vet. App.?305 (2024).

1. Service connection for erectile dysfunction is granted. 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303.

In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability.  Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310.  Allen v. Brown, 7 Vet. App. 439 (1995); Cf. Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating 3.310(b) for the use of the phrase "proximately due to" in the context of aggravation).  Specifically, in Spicer, the Court held that 38 U.S.C. § 1110 plainly requires compensation when a service-connected disease or injury is a but-for cause of a present-day disability.

The Board notes that this broad language applies to the natural progression of a condition not caused by a service-connected injury or disease, but that nonetheless would have been less severe were it not for the service-connected disability.  Stated another way, § 1110 provides for compensation for a worsening of functionality-whether through an inability to treat or a more direct, etiological cause.  The Federal Circuit noted that nothing in the statute limits § 1110 to onset or etiological causes of a worsening in functionality.  Thus, the Court in Spicer found the phrase "proximately due to" under 3.310(b) inconsistent with § 1110 and, therefore "unlawful,"
 a but-for cause of a present-day disability.

The Board notes that this broad language applies to the natural progression of a condition not caused by a service-connected injury or disease, but that nonetheless would have been less severe were it not for the service-connected disability.  Stated another way, § 1110 provides for compensation for a worsening of functionality-whether through an inability to treat or a more direct, etiological cause.  The Federal Circuit noted that nothing in the statute limits § 1110 to onset or etiological causes of a worsening in functionality.  Thus, the Court in Spicer found the phrase "proximately due to" under 3.310(b) inconsistent with § 1110 and, therefore "unlawful," consequently, for "aggravation of non-service-connected disabilities" it is enough to show that "but for" the service-connected disability the incremental-increase in severity of a nonservice-connected disease or injury would not have occurred.  Id. 

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant.  

To deny a claim on its merits, the weight of the evidence must persuasively stand against a finding that the evidence is in "approximate balance" or "nearly equal" to the evidence that supports the claim.  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

The Board must determine the value of all evidence submitted, including lay and medical evidence.  Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).  The evaluation of evidence generally involves a 3-step inquiry.  First, the Board must determine whether the evidence comes from a "competent" source.  

The Board must then determine if the evidence is credible, or worthy of belief.  Barr v. Nicholson, 21 Vet. App. 303 (2007) (Observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible).

The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record.  The Board also notes that under certain circumstances, lay evidence may be sufficient to establish a nexus.  See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); see also Layno v. Brown, 6 Vet. App. 465, 469 (1994).  

Lay evidence may be competent with regard to a disease that has "unique and readily identifiable features" that are "capable of lay observation."  See Barr, supra.

The Veteran contends that he suffers from sexual dysfunction/erectile dysfunction by way of loss of libido and erectile dysfunction due to either his service-connected PTSD or his service-connected lumbar spine disability.  Because the Board finds that the Veteran's erectile dysfunction is likely related to his service-connected PTSD, and is granting the claim based upon that theory, it need not consider or discuss remaining theories of entitlement.

The Veteran reports that since returning from deployments in the Persian Gulf in 2017, he has suffered from psychological symptoms that interfere with his libido and causes erectile dysfunction.  

In June 2021, a VA examiner conducted physical examination of the Veteran, and diagnosed erectile dysfunction based on the Veteran's reported symptoms.  The examiner concluded, however, that the Veteran's erectile dysfunction was less likely than not related to his PTSD because, for one, there was no diagnosis of erectile dysfunction in the record, either in service or after service.  The examiner noted medical articles that point to causes of erectile dysfunction, and these causes include stress and depression.  

On July 2024 VA examination, the Veteran reported the same symptoms of erectile dysfunction and loss of libido, stating that his primary care physician referred him to a mental health provider, who referred him back to his primary care physician.  He felt that his erectile dysfunction was related to his anxiety.  The examiner found that there was no objective medical evidence that the Veteran suffered from neurogenic sexual dysfunction because this disability had not been diagnosed in the record. 

In this case, the Board first finds that the Veteran is competent and credible to report that he suffers from anxiety and stress and has noticed that these symptoms impact his libido and lead to erectile dysfunction.  The Board notes that these are very personal symptoms that are capable of lay observation.  

In addition, the June 2021 VA examiner did not rule out that the Veteran's service-connected PTSD caused or aggravated his erectile dysfunction but rather seemed to rely heavily on no diagnosis of such in the VA treatment records.  At the same time, as stated, the VA examiner noted an association between erectile dysfunction and psychological symptoms, and
 was no objective medical evidence that the Veteran suffered from neurogenic sexual dysfunction because this disability had not been diagnosed in the record. 

In this case, the Board first finds that the Veteran is competent and credible to report that he suffers from anxiety and stress and has noticed that these symptoms impact his libido and lead to erectile dysfunction.  The Board notes that these are very personal symptoms that are capable of lay observation.  

In addition, the June 2021 VA examiner did not rule out that the Veteran's service-connected PTSD caused or aggravated his erectile dysfunction but rather seemed to rely heavily on no diagnosis of such in the VA treatment records.  At the same time, as stated, the VA examiner noted an association between erectile dysfunction and psychological symptoms, and so it was unclear to the Board why the evidence did not support this connection for the Veteran.

Thus, based upon the examiner's reasoning, it is entirely plausible that the Veteran's erectile dysfunction is related to his stress and anxiety, stemming from his PTSD.  Therefore, the Board finds that the but/for relationship necessary to establish secondary service connection has been met.  

In light of the foregoing, and after resolving all reasonable doubt in the Veteran's favor, the Board finds that service connection for erectile dysfunction is warranted.

 

 

STEVEN D. REISS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. Erdheim, 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.