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What's Wrong

with Her

Low Libido

3.15.2020

Starting my first job as a physician assistant was anxiety provoking. I knew there was going to be a learning curve. But I didn't anticipate just how sharp that curve would be when walking into primary care at the Department of Veterans Affairs.

Not only was there medicine to practice, but I had to learn the ins and outs of primary care, the computer systems, the chain of command, and the bureaucracy of federal government employees. I also spent time learning more about history to better understand my patients and their experiences. Additionally, I had to learn about veterans' service connections. 

Understanding a veteran's service connections is important because the care received for a service connected condition is free to the veteran. When a clinician at the VA completes a medical care visit or writes a prescription the clinician must flag the medical chart indicating that it is related to one of the veterans service connected conditions. By flagging the visit or medication it allows the veteran to obtain the medical care visit or prescription for free. Example, if a veteran is service connected for hypertension, both the medical care visit to follow up on his blood pressure readings and the prescription to treat his hypertension are free. 

The veteran's service connected conditions are listed in the chart, but the list is rather confusing. The confusion is because what is written in the list of service connections isn't actually what the veteran is service connected for. Unfortunately, there isn't any formal training to better understand the list of service connections.

 

When I first saw that a veteran was service connected for "hiatal hernia" I questioned how a veteran could be service connected for a hiatal hernia. From a clinical perspective, hiatal hernias are not treated in primary care and are only referred out to a gastroenterologist, a doctor who specializes in the stomach and bowel, if they are having symptoms. Symptomatic hiatal hernias are not that common on the civilian side of things. 

It was only when I started asking the veteran what they were service connected for did I start to put the puzzle pieces together. I learned that most of those veterans who had "hiatal hernia" listed as a service connection were actually service connected for gastroesophageal reflux disease, or GERD.

 

So you can only imagine the confusion that came when seeing "deformity of the penis" listed in a veteran's service connections. The clinical diagnosis for a deformity of the penis is peyronies disease. We learned about peyronies disease in physician assistant school but from observing how many veterans were service connected for "deformity of the penis" it seemed that men suffered from peyronies disease more than I anticipated. I'm not sure exactly how or when I learned that "deformity of the penis" was actually erectile dysfunction but I was able to appreciate that peyronies disease really wasn't as common as I had initially thought. 

It was years later, when I transferred to the Compensation & Pension Department, that I understood how the list of service connected conditions got their names. 

Most men are service connected for erectile dysfunction, or ED, as a secondary condition. For example, ED as secondary to a service connected mental health condition and the medications used to treat the mental health condition. A veteran who is granted service connection for erectile dysfunction gets the service rating of 0% but this qualifies the veteran for special monthly compensation. Meaning that as of March 15, 2020 the veteran will be paid 122.00 a month for having a special monthly compenstation. 

 

While most veterans are secondarily service connected for erectile dysfunction.

It wasn't until I became an accredite agent in 2017 that I really understood what special monthly compensation for erectile dysfunction meant. According to the 38CFR a loss of power of creative organ is a special monthly compensation for veterans. 

Most recently I was informed that men are able to be prescribed penis pumps at the VA for treatment of their erectile dysfunction. 

With that understanding...

The names:

erectile dysfucntion

deformity of the penis

loss of power of creative organ

In my experience as both a medical expert and an accredited agent, male veterans are often easily granted service connection after sending in a completed DBQ which makes it easy for the veteran to obtain. 

The first two female veterans that I represented had 

Women have a lack of treatment options. 

Both women were not initially granted service connection. 

They had to appeal the initial decision. 

I continue to see troubles with women getting a service connection for having a low libido associated with their service connected conditions. 

From a clinical perspective woman have more factors which affect her libido in comparison with the counterpart. 

When researching the issue I found that the VA does not offer a DBQ or space on a DBQ for her treating clinician to fill out for her.

 

I created a DBQ for these women. The DBQ is free for a period of time to help even out the numbers. 

 

So when posing the question, "What is wrong with her low libido?"

The answer is:

 

She's not getting paid for it. 

 

...

Updated March 12, 2020