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Denied for ED/SMC K

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I was denied for Erectile Dysfunction and SMC K even though I am service connected for Diabetes II and take lots of medications for my Depression which can cause this condition. Does anyone have any guidance? Would a nexus letter from my Endocrinologist help in an appeal? 

3. Service connection for erectile dysfunction smc k as secondary to the service-connected disability of diabetes mellitus type II.

Service connection may be granted for a disease or injury which resulted from a service- connected disability or was aggravated thereby. The evidence does not show that erectile dysfuncation smc k is related to the service-connected condition of diabetes mellitus type II, nor is there any evidence of this disability during military service. (38 CFR 3.303, 38 CFR 3.304, 38  CFR 3.310)

Service connection may be granted for a disability which began in military service or was caused by some event or experience in service. (38 CFR 3.303)

Service connection for erectile dysfuncation smc k is denied since this condition neither occurred in nor was caused by service. (38 CFR 3.303, 38 CFR 3.304)

We did not find a link between your medical condition and military service. (38 CFR 3.303)

Your service treatment records do not contain complaints, treatment, or diagnosis for this condition.

The evidence does not show an event, disease or injury in service. (38 CFR 3.303, 38 CFR 3.304)

The VA medical opinion found no link between your diagnosed medical condition and military service. The examiner opined that the vet has not undergone a sufficient medical work up to explore and explain the underlying etiology of his ED. Attributing the ED to hypothyroidism to include muscular weakness and weight gain, diabetes mellitus type II, sleep apnea, major depressive disorder,

recurrent is completely speculative.

We considered whether your condition resulted from a toxic exposure risk activity (TERA) in service. (38 U.S.C. 1168, 38 U.S.C. 1710(e)(4)) The evidence of record shows participation in a TERA.

We requested an examination with medical opinion based on toxic exposure risk activity (TERA). Although the evidence of record shows participation in a TERA, the medical opinion provided by the examiner does not show an association between your claimed disability and in- service TERA. (38 U.S.C. 1168, 38 CFR 3.303)

Favorable Findings identified in this decision:

You have been diagnosed with a disability. VA exam conducted August 25, 2023 diagnosed erectile dysfunction.



Edited by jdman
Hey, I deleted your attachment because your attachment had your personal information on it for all to see, please redact all personal info.
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Many vets receive sc for Ed as due to or secondary to their sc ptsd or depression and caused by VA strong medications for their mh condition/s.

You need to make this statement with copies of your prescriptions.

A doctors medical nexus letter saying this with his explaination is extremely important to win a claim or bva appeal.

My comment is not legal advice as I am not a lawyer, paralegal or VSO.


Edited by Dustoff1970
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The reasons and bases for decision which you posted suggested either a missing nexus, or defective nexus.  "Nexus killer".  

Many well meaning doctors put in words which are nexus killers.  They are words like, "could be", "may be", "might be" "is possible".   Instead, you need the classic, "at least as likely as not", because the previous words in quotes I posted are considered speculative.  

My advice is to check your medical records, specifically your medical exam, and see if it contains "nexus killer" statments.  If it does, you are gonna need another medical exam to win benefits with "at least as likely as not related to (SC diabetes, depression, etc)". 

ALSO:  Dont forget to have the doctor give a date the symptoms began.  Why?  Because that can be your effective date: aka retro.  

Something like this:  (Dont use my example, but it could be somewhat similar, your doctor will need to write it in his words)

"In my professional opinion, the Veteran's ED is at least as likely as not due to (list sc condition(s), and or medications for those conditions).  The records show the Veteran has complained of ED since Sept, 2003, when he first started medications for diabetes."  


This is a sample nexus, do not use my sample.  

Signed, Ima Doctor atVAorprivatedoc, Board certified to treat diabetetes ED, etc.  

The doctor in question signing this needs to demonstrate comepetence to make said opinion.  

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I talked to my doctor's office this morning for my psychiatrist and sent over the documentation needed(VA Medical Records). One of my medications I have been taking since 2014(Seroquel) per the NAMI website can be causing ED. I sent over what you said so they are gonna do a letter for me. My DAV rep said I wouldn't have to appeal just refile. He said that would be quicker.

Thanks for all your help. 

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4 hours ago, jdman said:

per the NAMI website can be causing ED. I sent over what you said so they are gonna do a letter for me.

Not to be a naysayer, but a website or case study will be given to no weight from the VA.  If your Doctor writes it up based on your evidence (cause and affect) then you should be good.  These VA raters deal with claims everyday from Veterans stating case study and thinking it applies to their situation.  Unfortunately, it doesn't.

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As said in above comments the doctor's or specialist nexus letter with a detailed explanation of why he/she believes your Ed is secondary to and/or aggravated by other serviced connected mental or physical condition/s and strong VA medications is important and my Doctor's nexus opinions for Sleep Apnea due to PTSD and for AO heart disease increase also included a list of other medical studies results references.  I won both appeals due to my solid medical evidence, his nexus opinions and my strong contentions I made on my behalf including citing previous similar court and BVA cases.  Last, I also included my own other medical studies from reputable medical research institutes supporting my contentions.

For added measure I also included CAVC court cases and BVA decisions similar to my situations that granted the vet their appealed claims.  Doesn't hurt a thing.  Works for me and extra work well worth it.  It was fun for me.

Except for recent favorable decisions for my GERD, Tinnitus and Hypertension claims the VARO raters denied my other claims for Sleep Apnea and heart disease increase and the BVA then granted these claims on the very same evidence that the VA raters and biased C&P examiner said was not sufficient.   Be prepared to appeal to BVA a VA denial.

My comment is not legal advice as I am not a lawyer, paralegal or VSO.



Edited by Dustoff1970
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