Question:
Jim,
I have not had sex with my wife in almost three years. Have told this to my VA primary, gave me Viagra, no help. Talked to my VA therapist, explaining that my main problem is that I find it almost impossible to be physically intimate (holding cuddling kissing) with my wife.(or others socially, hugging, kissing,hello/good by) States that it is one of my PTSD symptoms. I have no sexual desire, I do wake with an erection once in a while. Primary did check my testosterone levels. OK.
I read your article on filing your on claim where you mention the increase in ED claims in 2006. Don't want to appear as being a "Band Wagon Jumper." I am very grateful for the benefits I currently receive. Guys in my out patient group say; "get what you deserve." I don't want to be filing a frivolous claim and or making more logs in the jam. If you think I should file, I would like to follow your advice and go on my own. I went to the Internet and did a search for E. D. It appears that guys are claiming just Service Connected E. D. (no smc-k) and are awarded 0% SC w/ SMC payment once service connection is established. I am really confused...0% E. D. would support my ongoing PTSD diagnosis, treatment and "Quality of Life Issues".
Answer:
Your email and our subsequent exchanges started me wondering if I've done an adequate job of addressing Erectile Dysfunction. I haven't. Most of my references to ED have been along the lines of, "Don't just throw it into a complex claim when there are bigger fish to fry." I disagree with the process of filing multiple claims and hoping something gets approved.
In any case, you brought it to my attention that in many instances this is a serious issue and the condition deserves a better explanation.
Erectile Dysfunction is defined as a man's inability to achieve and maintain an erection adequate for sexual intercourse or failure to initiate or maintain an erection until ejaculation because of physical or psychological dysfunction.
There are numerous reasons a male veteran may suffer ED. Erectile dysfunction can have a physical or psychological cause and nerve damage and reduced blood flow from diabetes are common physical causes. The medications you take can cause ED. Psychological causes for ED may be PTSD that includes depression, anxiety, and stress.
In the not too distant past "impotence" was considered a natural event and it was accepted that a man would lose the ability to achieve and maintain an erection as he approached those "golden years". In our more enlightened ways of thinking today, we realize that those golden years aren't quite so golden if we lose our ability to be intimate with our partner. Today we know that sexual activity is not only possible well into our senior years, it's a sign of good health and healthy for you too.
Treatment options are plentiful but not always readily available through VHA. To be honest, some of the treatments seem barbaric; implanting intricate systems of pumps and valves that inflate hollow chambers to achieve an erection makes me think of needing to prime a squeaky old water pump on grandpa's farm. Making large incisions to insert a pair or more of stiff plastic rods that will assure a constant erection seems to be going too far in the opposite direction. Surely there are times when one won't want to deal with that effect. There are external pumps to promote blood flow and engorge the corpora cavernosa resulting in a more or less firm erection.
Outside of the obvious risks and a natural reluctance to have anyone with a sharp knife slicing and dicing in the nether regions, one imagines a certain loss of spontaneity when awkward medical devices are brought into the bedroom.
Enter Viagra, Cialis and Levitra. These medicines sparked a bit of a revolution and made it acceptable for the manliest of men to speak openly of ED. The moment Senator Dole came on national TV grinning and advertising his success with Viagra, American men simultaneously applauded him and then tried to blot the resulting image from their minds.
The veteran who suffers ED and seeks treatment at the VA won't get much sympathy. A few years back the VHA handed out enough of the blue pills to keep vets occupied for weeks, maybe longer. Then, in a display of the wisdom we all know too well, it was decided to switch to less costly Levitra and limit the veteran to one 20 mg. tablet each month. My PCP commented that DOD could spend billions on war but VA wasn't going to give an extra dollar for love.
The veteran who has ED and finds that those medicines help and wants more than one pill each month can usually ask his PCP for a prescription and carry it to a civilian pharmacy. That's an expensive option depending on some variables. I'll let you do the math and figure out those variables for yourself.
Is Erectile Dysfunction a valid claim? Should a veteran seek a service connection and claim the condition of ED as a disability?
In many cases, the answer is yes. I'll throw in my usual caveat here; If you're filing for a major illness or injury where the outcome is likely to be 100%, I advise against filing for the "minor" troubles you have. If you're a Vietnam veteran with a presumptive lung cancer, in your initial filing you don't need to throw in the ED, glaucoma, skin rashes, hair loss, ingrown toenails and sinusitis. If I were the RSVR who caught your file, that would piss me off too.
If you're a Vietnam vet filing for your diabetes and you've experienced ED, yes...go ahead and file.
The reader who wrote and got me started on this briefly mentioned "no smc-k". He's referring to Special Monthly Compensation (SMC) and the "k" is the designator for the amount of money to be compensated.
I usually think of SMC as a benefit above and beyond the usual table that runs from 0% to 100%. The SMC benefit is awarded to those veterans who are the most seriously ill or injured. If a vet loses a limb or an eye, he or she may be eligible for SMC on top of their established benefit rate. I had my doubts that SMC "k" would apply to ED.
Reading through and learning about SMC shows that VBA has addressed the loss of or loss of function of a "creative organ" as a condition making a veteran eligible for SMC "k". A "creative organ" isn't clearly defined but the regulation says, "Loss of a creative organ will be shown by acquired absence of one or both testicles (other than undescended testicles) or ovaries or other creative organ."
- http://www.vba.va.gov/bln/21/Rates/comp02.htm (SMC Rate Tables)
The language leaves open the possibility that beyond the testicles and ovaries there may be an "other creative organ" and that, "When loss or loss of use of a creative organ resulted from wounds or other trauma sustained in service, or resulted from operations in service for the relief of other conditions, the creative organ becoming incidentally involved, the benefit may be granted."
In English language that above says, "If you lose the use of your penis from trauma sustained in service you may be awarded the SMC 'k' benefit."
Ever the skeptic, I decided that I wasn't reading this carefully enough. Could it be true that our VBA would give us money if our ED was service connected? You'll understand that I wasn't a believer...not yet.
So, onto the BVA where these lofty matters are discussed by superior minds. We'll first look at a 2007 case.
In http://www.va.gov/vetapp07/files2/0717935.txt we read that the veteran claims service connection for impotence rated as loss of erectile power. Reading on we see that, "VA must infer claim for special monthly compensation from request for increased compensation involving a creative organ); see also AB v. Brown, 6 Vet. App. 35, 38 (1993) (VA must presume claim is for maximum benefits allowed by law and regulation).
The English interpretation of that is. "If you filed for ED, VA must consider that you filed for SMC even if you didn't know you qualified for it."
In the Findings of Facts we learn;
1. The veteran has service-connected erectile dysfunction with impotence.
2. The veteran's erectile dysfunction results in the loss of use of his penis as a creative organ.
The record goes on, "He is diagnosed with erectile dysfunction associated with his service-connected diabetes mellitus. The diagnostic code mandates review of disabilities rated under
that code for entitlement to special monthly compensation...if a veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of one or more creative organs, he shall receive a rate of compensation as set by statute, independent of any other compensation based upon service connection."
This case record continues to describe the law that applies and this should be required reading for any veteran with ED. Ultimately it's decided that, "Applying the law and regulation governing special monthly compensation for loss of use of a creative organ to the facts in this case, the reasonable conclusion is that the veteran is entitled to special monthly compensation for loss of use of a creative organ. Special monthly compensation for loss of use of a creative is granted..."
In our next case http://www.va.gov/vetapp03/Files/0305205.txt we have a similar outcome with a different basis for the original SC claim.
This appeal ends with, "After weighing all of the evidence, it is the Board's conclusion that the positive evidence outweighs any negative evidence with respect to the secondary service connection appellate issue. Based on this evidence, and with resolution of doubt in the appellant's favor, it appears that secondary service connection for sexual impotence is warranted.
ORDER
Secondary service connection for sexual impotence is granted."
How does all this apply to you?
The Veterans Benefits Administration doesn't address issues that are related to the quality of your life. VBA is restricted by law to only award compensation for a disability that would affect a veterans ability to seek and hold gainful employment and earn a living wage. When we consider the importance of a healthy sexual relationship we can easily infer that anything that would interfere with the veteran's ability to consummate such a relationship will also have a negative effect on his work as well as his personal life.
If you are a veteran with an established service connected disability that may cause, contribute to or aggravate the condition known as Erectile Dysfunction, you should file a claim for that condition to be rated as service connected, secondary to the primary condition.
Conditions that may influence your ED may be diabetes, PTSD, depression, any condition that may require medications that could cause ED and conditions that cause chronic pain. The fact is that almost any service connected rated condition might be thought of as causing or aggravating ED.
Beyond that initial filing for a rating for your ED, you should specifically apply for the benefit of SMC "k" as well. If you currently have ED as a rated condition (even as SC but 0%) and you do not receive the SMC "k" benefit, you should apply for that and then consider applying for retroactive benefits to the date of your original ED rating.
The SMC "k" benefit is only $91.00 per month. That's OK. You can buy a lot of Viagra with $91.00.
Jim Strickland's Mailbag: Volume #53 for 2008
NOTE: Letters in my mailbag are reprinted just as they come to me. Spelling and grammar are left as is and only small corrections are made to improve readability, ensure anonymity or delete expletives that may offend some readers. This is not legal advice. You should always seek the advice of an attorney who is qualified in Veterans' law before you make any decisions about your own benefits.
07.07.08
