How to file a VA erectile dysfunction claim — service connection, the 0% rating under DC 7522, and special monthly compensation (k)

Step 1: Get the diagnosis documented

Ask your VA primary care provider, urologist or private physician to document the diagnosis, when it began, and what treatment has been tried. Records are confidential under the Privacy Act and HIPAA. If you take medication for a service-connected condition that lists sexual dysfunction as a side effect, ask the prescriber to note the connection.

Step 2: Choose the route to service connection

Direct: the condition began in service — an injury, surgery or diagnosis in your service treatment records. Secondary (38 CFR 3.310): caused or aggravated by a service-connected condition — commonly diabetes, hypertension or other vascular disease, prostate conditions, spinal or pelvic injuries, or a mental health condition — or by medication prescribed for a service-connected condition. A secondary claim needs a physician's written opinion that it is "at least as likely as not" that the service-connected condition or its treatment caused or aggravated the erectile dysfunction, with the reasoning.

Reference: https://www.law.cornell.edu/cfr/text/38/3.310

Step 3: File VA Form 21-526EZ and ask for SMC(k)

File online, by mail to the Claims Intake Center (PO Box 4444, Janesville, WI 53547-4444), in person or through a free accredited representative. Name the condition and the route ("erectile dysfunction secondary to service-connected diabetes mellitus"), attach the records and opinion, and state that you are claiming special monthly compensation under 38 CFR 3.350(a) for loss of use of a creative organ. VA is required to consider SMC whenever the evidence raises it, but naming it avoids an oversight.

Reference: https://www.law.cornell.edu/cfr/text/38/3.350

Step 4: The claim exam

VA usually schedules a genitourinary claim exam. The examiner records onset, cause, whether the condition is attributable to a service-connected condition or its treatment, the treatments tried and their effect, and whether there is any anatomical loss or deformity. Answer plainly; the exam is clinical and brief, and the opinion on cause is what the secondary claim turns on.

Reference: https://www.va.gov/disability/va-claim-exam/

Step 5: What the decision should contain

Under DC 7522 erectile dysfunction, with or without penile deformity, is rated 0%; the footnote to the code requires VA to review entitlement to special monthly compensation under 38 CFR 3.350. SMC(k) is payable for each qualifying loss or loss of use (one hand, one foot, both buttocks, one or more creative organs, blindness of one eye with light perception only, deafness of both ears, complete organic aphonia, or loss of 25% or more of breast tissue), at $139.87 a month, in addition to the basic rate — provided the total does not exceed the (l) rate when paid with ratings under 1114(a)–(j) or (s), or the (o) rate with higher SMC levels. If the decision grants service connection but is silent on SMC(k), request a Higher-Level Review or file a Supplemental Claim within one year.

Reference: https://www.law.cornell.edu/cfr/text/38/4.115b