Is Hypogonadism a VA Disability?
by Benjamin Bunting BA(Hons) PGCert
Written by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.
There are many reasons to consider hypogonadism as a possible disability. The most common are decreased sexual function, less spontaneous erections while sleeping, and infertility. Low testosterone can also affect men physically, causing increased body fat, decreased muscle bulk, diminished bone density, swollen breasts (gynecomastia), and body hair loss. This condition can negatively impact a man's motivation, self-confidence, and concentration.
A diagnosis of hypogonadism is complicated, and the patient may have symptoms of traumatic brain injury (TBI) or another condition. Although the two conditions share many symptoms, hypogonadism may worsen the patient's disability, functional dependence, and cognition. Moreover, hypogonadism can be a contributing factor to depression and suicide. Consequently, it's important to find other causes of hypogonadism as well as TBI.
The prevalence of hypogonadism varies by age, but it is usually diagnosed by the physician. Among the symptoms of hypogonadism are impaired sexual function, reduced cognitive function, decreased libido, and increased LDL in lipid profiles. In addition, men with late-onset hypogonadism may suffer cardiovascular complications. To accurately diagnose hypogonadism in aging men, clinicians should look for other causes of low testosterone, such as hyperprolactinemia or pitta-related disorders.
The VA rates service-connected hypogonadism as 0% or a zero percent disabling disability. However, there are several factors that determine whether a service-connected condition is eligible for VA disability compensation. Generally, the conditions must be a consequence of physical injury or trauma or are a secondary effect of another condition. Physical injury to the lower body or the penis can also cause erectile dysfunction, and this causes it to occur. Surgical procedures to the penis can cause permanent damage to the body's tissues. Hence, some doctors will recommend surgery to treat the condition. Nevertheless, surgery for this condition may be necessary to treat the underlying cause of hypogonadism and provide compensation.
In addition to this, the condition may qualify for service-connected benefits under the presumptive conditions. Presumptive conditions are generally service-connected. Veterans who served in the Atomic, Gulf, and Vietnam wars are most likely to qualify. Since hypogonadism is a common disorder among older men, the VA has a good chance of approving your claim. However, if the condition is chronic, you may need to undergo medical treatment. If you think that your hypogonadism is a service-connected disability, a doctor should consult with you and discuss treatment options.
Musculoskeletal conditions have a high rate of success among VA claims. A musculoskeletal condition can be rated anywhere from 0% to 100%, but a VA disability rating of 20% or less is common. Because the condition is service-connected, the condition is likely to be rated as a musculoskeletal impairment. As such, it can add 10% to 20% to a veteran's disability rating.
Treatment of male hypogonadism is dependent upon the cause. While hypogonadism is an inherited condition, it can also be acquired later in life through an infection or injury. A rare congenital condition that results in a deficiency of testosterone is Klinefelter syndrome. It results from an abnormality of the sex chromosomes. Males have one X chromosome and one Y chromosome. The Y chromosome is responsible for determining sex, while the X chromosome is responsible for developing the body. The result is that the testicles are abnormally small and under-produced.
Recent findings have connected low testosterone with post-traumatic stress dissorder (PTSD). It's not entirely clear why a low testosterone level could increase the risk of developing PTSD. But researchers have hypothesized that a low testosterone level could lead to chronic stress, which is a component of PTSD. Low testosterone levels can also be a factor in the development of chronic anxiety. Therefore, increasing testosterone levels may help with treating PTSD. Let's take a closer look.
The hormone testosterone is responsible for regulating sexual behavior, cognition, and social behavior in both sexes. It is known to respond differently to stress than to other hormones. But the relationship between stress and testosterone secretion in psychiatric disorders is not well understood. In men, testosterone levels are associated with antisocial behaviors and anger. However, research on the relationship between low testosterone and PTSD is limited. And it has been unclear whether the stress hormone testosterone affects the risk of developing psychiatric disorders.
Acute dissociation has been associated with increased risk for PTSD. In well-designed studies, this association has been proven to be significantly predictive of severity and chronicity. One recent study attempted to tease apart the contributing factors and identified four clusters. The most accurate cluster was avoidance, and the least accurate was dissociation. In conclusion, there may be two independent risk factors for PTSD. If they are, the latter would be the best candidate for treatment.
Researchers found that both borderline personaility disorder (BPD) and PTSD patients had higher expectation for a threatening situation than those in the control group. The group did not differ when it came to the trier social stress test (TSST), although patients in both groups were more likely to agree with the statement. Low testosterone can also cause a patient's anxiety levels to spike. This may explain why low testosterone levels can increase the risk of developing PTSD. It's important to understand the connection between low testosterone levels and PTSD.
Many honorable veterans have PTSD. About 30% of soldiers who serve in war zones later become diagnosed with PTSD. Sadly, the ultra-masculine military culture stigmatizes soldiers with mental health issues, preventing them from seeking treatment and openly discussing their challenges. Accurate screening is crucial in the battle against PTSD. So how do we detect if a soldier has PTSD? The biggest challenge is having accurate screening.
While testosterone is a necessary hormone for the body, it also regulates the brain's response to stressful situations. In fact, low testosterone disrupts the brain's hypothalamus-pituitary axis, leading to mental fogginess, moodiness, and impaired cognitive function. Low testosterone levels in the brain also affect the prefrontal cortex, hippocampus, and bed nucleus of the stria terminalis, which moderates the activities of essential emotional processing regions. Those areas are responsible for determining personality expression, social behavior, and decision-making.
The rate of erectile dysfunction among veterans is three times higher than that of the general population. Though millions of men suffer from erectile dysfunction, veterans are particularly vulnerable to it. Even the VA rates erectile dysfunction as a service-connected disability. If untreated, erectile dysfunction can have significant negative effects on men's self-esteem and relationships. In fact, it's estimated that 80% of vets suffer from some form of erectile dysfunction.
For those veterans suffering from erectile dysfunction, there are several options for getting the disability rating increased. One option is to apply for SMC (k) compensation, which provides veterans with a monthly benefit based on their current level of erectile dysfunction. These special monthly compensations are also a great way for those affected by erectile dysfunction to get more money from the VA. However, it can be challenging to get the full compensation for such problems.
While the VA recognizes the loss of the penis as compensable, getting the right compensation is often difficult if you don't know how to get the necessary documentation. Erectile dysfunction is the inability to form a firm erection during sexual intercourse. Regardless of the cause, the loss of the penis can be extremely stressful and have a negative impact on a Veteran's emotional and social life. In addition, ED can lead to serious relationship problems, such as difficulty with maintaining an erection.
In determining if a veteran has low testosterone and erectile dysfunction, the VA has two options for treating erectile dysfunction. The VA accepts claims for both erectile dysfunction and low testosterone. These tests are done by a trained VA Rater. In addition to the C&P examination, an in-person exam is also available to confirm if the symptoms are due to a service-connected disability.
The two types of trials that were used in this review had different outcomes. In both, testosterone treatments resulted in a modest improvement in global sexual function. However, the results were not statistically significant. While the trials were not powered to detect differences in mortality rates, they were adjusted to exclude veterans with high risk for CVD. The evidence obtained for both treatments is moderate. And despite the fact that the evidence is largely weak, it is still worth studying.
While this study does not address the question of how much testosterone supplements are effective, it is worth considering if it's safe to recommend one over another. The American Academy of Family Physicians endorsed the guideline in this study. It's important to note that the authors did not represent the US government. All opinions expressed are their own. However, they do indicate that testosterone supplements may be helpful for men with low testosterone.