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I am 100% P&T. Just approved for Housebound. Denied for SMC K. Below is the denial. I see a private psychiatrist for meds and treatment. I discussed my SMC K claim with her and she told me one of my medications is causing the issue. The medication is Pristiq. The only problem is she refuses to write a nexus letter linking it to this medication. I feel like the only other option I have is to go to the Ellis Clinic here in OKC and have him write it for $500. I'm seeing a new PCP at the VA the end of the month but I'm not confident in them doing anything for this because in my records they have been giving me sildenafil which doesn't work. Will the VA do any "workup" as they say for the condition? Any advice? 

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

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
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This is an age old problem. While I have not read your medical opinion, or lack therof, in regard to the eitiology of your ED, you will need a medical statement from a qualified medical person that opines your ED is at least as likely due to either an event in service, or related to an existing service connected condition.  

I see it that you have some choices:

1.  Get another doctor in the VA and ask him or her for a nexus.  He or she may or may not do it either.  However, people are not the same, and doctors are not either.  The next doc may be willing to write a nexus, I can not speak for them.  

2.  Hire your own physician for his/ her  medical opinion. (nexus statement).  

3.  Forget about sc for ED, because it probably wont happen without a valid nexus either from a VA doc or from a private doc.  

     You can certainly try item 1, before shelling out the money to pay for your own doc.  You can try going to a nearby VAMC, or you can try another provider (doc).  

     Remember, the VA is signing the doc's paycchecks.  And, so their loyalty goes to the one that signs their checks, not to us Vets.  We dont have to like it.  Its the Golden rule:  The guy with the gold makes the rules.  In this case that is the VA.  

Edited by broncovet
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