ERECTILE DYSFUNCTION

Summary

The Veteran, who served from June 1989 to June 2009, appeals the denial of service connection for erectile dysfunction (ED) on a secondary basis to his service-connected diabetes mellitus type II and panic disorder with insomnia. The Veteran has a current diagnosis of ED and is service-connected for diabetes and panic disorder with insomnia. The VA examiner opined that the Veteran's ED was less likely than not related to his service-connected diabetes, stating the conditions were separate entities. However, a private physician in June 2025 opined that the Veteran's ED is at least as likely as not caused by his service-connected psychiatric condition and diabetes, citing research linking metabolic dysfunction from diabetes to ED and noting the impact of stressors during service in Southwest Asia and Iraq on his psychiatric condition. The Board found the evidence evenly balanced between the conflicting opinions, as both provided thorough rationales. Applying the benefit of the doubt doctrine, service connection for erectile dysfunction secondary to diabetes mellitus type II and panic disorder with insomnia was granted.

Rationale

Current disability (ED) established.; Veteran service-connected for diabetes and panic disorder.; Conflicting medical opinions presented.; Evidence evenly balanced.; Benefit of the doubt applied.

Full Decision Text

Citation Nr: A26040886
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 210909-183516
DATE: April 30, 2026

ORDER

Entitlement to service connection for erectile dysfunction, secondary to service connected diabetes mellitus type II and panic disorder with insomnia, on a causation basis, is granted.

FINDING OF FACT

The evidence is at least evenly balanced as to whether the Veteran's erectile dysfunction was caused by service-connected diabetes mellitus type II and panic disorder with insomnia.

CONCLUSION OF LAW

The criteria for service connection for erectile dysfunction, secondary to service-connected diabetes mellitus type II and panic disorder with insomnia, on a causation basis, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 1989 to June 2009.

This case comes to the Board of Veterans' Appeals (Board) on appeal from a February 2021 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In the September 9, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On April 8, 2025, the Veteran withdrew the hearing request. Therefore, the Board may only consider the evidence of record at the time of the February 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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. 

Erectile Dysfunction  

Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in the active military, naval, air, or space service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection is also warranted for disability that is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a).

The Veteran contends that his erectile dysfunction is caused by his service-connected diabetes mellitus type II and panic disorder with insomnia. For the following reasons, service connection for erectile dysfunction on a secondary, causation basis, is warranted.

In this case, the evidence of record demonstrates a current disability. Specifically, a March 2020 VA examination report shows a diagnosis of erectile dysfunction.  The current disability requirement has thus been met.  Moreover, the Veteran is in receipt of service connection for diabetes and panic disorder with insomnia.

In a March 2020 VA examination report, the 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 diabetes mellitus type II. The examiner's rationale was that these two conditions are not medically related. The erectile dysfunction is a separate entity entirely from the service connected diabetes mellitus type II and unrelated to it. The examiner indicated the medical literature does not support a medical relationship and a nexus has not been established. 

In June 2025 the Veteran submitted a private medical opinion dated in June 2025 in support of his claim. The physician opined that the Veteran's erectile dysfunction is at least as likely as not caused by his service-connected psychiatric condition (including insomnia) and diabetes mellitus type II.  The physician's rationale was that researched shows metabolic dysfunction, such as that caused by diabetes, is strongly associated with the development erectile dysfunction. The physician noted the Veteran service in Southwest Asia and Iraq, where he was exposed to multiple stressors that likely contributed to the onset of his insomnia and subsequent psychiatric condition. The physician further noted that despite ongoing treatment and compliance
 indicated the medical literature does not support a medical relationship and a nexus has not been established. 

In June 2025 the Veteran submitted a private medical opinion dated in June 2025 in support of his claim. The physician opined that the Veteran's erectile dysfunction is at least as likely as not caused by his service-connected psychiatric condition (including insomnia) and diabetes mellitus type II.  The physician's rationale was that researched shows metabolic dysfunction, such as that caused by diabetes, is strongly associated with the development erectile dysfunction. The physician noted the Veteran service in Southwest Asia and Iraq, where he was exposed to multiple stressors that likely contributed to the onset of his insomnia and subsequent psychiatric condition. The physician further noted that despite ongoing treatment and compliance with medical recommendations, the chronic nature of his diabetes has led to the development of erectile dysfunction, significantly impacting his quality of life.

In this case, the evidence of record includes conflicting opinions as to the etiology of the Veteran's erectile dysfunction, with one opinion indicating that the ED is caused by diabetes and the other indicating that it is not. The VA examiner and private physician provided a thorough rationale for the basis of their medical opinions. Thus, the Board can find no basis upon which to assign greater probative weight to either of the medical opinions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning).

For the reasons above, the evidence is at least evenly balanced as to whether the Veteran's erectile dysfunction is caused by his service-connected diabetes mellitus type II and panic disorder with insomnia. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in the Veteran's favor, service connection for erectile dysfunction, secondary to service-connected diabetes mellitus type II and panic disorder with insomnia, on a causation basis, is warranted. 38 U.S.C. § 5107(b) 38 C.F.R. § 3.102.

 

 

Jonathan Hager

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. Walker, 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.