ERECTILE DYSFUNCTION

Summary

The Veteran, a veteran who served from May 1985 to November 1989, appeals the denial of service connection for erectile dysfunction as secondary to his service-connected major depressive disorder. The Veteran also contended that his erectile dysfunction onset during service after a fall and continued intermittently thereafter. The Board reviewed the evidence, including the Veteran's VA treatment records showing a history of impotence, a January 2021 VA examination diagnosing erectile dysfunction but finding an unknown etiology and attributing it to non-service-connected conditions or age, and a February 2021 private medical opinion from his doctor stating his longstanding anxiety and depression were at least as likely as not the cause of his erectile dysfunction. The Board noted the January 2021 VA examiner's indication that psychiatric disorder "could be" the cause, and found this speculative opinion supported by the private doctor's opinion, despite the private opinion lacking a detailed rationale. The Board found the evidence in approximate balance regarding the secondary connection to major depressive disorder. Applying the benefit of the doubt, the Board granted service connection for erectile dysfunction as secondary to major depressive disorder.

Rationale

Evidence in approximate balance regarding secondary connection to major depressive disorder.; VA examiner found erectile dysfunction less likely than not due to major depressive disorder, but noted it could be a cause.; Private physician opined psychiatric disorder was at least as likely as not the cause, despite lacking detailed rationale.; Board resolved doubt in Veteran's favor, granting service connection.

Full Decision Text

Citation Nr: A26040559
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 210315-147330
DATE: April 30, 2026

ORDER

Service connection for erectile dysfunction as secondary to major depressive disorder is granted.

FINDING OF FACT

Resolving reasonable doubt in the Veteran's favor, his erectile dysfunction is secondary to his service-connected major depressive disorder.

CONCLUSION OF LAW

The criteria for service connection for erectile dysfunction as secondary to major depressive disorder have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from May 1985 to November 1989.

The modernized review system, also known as the Appeals Modernization Act (AMA), applies to this appeal. See 38 C.F.R. § 3.2400(a)(1). In October 2019, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of service connection for erectile dysfunction, most recently addressed in a June 2019 rating decision. In October 2019, the agency of original jurisdiction (AOJ) issued a supplemental claim decision, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.

Although the Veteran initially requested Higher-Level Review when submitting the June 2020 VA Form 20-0996, Decision Review Request: Higher-Level, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development. In January 2021, the AOJ issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.  

In the March 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on August 28, 2024. 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 his 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. 

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.

The record does not indicate that a docketing letter was mailed to the Veteran's current representative or that the Veteran's current representative was given an opportunity to submit argument on the Veteran's behalf. Although the Board must accord the Veteran with the full right to representation in all stages of an appeal, the Board has granted the Veteran's claim. 38 C.F.R. §§ 20.5, 20.1000(a)(1). Therefore, the Board finds there is no prejudice to the Veteran as the claim for service connection for erectile dysfunction is granted in its entirety.  

Service connection for erectile dysfunction as secondary to major depressive disorder is granted. 

The Veteran contends his erectile dysfunction manifested as a result of his service-connected major depressive disorder. Alternatively, he contends his erectile dysfunction onset during service after a fall on the ship and continued intermittently thereafter. See August 2024 Board hearing transcript at 3.  

Service connection may be established on a secondary basis for a disability resulting from a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability results from the service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310; Spicer v. McDonough, 61 F.4th 
 result of his service-connected major depressive disorder. Alternatively, he contends his erectile dysfunction onset during service after a fall on the ship and continued intermittently thereafter. See August 2024 Board hearing transcript at 3.  

Service connection may be established on a secondary basis for a disability resulting from a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability results from the service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310; Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023); Allen v. Brown, 7 Vet. App. 439 (1995).

Service connection may be granted 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).

In the January 2021 rating decision on appeal, the AOJ favorably found that the Veteran is service-connected for major depressive disorder and that the Veteran has been diagnosed with erectile dysfunction. Therefore, the question for the Board is whether the Veteran's current erectile dysfunction results from his service-connected major depressive disorder.

The Veteran's VA treatment records reflect a history of impotence. See, e.g., December 2008 VA treatment record. In June 2009, the Veteran reported noticing a decrease in erections when he takes his blood pressure medicine. In December 2011, he was noted to still have erectile dysfunction. 

The Veteran underwent a VA male reproductive organ conditions examination in January 2021. The examiner diagnosed erectile dysfunction. The examiner indicated that the etiology of his erectile dysfunction was unknown but also indicated that the Veteran's erectile dysfunction is as likely as not attributable to his nonservice-connected prostate hypertrophy.  

The January 2021 VA examiner opined that the Veteran's erectile dysfunction is less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner indicated that the Veteran's erectile dysfunction could be a result of medications he takes for his major depressive disorder but also indicated that his erectile dysfunction could be related to his age, being overweight, or his other medical conditions including hypertension and benign prostatic hypertrophy. Finally, the examiner indicated that it is difficult to say without speculation what is the exact cause of his erectile dysfunction.  

In August 2024, the Veteran testified to first noticing erectile dysfunction in 1985 during service. He reported his erectile dysfunction continued intermittently during service and worsened thereafter. He indicated that he believes his seizures, migraines, and back disabilities contribute to his erectile dysfunction because of pain. The Veteran indicated that he never went to sick call for his erectile dysfunction and did not seek treatment from a medical provider until 15 to 20 years ago. 

In October 2024, the Veteran submitted an October 2022 opinion from his private doctor. The doctor opined that the Veteran's longstanding anxiety and depression are at least as likely as not the cause of his erectile dysfunction. 

After a review of the evidentiary record, the Board finds the evidence is at least in approximate balance as to whether the Veteran's erectile dysfunction is secondary to his service-connected major depressive disorder. 

Although the January 2021 VA examiner opined that the Veteran's erectile dysfunction is less likely than not due to or the result of his service-connected major depressive disorder and as likely as attributable to his nonservice-connected prostate hypertrophy, the VA opinion does not directly address the theory of aggravation. 38 C.F.R. § 3.310 (b); El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). However, the VA examiner indicated that the Veteran's psychiatric disorder "could be" the cause of his erectile dysfunction. Although that opinion was speculative in nature, the Board notes that is supported by the October 2022 private opinion that indicates the Veteran's psychiatric disorder is the cause of his erectile dysfunction.  The October 2022 medical opinion was not supported by a rationale, which diminishes its probative value as well. In short, there is medical evidence that supports a causal nexus between the Veteran's erectile dysfunction and his service-connected
 theory of aggravation. 38 C.F.R. § 3.310 (b); El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). However, the VA examiner indicated that the Veteran's psychiatric disorder "could be" the cause of his erectile dysfunction. Although that opinion was speculative in nature, the Board notes that is supported by the October 2022 private opinion that indicates the Veteran's psychiatric disorder is the cause of his erectile dysfunction.  The October 2022 medical opinion was not supported by a rationale, which diminishes its probative value as well. In short, there is medical evidence that supports a causal nexus between the Veteran's erectile dysfunction and his service-connected psychiatric disorder. Accordingly, and after resolving all  reasonable doubt in favor of the Veteran, the Board finds that service connection for erectile dysfunction is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

 

D. JOHNSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Aoughsten, 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.