MAJOR DEPRESSIVE DISORDER

LESLEY A. REIN · 2026 · Case ID: 26000344

GRANTED

Summary

The Veteran, who served from March 1972 to April 1975, appeals the denial of service connection for depressive disorder. The Board remanded the case twice for further development. The Veteran testified about an in-service stressor involving a jet fuel spill, but VA examiners found he did not meet PTSD criteria, diagnosing him with anxiety disorder and attributing his symptoms to childhood trauma. Multiple VA examinations noted pre-existing anxiety and depression, with examiners concluding it was less likely than not that his conditions were service-related. However, a July 2024 VA examination found that while his anxiety and trauma disorders were linked to childhood abuse, his depressive disorder was at least as likely as not due to his service-connected left knee patellofemoral pain syndrome and left knee postoperative traumatic scar, citing VA treatment records noting depression related to chronic pain. Resolving all reasonable doubt in the Veteran's favor, the Board found the evidence in approximate balance and granted service connection for depressive disorder as secondary to his service-connected knee conditions.

Rationale

Depressive disorder found secondary to service-connected knee conditions.; Resolving all reasonable doubt in favor of the Veteran.; Evidence found in approximate balance.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

16-43 413

Full Decision Text

Citation Nr: 26000344
Decision Date: 01/09/26 Archive Date: 01/09/26

DOCKET NO. 16-43 413
DATE: January 9, 2026

ORDER

Entitlement to service connection for depressive disorder is granted.

FINDING OF FACT

Resolving all reasonable doubt in favor of the Veteran, his depressive disorder is due to his service-connected left knee patellofemoral pain syndrome and left knee postoperative traumatic scar.

CONCLUSION OF LAW

The criteria for service connection for depressive disorder as secondary to service-connected left knee patellofemoral pain syndrome and left knee postoperative traumatic scar are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from March 1972 to April 1975.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this case in September 2020 and April 2024 for further development. The Board is satisfied that there was substantial compliance with the prior remand. See Stegall v. West,?11?Vet. App.?268, 271?(1998);?D'Aries?v. Peake,?22?Vet. App.?97, 105?(2008).

The Veteran testified at a travel board hearing before the undersigned in May 2019. A transcript is of record.

Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159. Given the Board's favorable disposition of the claim, the Board finds that all notification and development action needed to fairly adjudicate the appeal has been accomplished.

1. Entitlement to service connection for depressive disorder is granted.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). Generally, service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166 - 67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d).

In addition, service connection may be established on a secondary basis for a disability which is shown to be due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).

Service treatment records show that while the March 1972 enlistment examination clinical evaluation did not note a psychiatric disability, the Veteran reported depression or excessive worry and nervous trouble. Further, the examiner noted that the Veteran had nervous tension. In September 1973, the Veteran had acute gastroenteritis and reported having much stress at home.

In June 2012, May 2013, and August 2014 lay statements, the Veteran reported that his in-service stressor was an incident when a bucket full of JP-4 jet fuel smashed into him and spilled all over him. He reported that he was very scared to open his eyes and was afraid that he was never going to see his family again. His face and body felt like it was on fire. He reported having nightmares about this every night.

In a September 2012 VA examination, the examiner found that the Veteran did not meet the DSM-4 criteria for a PTSD diagnosis. He was diagnosed with an anxiety disorder.
acute gastroenteritis and reported having much stress at home.

In a September 2012 VA examination, the examiner found that the Veteran did not meet the DSM-4 criteria for a PTSD diagnosis. He was diagnosed with an anxiety disorder. It was noted that the Veteran had had anxiety symptoms since his formative years during which time he was raised in a home where he was regularly physically abused and verbally threatened by his mother. Upon enlistment, he had excessive worry and was determined to have neurotic tension by the examining medical officer. The examiner opined that it was less likely than not that his anxiety disorder was due to his active duty service. He found it could reasonably clinically be concluded that the Veteran did not have PTSD that could be related to his active duty service based on the fact that his anxiety symptoms prior to enlistment although he was deemed fully psychologically fit for induction, he expressed incidental personal stress that did not resulting in continuing symptoms of psychological distress, in-service mental health diagnosis or treatment, his episodic anxiety symptoms had been tied primarily to intercurrent life stressors, there was no evidence of being treated for the jet fuel incident, and since notable VA mental health professionals questioned the veracity of the Veteran's statements about his life. Thus, the anxiety disorder was not determined to have been caused by or aggravated beyond its natural progression by evidence active duty injury, event, or illness.

In a May 2014 private Disability Benefits Questionnaire (DBQ), Dr. A. Z. diagnosed the Veteran with PTSD and panic disorder with agoraphobia. She referred to the Veteran's military trauma.

In an August 2014 lay statement, his sister reported that in 1973 she received a phone call from her sister-in-law that the Veteran had been injured in an accident and was receiving treatment at a local hospital. The incident was the jet fuel spill accident. The Veteran's sister asked to speak with him, but was told that he was too traumatized to speak with her at that time. She stated that after service, the Veteran would at times refuse to eat due to fear of swallowing his tongue, had difficulties sleeping, and woke up in the middle of the night due to nightmares about the accident. He was reluctant to speak of the accident and had not been the same.

In an August 2014 lay statement, the Veteran's mother stated that she first learned of the incident in 1973 from the Veteran's sister. His mother spoke with him about the accident. He was very nervous and having nightmares about being blinded and feeling like his skin was on fire. He lost a lot of weight and irrationally thought he was going to choke on his tongue.

In a September 2014 VA examination, the Veteran was diagnosed with childhood related PTSD and personality disorder. It was noted that there was a history of abuse by the mother. The examiner concurred with treatment notes that the Veteran endorsed symptoms of PTSD, but found this was due to severe childhood trauma. His PTSD was not related to service as there was no evidence that he was ever treated for such a self-described serious incident (jet fuel spill) where he stated tat he was at risk of permanent blindness or death.

In a December 2014 VA medical opinion, the examiner reviewed the Veteran's service treatment records and opined that there was no stressor evident in those records that would contribute to an aggravation of the Veteran's PTSD. The examiner found that nothing in the service treatment records indicated that the Veteran had any stressor relating to his family that would aggravate his pre-existing PTSD or mental health issues.

At the May 2019 hearing, the Veteran reported that he had not been treated for a psychiatric condition prior to service. He reported that the extent of his depression, worry, and nervous troubles as noted upon enlistment was that he had gotten his girlfriend pregnant and his mother kicked him out of the house. He contended that his psychiatric problems upon enlistment were isolated, not persistent. He repeated his assertions regarding his in-service stressor. He reported that he did not seek mental health treatment in service because his sergeant would deny him. He reported continuous psychiatric issues since service.

In an August 2023 VA examination, the Veteran was diagnosed with unspecified trauma- and stressor-related disorder, persistent depression disorder, and personality disorder. The examiner
9 hearing, the Veteran reported that he had not been treated for a psychiatric condition prior to service. He reported that the extent of his depression, worry, and nervous troubles as noted upon enlistment was that he had gotten his girlfriend pregnant and his mother kicked him out of the house. He contended that his psychiatric problems upon enlistment were isolated, not persistent. He repeated his assertions regarding his in-service stressor. He reported that he did not seek mental health treatment in service because his sergeant would deny him. He reported continuous psychiatric issues since service.

In an August 2023 VA examination, the Veteran was diagnosed with unspecified trauma- and stressor-related disorder, persistent depression disorder, and personality disorder. The examiner found that the Veteran did not meet the full criteria for PTSD. She further found that the evidence of record did not corroborate the reported stressor event. As such, it was less likely than not that the Veteran's current mental health disorders were due to his service. The examiner further found that she could not confirm that he unmistakably had an acquired psychiatric disorder prior to service. There was also no information to sustain aggravation of a mental health disorder.

In September 2023 addendum opinion, the August 2023 examiner found that the Veteran's chronic anxiety disorder was not determined to have been significantly clinically caused by or aggravated beyond its natural progression by an active duty injury, event, or illness. Further, the examiner found that there was no nexus between the Veteran's anxiety disorder and an active duty injury, event, or illness.

In an April 2024 VA examination, the examiner diagnosed the Veteran with unspecified trauma- and stressor-related disorder, persistent depressive disorder, and personality disorder. The Veteran did not meet the DSM-5 criteria for a standalone sleep/wake disorder.

In the July 2024 VA medical opinions, the examiner opined that the Veteran's mental health diagnoses, unspecified trauma- and stressor-related disorder and personality disorder, were related to childhood trauma that predated his military enlistment. The examiner stated that the Veteran was noted as having anxiety symptoms prior to enlistment. She also found that the March 1972 endorsement of nervous trouble, depression, and excessive worry were due to his pre-military childhood trauma experienced in the family home. Thus, the Veteran's trauma and related symptoms existed prior to his entry into active service. Further, the examiner found that there was no evidence in the service treatment records and that the Veteran had not presented any evidence during the interview to suggest that his symptoms were exacerbated by service. Thus, his current mental health disorders were not permanently aggravated by service. However, the examiner also opined that the Veteran's depressive disorder was at least as likely as not due to his left knee patellofemoral pain syndrome and left knee postoperative traumatic scar. She specifically noted the September 2017 and April 2021 VA treatment records in which the Veteran endorsed depression due to chronic pain.

In an October 2024 VA medical opinion, the examiner found there was clear and convincing evidence that the Veteran had mental health issues prior to enlistment. He had anxiety symptoms during the formative years due to childhood abuse. She found that the diagnosis of trauma disorder could not be related to his active duty as the evidence did not corroborate the occurrence of a stressor event beyond a reasonable doubt and his report of symptoms were subclinical for PTSD.

According to post-service VA treatment records, the Veteran was diagnosed with and treated for a number of mental health disorders. While he reported an in-service stressor, he also reported a history of childhood abuse, particularly from his mother. His PTSD was attributed to this childhood trauma and it was noted that his emotional difficulties occurred prior to his enlistment into service. It was noted during his mental health treatment that he suffered from chronic pain. VA treatment records in September 2017, April 2021, August 2021, and April 2022 noted that the Veteran's chronic pain was a stressor, to include pain in his left knee.

Based on a careful review of the evidence and resolving all reasonable doubt in favor of the Veteran, the Board finds that the evidence supports a finding that the Veteran's diagnosed depressive disorder is secondary to his service-connected left knee patellofemoral pain syndrome and left knee postoperative traumatic scar.

The Board notes that while VA examiners have found that the Veteran has mental health disorders that clearly and unmistakably pre-existed service, the rationales indicate that it was specifically in reference to his diagnosed anxiety and trauma disorders that pre-existed service, not his depressive disorder. As such, the Board finds that the Veteran's depressive disorder did not pre-exist his active duty service.

Further, the July 2024 VA examiner opined that the Veteran's depressive disorder was due
the evidence and resolving all reasonable doubt in favor of the Veteran, the Board finds that the evidence supports a finding that the Veteran's diagnosed depressive disorder is secondary to his service-connected left knee patellofemoral pain syndrome and left knee postoperative traumatic scar.

Further, the July 2024 VA examiner opined that the Veteran's depressive disorder was due to his service-connected left knee patellofemoral pain syndrome and left knee postoperative traumatic scar. This is consistent with VA treatment records that show that the Veteran's depression was related to his chronic pain.

Accordingly, and resolving all reasonable doubt in favor of the Veteran, the Board finds that the evidence is in approximate balance that his depressive disorder was due to his service-connected left knee patellofemoral pain syndrome and left knee postoperative traumatic scar. Accordingly, his claim for service connection for depressive disorder is granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

LESLEY A. REIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Ko, Elise

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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