MAJOR DEPRESSIVE DISORDER

Summary

The Veteran, a U.S. Navy Veteran who served from April 1989 to May 1996, appeals the denial of service connection for major depressive disorder with anxiety. The Veteran claimed the condition arose from toxic exposure during Gulf War service or as secondary to his service-connected tinnitus. The Board found that the Veteran had a current diagnosis of major depressive disorder, but the evidence did not support a service connection. Service treatment records showed no psychiatric complaints during service, and the Veteran denied such issues on his separation exam. A mental health diagnosis only appeared decades after service, linked to alcohol abuse treatment. The Board rejected the claim for toxic exposure, noting major depressive disorder is not a presumptive condition. Regarding the secondary claim, the Board found the Veteran's private opinion from October 2022, which linked the depression to tinnitus, to be unprobative. The Board noted the opinion provider, a nurse practitioner, did not review the claims file or conduct an examination, and the cited studies were not factually relevant. The Board also found the Veteran's own treatment records and statements did not link his depression to tinnitus, but rather to marital stress and alcohol abuse. The Board concluded the evidence did not preponderate in favor of service connection for major depressive disorder, and therefore, service connection was denied.

Rationale

Service treatment records negative for psychiatric complaints during service.; Separation exam negative for psychiatric concerns.; No evidence linking major depressive disorder to tinnitus.; Private opinion deemed unprobative due to lack of review and relevance.; Veteran's own treatment records link mental health issues to marital stress and alcohol abuse.

Full Decision Text

Citation Nr: A25051440
Decision Date: 06/11/25	Archive Date: 06/11/25

DOCKET NO. 220818-268915
DATE: June 11, 2025

ORDER

Entitlement to service connection for major depressive disorder, with anxiety is denied.

FINDING OF FACT

The evidence of record persuasively weighs against finding that the Veteran's major depression disorder began during active service or is otherwise related to an in-service injury or disease, to include as secondary to his already service-connected tinnitus.

CONCLUSION OF LAW

The criteria for service connection for major depressive disorder, with anxiety have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty with the U.S. Navy from April 1989 to May 1996.

In the August 18, 2022, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.  Therefore, the Board may only consider the evidence of record at the time of the January 2022 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182.  38 C.F.R. § 20.303.  If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.303, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence.  38 C.F.R. § 3.2501.  If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

SERVICE CONNECTION

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.  The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 

Service connection may be granted for a disability that is due to, or aggravated by, service-connected disease or injury.  38 C.F.R. § 3.310.

1. Service connection for major depressive disorder, with anxiety.

The Veteran contends that he developed a psychiatric condition as a result of his service, to include toxic exposure or as secondary to his already service-connected tinnitus.  

A favorable finding from the July 2022 Rating Decision includes a current diagnosis of major depressive disorder confirmed in December 2016 VA treatment records.  As such, the first element of service connection has been met. 

Review of the Veteran's service treatment records does not show any complaints, findings, or treatment for any psychiatric disorder.  On his April 1996 report of medical history, the Veteran checked "no" for depression, excessive worry, and nervous trouble of any sort.  His separation exam was also negative for any psychiatric concerns.  VA treatment records do not show a mental health diagnosis until the Veteran sought treatment in December 2016, decades after separating from service.  As such, the second element of service connection is not met and service connection on a direct basis is not warranted. 

The Veteran initially claimed that his psychiatric disorder was caused by toxic exposure experienced during his Gulf War service.  Notably, in the July 2022 Rating Decision, the AOJ overturned a favorable finding from its previous decision indicating the Veteran had sufficient service to meet the minimum requirements for presumptive service connection because major depressive disorder is not a presumptive condition.
" for depression, excessive worry, and nervous trouble of any sort.  His separation exam was also negative for any psychiatric concerns.  VA treatment records do not show a mental health diagnosis until the Veteran sought treatment in December 2016, decades after separating from service.  As such, the second element of service connection is not met and service connection on a direct basis is not warranted. 

The Veteran initially claimed that his psychiatric disorder was caused by toxic exposure experienced during his Gulf War service.  Notably, in the July 2022 Rating Decision, the AOJ overturned a favorable finding from its previous decision indicating the Veteran had sufficient service to meet the minimum requirements for presumptive service connection because major depressive disorder is not a presumptive condition.  Mental disorders are not considered presumptive conditions as a result of toxic exposure in service.  Service connection on a presumptive basis is not warranted. 

The remaining question for the Board is whether the Veteran's diagnosed major depressive disorder is due to or the result of or was aggravated by service-connected tinnitus.  The Veteran was service connected for tinnitus effective June 13, 2022.  

The October 2022 private opinion found that the Veteran's major depressive disorder was at least as likely as not due to his service-connected tinnitus.  Specifically, the Veteran reported that the constant ringing in his ear led to symptoms of depression.  He had difficulty falling asleep due to tinnitus.  He was unable to be around others and began to have issues with loved ones, friends, and coworkers.  Medical research has shown a correlation between veterans with tinnitus and the development of depression and anxiety.  The physician noted that 77 percent of those with tinnitus may present with some psychiatric comorbidities.  Among those psychiatric disorders, anxiety and depression seem to be the most common complications with tinnitus.  "Although tinnitus and anxiety/depression involve distinct perceptual events, they may share many mechanisms of the central nerve system, particularly those comprising the auditory cortical pathways and limbic system."  

The Board does not find the October 2022 private opinion probative.  V.O., a nurse practitioner, opined that the Veteran's tinnitus led to the development of his psychiatric disorder.  There is no evidence V.O. reviewed the claims file or conducted a physical examination of the Veteran.  Moreover, the studies upon which the opinion hinges do not consider the facts relevant to the Veteran's claim.   

The Veteran participated in both group and individual counseling sessions through VA, as well as prescription treatment.  Review of associated notes do not indicate the Veteran made any complaints of depression or anxiety symptoms in relation to his tinnitus.  Rather, he expressed stress as a result of his failing marriage and drinking.  In fact, seeking treatment for alcohol abuse in December 2016 resulted in the major depressive disorder diagnosis.  In December 2019, he reported experiencing anxiety and depression for 10 years.  He described feeling: anhedonia, down/depressed/hopeless mood, difficulties falling asleep (even with CPAP), fatigue, fluctuation in appetite (mostly overeating), feeling bad about himself and letting his children down, difficulties concentrating, psychomotor retardation, anxious/nervous mood, difficulty controlling worrying, worrying too much about multiple things, difficulties relaxing, restlessness, becoming easily annoyed/irritable, and feeling afraid as if something awful might happen.   In December 2020, an examiner noted that the Veteran's diagnosis was well controlled and improved while on the prescribed medication.  Notably, the Veteran did not express any ongoing mental discomfort as a result of his tinnitus. 

As for tinnitus, in September 2017, the Veteran reported it as occurring daily for 15 to 20 seconds and described it as annoying.  The Veteran told the private examiner that tinnitus made it difficult to fall asleep and he was later awakened by his sleep apnea.  Again, there is no other evidence linking the Veteran's diagnosed major depressive disorder to his service-connected tinnitus.  

It was not until after service connection for tinnitus was granted in the August 2022 Rating Decision that the Veteran submitted evidence (the October 2022 private opinion) indicating his psychiatric disorder developed secondary to tinnitus.  

Based on the foregoing, the Board finds that service connection for major depression disorder is not warranted.  The Veteran has repeatedly connected his mental health struggles with other conditions and symptoms, unrelated to tinnitus, throughout the appeal period.  Therefore, the Board does not find the evidence to be in equipoise as to whether the Veteran's current major depressive disorder is due to his service-connected tinnitus.  Accordingly, there is no doubt to resolve, the Board finds that service connection for major depressive disorder is not warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

David Robertson
 (the October 2022 private opinion) indicating his psychiatric disorder developed secondary to tinnitus.  

Based on the foregoing, the Board finds that service connection for major depression disorder is not warranted.  The Veteran has repeatedly connected his mental health struggles with other conditions and symptoms, unrelated to tinnitus, throughout the appeal period.  Therefore, the Board does not find the evidence to be in equipoise as to whether the Veteran's current major depressive disorder is due to his service-connected tinnitus.  Accordingly, there is no doubt to resolve, the Board finds that service connection for major depressive disorder is not warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

David Robertson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Price Umaru, Esq.

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.