How the Board ruled on erectile dysfunction claims, 2021–2025

Erectile dysfunction (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

45.9% granted of 1,046 decided cases (margin of error 42.9–48.9%). 480 granted, 566 denied, 1,523 sent back to VA (remanded, not decided), 305 dismissed.

What convinced the Board in granted cases

• Nearly every grant here was on a secondary basis: the Board linked ED to an already service-connected condition or its treatment, such as hypertension and its medicines, PTSD or depression, prostate or bladder cancer, or a TBI. (10 of 10 decisions read; e.g. 21040968, 22020738, A24015322)
• The Board credited medical opinions linking ED to the service-connected condition, including VA examiners agreeing it was vascular from hypertension and an unrebutted private doctor tying it to prostate cancer treatment. (3 of 10 decisions read; e.g. 21040968, A24015322, 22020738)
• VA opinions lost weight when they ignored the veteran's psychiatric medication or statements, wrongly ruled out a link because ED began before the primary grant, or could not address aggravation without speculating. (2 of 10 decisions read, few decisions; e.g. A24050580, 21070537)

Common reasons in denied cases

• No medical evidence linked ED to service; the veteran's own belief about cause was not competent medical evidence. (5 of 12 decisions read; e.g. 22061004, A24061216, 21072431)
• Thorough VA and private urologist opinions found ED came from other causes, such as vascular disease, non-service-connected hypertension, age, smoking or obesity, and general studies submitted did not outweigh them. (2 of 12 decisions read, few decisions; e.g. 21041174, A21001466)
• Other denials found the underlying condition (diabetes, a psychiatric condition, prostate cancer) was not service-connected, or there was no current ED diagnosis in the records. (7 of 12 decisions read; e.g. 23015656, 23055166, A25000818)

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Erectile dysfunction secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

59.9% granted of 709 decided cases (margin of error 56.3–63.5%). 425 granted, 284 denied, 1,063 sent back to VA (remanded, not decided), 49 dismissed.

What convinced the Board in granted cases

• The Board gave high weight to private or treating doctors' opinions that laid out an accurate history, cited medical literature, considered the veteran's statements, and fully explained the link to the service-connected condition. (5 of 13 decisions read; e.g. A24031540, 24004735, A25010873)
• The Board discounted VA opinions that gave no rationale on aggravation, ignored earlier symptoms, contradicted themselves, or wrongly demanded certainty instead of an even balance of evidence. (4 of 13 decisions read; e.g. A24031540, 24004735, A25000913)
• The Board also granted when a VA examiner's own opinion or VA treatment records tied the erectile dysfunction to a service-connected condition, such as depression, PTSD, or prostate cancer treatment. (4 of 13 decisions read; e.g. A25035815, 23053592, 21033749)

Common reasons in denied cases

• The most common reason for denial was no current diagnosis of erectile dysfunction in the records; the veteran's own report was not enough to establish a diagnosis. (5 of 11 decisions read; e.g. 22030371, A21009418, A24016400)
• The Board relied on thorough VA opinions against a link and gave no weight to opinions that lacked a rationale or rested on broad, general assertions. (3 of 11 decisions read; e.g. 21059136, 21043244, A25025331)
• The Board denied when the condition claimed as the cause, often diabetes, was not service connected. (3 of 11 decisions read; e.g. A24020169, 23011727, A25025331)

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Erectile dysfunction secondary to diabetes

Secondary (caused or worsened by a service-connected condition)

58.1% granted of 117 decided cases (margin of error 49.1–66.7%). 68 granted, 49 denied, 154 sent back to VA (remanded, not decided), 10 dismissed.

What convinced the Board in granted cases

• A VA examiner gave a favorable opinion that diabetes caused or worsened the erectile dysfunction, and the Board accepted it. (6 of 18 decisions read; e.g. 24025768, 23002189, A23010608)
• Private doctors, disability questionnaires, or treatment records linked the erectile dysfunction to diabetes (for example, diabetes damaging blood vessels or nerves), and no medical opinion of equal weight said otherwise. (5 of 18 decisions read; e.g. 21055040, 21052254, A25024068)
• Negative VA opinions lost weight when they gave no real rationale, did not address aggravation, or required a level of certainty the law does not require. (3 of 18 decisions read; e.g. 21055040, 21029180, 21041378)

Common reasons in denied cases

• Diabetes itself was not service connected or not diagnosed (often because herbicide exposure was not established), so the secondary claim could not succeed. (8 of 22 decisions read; e.g. A23025527, 22020006, A24005832)
• The medical evidence tied the erectile dysfunction to another cause, such as tobacco use and high blood pressure, opiate use, bladder cancer, or onset before diabetes was diagnosed. (6 of 22 decisions read; e.g. 21075199, 21065675, 21040052)
• The only support was a private opinion with no rationale, a general article saying the condition is common in men with diabetes, or the veteran's own belief. (3 of 22 decisions read; e.g. 21039054, A23026411, 22003680)

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Erectile dysfunction secondary to depression / psychiatric disorder

Secondary (caused or worsened by a service-connected condition)

67.6% granted of 108 decided cases (margin of error 58.3–75.7%). 73 granted, 35 denied, 135 sent back to VA (remanded, not decided), 5 dismissed.

What convinced the Board in granted cases

• The Board granted when an opinion, most often from a VA examiner, explained how depression, anxiety, or their treatment causes or worsens erectile dysfunction, often citing medical literature and the veteran's history. (7 of 13 decisions read; e.g. A25035815, A25033214, 23041083)
• Negative VA opinions lost weight when they were conclusory, cited no literature, or never addressed whether psychiatric medications caused or worsened the erectile dysfunction. (3 of 13 decisions read; e.g. A24040142, 24017757, 23003828)
• Records showing sexual side effects from psychiatric medications, such as antidepressants or antipsychotics, supported grants, along with the veteran's competent report of what providers told him. (4 of 13 decisions read; e.g. 24007037, 23041083, 23036175)

Common reasons in denied cases

• The Board denied when no competent medical opinion supported a link: only the veteran's belief, a generic statement that depression can contribute, or general literature saying it can happen. (7 of 12 decisions read; e.g. 22021034, A24070056, 21004485)
• Reasoned VA opinions pointing to other causes, such as age, diabetes, high blood pressure, smoking, or prostate surgery, outweighed the claim when no contrary opinion was persuasive. (2 of 12 decisions read, few decisions; e.g. 21004485, 21023047)
• Some claims failed because the psychiatric condition was not service connected, or because no current erectile dysfunction disability was shown. (5 of 12 decisions read; e.g. 21069501, 21018523, A22001608)

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Erectile dysfunction secondary to PTSD

Secondary (caused or worsened by a service-connected condition)

63.3% granted of 98 decided cases (margin of error 53.4–72.1%). 62 granted, 36 denied, 169 sent back to VA (remanded, not decided), 10 dismissed.

What convinced the Board in granted cases

• The Board granted when a private or treating provider gave a well-reasoned opinion, based on an accurate history and the veteran's statements, often explaining with medical literature how PTSD or depression affects erections. (5 of 10 decisions read; e.g. A25011330, A25016559, 24025674)
• VA examiners' and VA doctors' own favorable findings also carried grants, including notes that PTSD or psychiatric medications contribute to erectile dysfunction. (4 of 10 decisions read; e.g. A25038315, 23048069, 21072118)
• Negative VA opinions lost weight when they contradicted themselves or ignored PTSD symptoms that existed before the formal diagnosis. (3 of 10 decisions read; e.g. 24004735, A25000913, A25016559)

Common reasons in denied cases

• Most denials had no medical opinion linking erectile dysfunction to PTSD, only the veteran's own belief or a general article, which the Board did not treat as competent medical evidence. (6 of 9 decisions read; e.g. A25029015, 21004951, A23026411)
• Some claims failed because the Board found no current erectile dysfunction diagnosis, giving more weight to a thorough VA opinion than to short, conclusory private ones. (3 of 9 decisions read; e.g. A24067640, 23051098, A24016400)
• Some denials rested on medical evidence attributing erectile dysfunction to other causes, such as high blood pressure, its medications, or age. (2 of 9 decisions read, few decisions; e.g. 21026901, 21058050)

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Erectile dysfunction secondary to prostate cancer

Secondary (caused or worsened by a service-connected condition)

68.2% granted of 88 decided cases (margin of error 57.9–77.0%). 60 granted, 28 denied, 76 sent back to VA (remanded, not decided), 7 dismissed.

What convinced the Board in granted cases

• The Board granted when a private or treating provider's opinion linked the erectile dysfunction to prostate cancer or its treatment, and gave a negative VA opinion no weight when it was inadequate or ignored aggravation. (4 of 12 decisions read; e.g. 22017780, 21073876, 24015876)
• Many grants followed once the Board found herbicide exposure and service-connected the prostate cancer itself; the erectile dysfunction was then granted as secondary to it. (6 of 12 decisions read; e.g. A24021795, A24017140, 23000202)
• The Board resolved doubt for the veteran when the evidence was evenly balanced, including when the effects of prostate cancer could not be separated from a non-service-connected cause. (2 of 12 decisions read, few decisions; e.g. 22060666, 23054209)

Common reasons in denied cases

• Most denials happened because the prostate cancer itself was not service-connected, often because herbicide exposure was not shown, so there was nothing to grant the erectile dysfunction secondary to. (8 of 14 decisions read; e.g. 22031690, 22011020, 22030645)
• Some claims failed because there was no current medical diagnosis of erectile dysfunction during the appeal. (3 of 14 decisions read; e.g. A21009621, A23010272, A21003881)
• A VA opinion with a rationale based on an accurate history, finding age or medication the more likely cause, was given high weight against the claim. (2 of 14 decisions read, few decisions; e.g. 21005576, 23004687)

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Erectile dysfunction secondary to hypertension

Secondary (caused or worsened by a service-connected condition)

60% granted of 45 decided cases (margin of error 45.5–73.0%). 27 granted, 18 denied, 63 sent back to VA (remanded, not decided), 2 dismissed.

What convinced the Board in granted cases

• Most grants came from a favorable VA examiner opinion that tied the ED to hypertension or its medications, sometimes noting from medical literature that ED is common with hypertension. (7 of 13 decisions read; e.g. A24046332, 21020075, A24026856)
• Private physician opinions also won when they gave a full rationale with medical literature and the veteran's history. (4 of 13 decisions read; e.g. 24009945, A23001751, A21012275)
• A negative VA opinion lost weight when it ignored the veteran's credible reports of earlier ED symptoms or failed to address worsening. (2 of 13 decisions read, few decisions; e.g. A24026856, A24003968)

Common reasons in denied cases

• The Board denied when no medical opinion supported the link and the only evidence was the veteran's own belief, which is not competent medical evidence. (4 of 14 decisions read; e.g. A21010950, 21071518, A24040537)
• In several denials the hypertension itself was not service connected, so ED could not be granted as secondary to it. (5 of 14 decisions read; e.g. A23011162, 21027229, 22040592)
• VA opinions against the claim, citing timing, aging, or a long gap after service, were found probative. (3 of 14 decisions read; e.g. 21043244, A25035454, 23046135)

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Erectile dysfunction secondary to low back (lumbar spine)

Secondary (caused or worsened by a service-connected condition)

56.1% granted of 41 decided cases (margin of error 41.0–70.1%). 23 granted, 18 denied, 62 sent back to VA (remanded, not decided), 2 dismissed.

What convinced the Board in granted cases

• The Board granted when a private opinion explained how the back condition leads to erectile dysfunction, such as compressed lumbar nerve roots, chronic pain, or back pain medication, often with supporting studies. (6 of 11 decisions read; e.g. 22055667, A24018853, 21000143)
• VA opinions against the claim lost weight when they relied only on a lack of treatment records, ignored the record, answered too narrow a question, or blamed diabetes when the symptoms began years before it. (4 of 11 decisions read; e.g. A24065131, 21005345, 21000143)
• The Board also granted on a VA examiner's own favorable opinion that reviewed the medical and lay evidence and literature, or that named the back condition as one contributing cause. (2 of 11 decisions read, few decisions; e.g. A24011883, A24060472)

Common reasons in denied cases

• The Board denied when no medical opinion linked the erectile dysfunction to the back condition and only the veteran or spouse believed it was related, which is not competent medical evidence. (4 of 12 decisions read; e.g. 21016823, 21041044, 22003177)
• The Board denied when a thorough VA opinion, based on the record and literature, pointed to other causes such as age and went unrebutted. (4 of 12 decisions read; e.g. A24002099, 21041044, 21023047)
• The Board denied when the record showed no current diagnosis of erectile dysfunction during the appeal. (4 of 12 decisions read; e.g. A21009418, A23015454, A25003120)

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Erectile dysfunction secondary to heart disease

Secondary (caused or worsened by a service-connected condition)

Small sample: 15 decided cases, too few for a reliable percentage. 8 granted, 7 denied, 24 sent back to VA (remanded, not decided), 0 dismissed.

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