How is Erectile Dysfunction defined?
Erectile dysfunction, or ED, is the inability to have or sustain an erection in sexual intercourse. Many veterans from all military branches have medical evidence of erectile dysfunction. In cases where erectile dysfunction is persistent, there may be significant impacts on psychological well-being and in the relationship with the veteran’s intimate partner.
Erectile dysfunction symptoms might include:
- Trouble getting/maintaining an erection.
- Reduced sexual desire.
- Premature ejaculation.
- Difficulty reaching climax.
- Stress and mental fatigue.
ED can signal other underlying health conditions. It may be a risk factor for coronary diseases. In some cases, ED can be diminished or reversed by treating an underlying condition. In others, ED-specific treatments can be helpful.
To the extent that there is a loss of use of an organ and a connection with a condition related to service, ED can have relevance to a disability claim. Here is the key question: Is the veteran’s erectile dysfunction shown to be related to active service or any service-connected disability? Here, we discuss this in more detail, in the context of claiming benefits from the VA.
Service Connection for Erectile Dysfunction
To prove a service connection, the veteran’s claim must link the military duty to the condition of erectile dysfunction. This means proving a “nexus” — as outlined in key cases including Pond v. West, 12 Vet. App. 341 (1999) and Shedden v. Principi, 381 F.3d 1163 (2004) — between ED and military service. For a successful service connection claim, the veteran would need all three of these:
- Current medical evidence of ED, dated near the time of the claim.
- Evidence that something occurred during the time of service to cause or aggravate the ED.
- A medical nexus connecting the current ED to the occurrence or incident during service. Note: Under federal law, service can include active duty or inactive duty for training.
When looking at the second and third of those three requirements, is there a service connection to what has caused or aggravated the ED? Questions to consider include:
- Was a complaint or treatment noted about the veteran’s genitourinary functioning during service or upon separation?
- Is the ED a side effect of medications such as anti-depressants or anxiety medication taken for service-connected PTSD?
Sexual dysfunction is a common effect of most psychiatric medications, such as Risperidone and Sertraline, as noted in expert communications considered by the Board of Veterans’ Appeals.
Secondary Service Connection for Erectile Dysfunction
A disability can constitute a VA claim if not directly connected to service if it is a secondary service connection. 38 C.F.R. § 3.309-310. Under the relevant case law, including Wallin v. West, 11 Vet. App. 509 (1998), the vet must show:
- Evidence of the current condition.
- Evidence of some service-connected disability.
- A medical nexus between those two, as found by a specialized medical expert, that the service-connected disability, in fact, relates to the current ED.
What underlying conditions could there be that you have already claimed? They might include diabetes or different metabolic syndrome. Many other conditions common in veterans, which may have a service connection, can cause ED as a secondary result. Examples are:
- PTSD, anxiety or depression, and related treatment.
- Alcohol or other substance dependencies.
- Sleep disorders.
- Musculoskeletal injury in the lower torso.
If a new condition arises from already claimed service-connected disabilities, a correctly filed secondary disability claim may be able to heighten your level of benefits. Even if you never discussed ED before in your earlier claims, a new claim may be viable for a secondary service connection. Finally, under 38 C.F.R. § 3.303, if a veteran maintains that the erectile dysfunction has spanned a period from the time of military service to the current day, there may be a claim for a “chronic” ED condition.
Compensation & Pension (C&P) Exams for Erectile Dysfunction
The VA asks vets to attend C&P exams to determine disability ratings and to validate service connections before approving claims. The VA can require a C&P test for any vet who submits a disability claim. It’s the veteran’s burden to show evidence. If the evidence comes out to 50-50 for or against, the veteran receives the benefit of the doubt.
The process is as follows:
- The VA mails an exam notice to the vet. This is the time to seek expert knowledge, to bolster the chances of a good outcome. Additionally, a specialist can complete a Disability Benefits Questionnaire to back up a disability claim.
- The exam takes place. The veteran may bring notes and witnesses. Generally, the more information given to the examiner, the better — but case-specific advice on how to offer the most helpful information can make or break a case. An experienced adviser can inform you that what seems like a minor detail is actually major.
- The examiner sends the exam report to the VA Regional Office (RO).
- The RO makes a decision in the case.
A detailed set of notes should be written once the exam wraps up. If the examiner or the RO makes any errors, the notes will be a helpful tool in explaining why.
How Does the VA Rate Erectile Dysfunction?
The Schedule for Rating Disabilities is used by the VA to rate a disability so benefits can be determined. The Schedule sets out a range up to 100% disability for the most severe loss of function. What does this mean for ED?
There are diagnostic codes for removal or deformity of a physical organ, but erectile dysfunction does not equate to deformity. In such a case, a veteran might apply for Special Monthly Compensation for the loss of use. Loss of use generally refers to a loss of function that leaves the organ no better than one that is removed and replaced with a prosthetic device.
At Hill and Ponton, We’re Here to Help
We provide general information in our online articles, but cannot publish case-specific advice. Call for an initial, complimentary evaluation if you’d like to discuss the specifics of your own situation. Whether you have a newly arising claim or believe your claim was incorrectly denied, our team at Hill and Ponton can support you and work hard for the best possible outcome under the law.