What is Erectile Dysfunction and What Causes It.
Simply put, erectile dysfunction is the inability to get and keep an erection firm enough for sex. In my casual observance, an increasing number of veterans with male sex organs areseeking to service connect, and receive disability benefits for erectile dysfunction. It is becoming one of the more common disabilities for service connection. So, today, we will tackle how to make sure you are getting the highest VA Disability rating for erectile dysfunction by looking at the 3 ways the VA rates erectile dysfunction.
But when you ask the VA about it, most times, the VA dismisses it out of hand as one of those medical conditions that isn’t “real.”
They used to do this for a lot of conditions when veterans file claims for disability compensation.
For example, back for the VA was known as the Department of Veterans Affairs (i.e., pre Vietnam), there was no such thing as PTSD. Veterans with PTSD were said to have a “character defect”.
They used to do this for Sleep Apnea. I have heard many a story from many a veteran at a VA regional office that when they filed a claim to service connect sleep apnea, VA benefits were denied because the government thought veterans were scamming the federal government. Now, we know better: sleep apnea is a hurricane that is decimating the veterans’ community.
There are a lot of causes for erectile dysfunction. Sometimes it is caused by medication. A good number of anti-depressants note that erectile dysfunction is a side effect. A lot of mental health conditions – depression, anxiety, PTSD, and more – can cause erectile dysfunction. And an endless list of medical conditions can cause erectile dysfunction.
This makes sense when you think about it. The erection results from blood filling up the tissues in the penis. So anything that affects the tissue in the penis, or that affects the blood, its ability to flow easily and regularly, or anything that is in it, can cause erectile dysfunction. Here are some examples of conditions that I have seen, in veterans, to have a secondary effect of erectile dysfunction:
- Heart disease
- Metabolic syndrome
- Parkinson’s disease
- Multiple sclerosis
- Peyronie’s disease (scar tissue inside the penis)
- Alcohol and substance abuse
- Sleep disorders
- Prostate cancer
- BPH, or enlarged prostate
- Injuries in the hips, lower spine, upper parts of your legs (basically any musculoskeletal injury in or adjacent to the pelvis)
In this post, I want to talk to you about how the VA rates erectile dysfunction. We are not going to talk about how to service connect erectile dysfunction. But in the majority of cases, erectile dysfunction is a secondary condition – it is either caused by a service-connected condition or, in some cases, can aggravate a service connected condition.
How does the VA Rate Erectile Dysfunction?
The rest of this post assumes you have service connected your erectile dysfunction, and you are just trying to get the right disability rating for it. There are generally 3 ways to rate erectile dysfunction:
- SMC(k) – Special monthly compensation for the loss of use of a creative organ due to erectile dysfunction
- Schedular rating criteria for erectile dysfunction
- Extra-schedular rating for erectile dysfunction.
I will tackle each in turn.
SMC(k) is the most common VA Disability rating for erectile dysfunction.
The most common rating for erectile dysfunction comes from the Special Monthly Compensation criteria. SMC (k) specifically is awarde for loss or loss of use of a creative organ. 38 C.F.R. 3.350(a)(1).
SMC(k) is awarded for more than just erectile dysfunction – it is awarded by absence, or loss of use or one or both testicles, one or both ovaries, or other creative organ. A creative organ is a procreative or reproductive organ. In fact, you can recover SMC(k) if you have male sex organs and had an Epedidectomy, or if you have female sex organs, if you have had a fallopian tube removed).
Proving the loss, or loss of use, of a creative organ due to erectile dysfunction is a fairly straightforward proof. Most times, your medical records (or your VA medical records if you are treated at a VA medical center) will contain a pretty clear statement that your erectile dysfunction causes you loss of use of your creative organs. You should still add competent lay evidence establishing the frequency, chronicity and severity of how you lost use of your creative organ due to erectile dysfunction.
One thing to keep in mind – if you choose to get an elective surgery, like a vasectomy, you are likely not going to be able to show a loss of use of a creative organ. The operative word there is “elective.” If your medical condition required – or resulted in – a vasectomy, this could be a different story.
As of December 2018, SMC(k) adds – for a single veteran – monthly payments of $108.57.
Schedular VA disability rating for Erectile Dysfunction
Schedular ratings are used when a medical condition appears by name in the Schedule of Ratings in 38 C.F.R. Table 4.
When a medical condition does not appear by name, the condition is rated by analogy. This means that the VA or the BVA must pick a schedular rating diagnostic code that most closely approximates the symptoms of your erectile dysfunction.
Unless of course, you have obesity, and then the VA simply says its not a medical condition.
In most cases, but not all, this will be DC 7522. You can find diagnostic code at 38 C.F.R. §4.115(b).
Diagnostic Code 7522 says the following:
7522 Penis, deformity, with loss of erectile power – 20%
So, to get a 20% rating – on top of the SMC mentioned above – you have to show two things. First, you have to show loss of erectile power. This is not incredibly difficult because to have the diagnosis of erectile dysfunction you must by definition have a loss of erectile power.
Second, you have to show deformity of the penis. This is a little more challenging. It requires knowing the definition of “deformity.” The Court of Appeals for Veterans Claims (CAVC) tackled this issue in 2018. Williams v. Wilkie, 30 Vet. App. 134 (August 7, 2018). Now, to be clear, the Court did not define “penile deformity.” Instead, they remanded an appeal to the BVA to make that finding of fact in the first place.
So let’s talk about the two components of deformity.
The deformity can be internal. Anything within the penis – tissue, blood vessels, nerve endings, etc – if sufficiently damaged, can constitute an internal deformity. (Unless the VA someday decides otherwise). Severed nerves inside the penis are an example of an internal deformity.
The deformity can also be external. Anything that affects the external appearance – form or function – of the penis can be an external deformity. The deformity does not necessarily have to be the cause of the function, but there are limits to this. A deformity you were born with, or that tattoo you got on your penis in Shangri-La (I’m talking to you, Marines. Just kidding.) probably will not count as an external deformity.
To recap, to get a 20% rating for erectile dysfunction, introduce competent and credible lay and medical evidence demonstrating that you have a loss of erectile power, as well as lay and medical evidence showing that you have either an internal or external deformity of the penis.
Effect of medication on the VA disability rating for Erectile Dysfunction.
Can the VA or the BVA consider the effects of medication on erectile dysfunction when rating the condition.
There are two schools of thought.
The first school – typically the veteran – says no. The general rule is that unless the specific rating criteria for your condition allow the VA to consider the effects of medication, the VA may not do so. DC 7522 for rating erectile dysfunction does not specifically allow the VA to consider the effects of medication on your erectile dysfunction.
The second school of thought, typically the VA, says yes, the VA may consider the effects of medication on your erectile dysfunction. Their thinking is that because medication can restore erectile power that was lost, then the medication effectively removes one of the two criteria needed for a compensable rating for erectile dysfunction.
As near as I can tell, there is no binding precedent deciding this question, so if you have examples of the VA or BVA considering the effects of medication when rating your erectile dysfunction, please tell me in the comments below.
I try to read as many of the comments as I can, but I receive hundreds of them on the blog every day, and cannot get to them all. I do not post all the comments either. I only post comments that I think will have a broad impact on a lot of veterans.
Extra-Schedular VA disability rating for Erectile Dysfunction.
If you have symptoms of erectile dysfunction that are above and beyond what the schedule lists in DC 7522, then you could theoretically argue that you are entitled to a higher, extra-schedular rating, for your erectile dysfunction.
I’ve not seen a case like this yet, but that doesn’t mean it hasn’t happened. If you received an extra-schedular rating for your erectile dysfunction, I’d love to hear about it.
Let me know if you have any questions about how the VA rates service connected erectile dysfunction, either in the comments below, or by sending me a message on Facebook.