MAJOR DEPRESSIVE DISORDER

Summary

The Veteran, a Veteran who served from September 1980 to May 1985, appeals the denial of service connection for an unspecified depressive disorder and unspecified anxiety disorder, claimed both directly and as secondary to service-connected knee conditions. The Veteran's attorney argued for direct service connection based on a motor vehicle accident during service and subsequent harassment, leading to psychiatric symptoms. However, the Veteran's testimony during a May 2024 hearing was inconsistent regarding the chronicity of these symptoms, and service treatment records from May 1985 indicated a normal psychiatric evaluation with no reported psychiatric symptoms. The Board found the Veteran's denial of persistent psychiatric symptoms credible and supported by service records, thus failing the in-service injury element for direct service connection. The Board also found no pre-decisional duty to assist error, as the direct theory was first raised at the May 2024 hearing, after the January 2020 rating decision on appeal, and no in-service event related to a mental disorder was established. For secondary service connection, while a current psychiatric disorder and service-connected knee conditions were acknowledged, the Board found the private psychological evaluation from August 2024 to be minimally probative. The Board noted the opinion was generalized, speculative, and failed to adequately address the lack of in-service psychiatric complaints or nexus to the service-connected knee conditions, which were not reported by the Veteran as contributing to his psychiatric symptoms. The Board denied service connection for the psychiatric conditions on both direct and secondary bases.

Rationale

No evidence of in-service psychiatric injury or disease.; Veteran's testimony regarding chronic psychiatric symptoms was not credible.; Private psychological evaluation was generalized and speculative.

Full Decision Text

Citation Nr: A26007209
Decision Date: 01/27/26	Archive Date: 01/27/26

DOCKET NO. 200610-92120
DATE: January 27, 2026

ORDER

Entitlement to service connection for unspecified depressive disorder and unspecified anxiety disorder, to include as secondary to the service-connected right knee degenerative arthritis (flexion), right knee, instability, and left knee meniscal tear with degenerative arthritis, flexion. 

FINDING OF FACT

The Veteran's unspecified depressive disorder and unspecified anxiety disorder did not have its onset in service, is not otherwise related to service, and is not caused or aggravated by a service-connected disability.

CONCLUSION OF LAW

The criteria for entitlement to service connection for unspecified depressive disorder and unspecified anxiety disorder as secondary to the service-connected right knee degenerative arthritis (flexion), right knee, instability, and left knee meniscal tear with degenerative arthritis, flexion.  38 U.S.C. §§ 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 from September 1980 to May 1985.  

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 2020 rating decision in which the Agency of Original Jurisdiction (AOJ) denied service connection for a psychiatric condition to include depression, and/or anxiety, to include as secondary to a service-connected disability.           

In June 2020, the Veteran timely appealed the decision to the Board by submitting a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD) and requesting a hearing with a Veterans Law Judge.  In May 2024, the Veteran testified at a virtual hearing before a Veterans Law Judge.     

In an Appeals Modernization Act (AMA) hearing docket appeal, the Board considers the evidence of record at the time of the January 2020 rating decision on appeal, and any evidence submitted by the Veteran or the Veteran's representative at the hearing and within 90 days following the hearing, which was August 13, 2024.  38 C.F.R. § 20.302(a).  

The Board notes that on August 13, 2024, the Veteran's attorney submitted numerous entries of evidence, including evidence identified as VA medical records.  However, an error occurred during the submission of that evidence such that the documents are blank and contain writing in what appears to be an Asian language.  Consequently, the Board was unable to review those specific records.  Nonetheless, the AOJ has obtained the Veteran's VA treatment records and associated those records with his claims file.  Those records relate to various VA facilities and cover treatment dates from 1999 through the January 2020 rating decision on appeal.  The Board has considered these records in its decision herein.  

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in this decision.  38 C.F.R. § 20.300.  If the Veteran would like VA to consider any evidence that was added to the claims file 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.

Entitlement to service connection for unspecified depressive disorder and unspecified anxiety disorder, to include as secondary to a service-connected disability.

In an October 2019 VA Form 21-526EZ claims application, the Veteran contends that he is entitled to service connection for depression and/or anxiety as secondary to a service-connected disability.  During a May 2024 Board hearing, the Veteran's attorney additionally raised a direct theory of entitlement.  The Veteran's attorney argued that the Veteran's acquired psychiatric disorder was due to a motor vehicle accident during service wherein he was thrown out of a vehicle landing on the right side of his body.  The Veteran testified that he received treatment for his injuries at sick bay.  He stated that, thereafter, he was harassed for his injuries.  The Veteran testified that his sergeant berated him for damaging "government property" because he was the property of the government.  This experience led to a decline in the Veteran's performance, resulting in his development of depression and anxiety while still in service.  To deal with the psychological trauma, he self-medicated with alcohol.  

As to
, the Veteran's attorney additionally raised a direct theory of entitlement.  The Veteran's attorney argued that the Veteran's acquired psychiatric disorder was due to a motor vehicle accident during service wherein he was thrown out of a vehicle landing on the right side of his body.  The Veteran testified that he received treatment for his injuries at sick bay.  He stated that, thereafter, he was harassed for his injuries.  The Veteran testified that his sergeant berated him for damaging "government property" because he was the property of the government.  This experience led to a decline in the Veteran's performance, resulting in his development of depression and anxiety while still in service.  To deal with the psychological trauma, he self-medicated with alcohol.  

As to secondary service connection, the Veteran testified that he constantly feels pain in his knees, for which he wears metal braces to walk.  He testified that the pain in his knees interferes with his ability to sleep at night, contributing to his lack of patience and aggressive behavior.  He further testified that the pain in his knees deteriorates his quality of life and that he would be happier if he did not have pain in his knees.  

Service Connection

Service connection may be granted for a disability resulting from injury or disease incurred in or aggravated by active service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  The three-element test to establish 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 disease or injury incurred or aggravated during service.  Shedden v. Principi, 381 F.3d 1163, 1166-1167 (Fed. Cir. 2004).  Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d). 

Service connection may be granted for a disability that is proximately due to, or the result of, a service-connected disability.  See 38 C.F.R. § 3.310 (a).  When service connection is established for a secondary disability, the secondary disability shall be considered a part of the original disability.  Id.  Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability.

The Board has carefully reviewed the evidence of record and finds that service connection for unspecified depressive disorder and unspecified anxiety disorder (acquired psychiatric disorder) is not warranted on direct or secondary bases.  The reasons follow.  

Direct Service Connection 

As to direct service connection, in an August 2024 private Psychological Evaluation, Dr. Amir Niazmand, PsyD, diagnosed the Veteran with unspecified depressive disorder and unspecified anxiety disorder.  Thus, the first element of a service-connection claim, a current disability, is met.  

However, regarding the second element, an in-service disease or injury, the Board finds that this element has not been met.  A May 1985 Report of Medical Examination completed for purposes of separation from service documents that a clinical evaluation of the Veteran's psychiatric system was normal.  In an associated Report of Medical History, the Veteran denied a history of depression or excessive worry and nervous trouble of any sort while reporting a positive history for musculoskeletal and gastrointestinal symptoms.  As such, based on the Veteran's service treatment records (STRs), there is no evidence to support a finding of an in-service disease, injury, or event related to an acquired psychiatric disorder.    

During the May 2024 Board hearing, the Veteran's attorney argued that the Veteran's depression and anxiety symptoms began during service following a traumatic motor vehicle accident wherein the Veteran was thrown from a deuce and a half, landing on his right side.  The Veteran's attorney stated that after this accident, the Veteran's sergeant harassed and berated the Veteran for his injuries.  The Veteran's attorney argued that the psychological trauma from this incident manifested in a decline in the Veteran's performance and self-medication with alcohol.  The Veteran's attorney noted that the Veteran experienced chronic depression and anxiety symptoms that continued from service up and until the present.  

While the Board acknowledges this contention and that the Veteran ultimately testified to experiencing continuous psychiatric symptoms since service, the Veteran's initial and overall testimony was that he did not have continuous and chronic symptoms during service through the present.  Notably, the Veteran further denied current psychiatric symptoms during the May 2024 hearing.  A review of the hearing transcript reflects the following: 

MR. JAHIZI: Okay. And you began
 and berated the Veteran for his injuries.  The Veteran's attorney argued that the psychological trauma from this incident manifested in a decline in the Veteran's performance and self-medication with alcohol.  The Veteran's attorney noted that the Veteran experienced chronic depression and anxiety symptoms that continued from service up and until the present.  

While the Board acknowledges this contention and that the Veteran ultimately testified to experiencing continuous psychiatric symptoms since service, the Veteran's initial and overall testimony was that he did not have continuous and chronic symptoms during service through the present.  Notably, the Veteran further denied current psychiatric symptoms during the May 2024 hearing.  A review of the hearing transcript reflects the following: 

MR. JAHIZI: Okay. And you began to experience -- and you began to experience depression and anxiety at that time as well, while you were still in the service?

VETERAN: Yes.

MR. JAHIZI: Is it also true that those symptoms that I just listed have been chronic and continuous from the service up and until the present?

VETERAN: Not until the present no.

MR. JAHIZI: I'm sorry?

VETERAN: Not until the present, no, with the alcohol.

MR. JAHIZI: You're not -- not that, no, not the alcohol. I'm sorry. But the symptoms of depression and anxiety and difficulty sleeping. Those have been present -- those have been continuous up and until the present, correct?

VETERAN: No, not really.

MR. JAHIZI: T[].

VETERAN: Yes.

MR. JAHIZI: This is a claim for service-connected disabilities, okay?

VETERAN: Yeah.

MR. JAHIZI: Okay?

VETERAN: Yup.

MR. JAHIZI: All right. You're telling me that you no longer have any symptoms of depression or anxiety or the difficulty that you have sleeping as a result of your accident and being berated in the service? You're no longer having any of those symptoms? Or do you still feel depressed and anxious at times as a result of what happened in the service? Thomas, do you know --

VETERAN: I don't know.

MR. JAHIZI: Do you not suffer - T[], listen. Do you not suffer from --

VETERAN: Yeah.

MR. JAHIZI: Depression or anxiety today? I -- we may be on the total wrong page because we've been working on your case for a very long time developing, you seeking treatment, going to your doctor. Are you telling me that that's I -- I -- I'm not -- I'm a little -- a little confused here. Are you currently suffering from any depression or anxiety, T[]?

VETERAN: No.

Transcript, pp. 4-6

The Veteran's attorney later asks: 

MR. JAHIZI: Yeah, the pain in your knees. But I'm saying the psychological trauma that you experienced in the service you no longer have, is that correct? And -- or do you suffer from those symptoms that you had in the service as a result of the trauma you experienced?

VETERAN: No. 

Transcript, p. 7.

After further questioning about the Veteran's motor vehicle accident during service and his sergeant's mistreatment of him, the Veteran's attorney states: 

MR. JAHIZI: Okay. Over the years those symptoms have stayed with you. Now you may have overcome the alcoholism, but do you still feel depressed and anxious at times up and until today because of what happened in the service?

VETERAN: Yes.

MR. JAHIZI: Okay. All right. So, notwithstanding the alcoholism, which you overcame, which is great, you still experience the feelings of depression and anxiety and the memories of being harassed while you were in the service as a result of the accident you experienced. Is that correct?

VETERAN: Yes.

Transcript, p. 9.

Based on the above, the Board finds that to the extent that the Veteran testified that he has had continuous depression and anxiety symptoms since service, the Board does not find this testimony credible.  In this case, the referenced testimony illustrates that prior to the extended prodding from his attorney regarding his denial of chronic psychiatric symptoms, the Veteran clearly and consistently denied having chronic psychiatric symptoms from service through the present, to include a denial of current psychiatric symptoms.  

The Board finds the Veteran's denial of persistent psychiatric symptoms from service through present to be supported by STRs, which document that he denied psychiatric symptoms at separation from service in May 1985.  The Board affords high probative value to the Veteran's STRs, as these documents were completed contemporaneously to service, which facts tend to be reliable.  Moreover, in the May 1985
 and anxiety symptoms since service, the Board does not find this testimony credible.  In this case, the referenced testimony illustrates that prior to the extended prodding from his attorney regarding his denial of chronic psychiatric symptoms, the Veteran clearly and consistently denied having chronic psychiatric symptoms from service through the present, to include a denial of current psychiatric symptoms.  

The Board finds the Veteran's denial of persistent psychiatric symptoms from service through present to be supported by STRs, which document that he denied psychiatric symptoms at separation from service in May 1985.  The Board affords high probative value to the Veteran's STRs, as these documents were completed contemporaneously to service, which facts tend to be reliable.  Moreover, in the May 1985 separation Report of Medical History, the Veteran reported a positive history for various musculoskeletal and gastrointestinal symptoms while denying psychiatric symptoms.  This serves as further support that had the Veteran continued to experience depression and anxiety from his sergeant's berating and harassment through service discharge, he would have reported a positive history for psychiatric symptoms as he did regarding his musculoskeletal and gastrointestinal symptoms.  Thus, based upon the competent and credible evidence of record, which includes the Veteran's Board testimony denying chronic psychiatric symptoms, and STRs wherein the Veteran denied a history of psychiatric symptoms, the Board finds that the in-service disease or injury element is not met.  

The Board similarly finds that the third element, the nexus requirement of direct service connection, is also not met.  As noted, there was no in-service disease or injury related to an acquired psychiatric disorder.  Without an in-service disease or injury related to an acquired psychiatric disorder, there is no basis upon which to find that the Veteran's current unspecified depressive disorder and unspecified anxiety disorder, which were first diagnosed in 2024, are related to his service.

The Veteran was not afforded a VA direct medical examination and medical opinion related to his direct service-connection claim.  VA must provide a medical examination or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim.  McLendon v. Nicholson, 20 Vet. App. 79 (2006).

The Board finds that the Veteran was not entitled to such examination and medical opinion at the time of the January 2020 rating decision on appeal. McLendon, 20 Vet. App. 79.  As detailed above, the Veteran's attorney first raised the theory of direct service connection at the May 2024 Board hearing, which is after the January 2020 rating decision on appeal.  Furthermore, a direct theory of entitlement was not otherwise reasonably raised by the record.  As previously discussed, there was no event, injury, or disease in service related to a mental disorder.  Without evidence of an event, injury, or disease in service, there is no indication that the Veteran's acquired psychiatric disorder may be associated with the Veteran's service.  Therefore, at least one element was not met.  As such, the Veteran was not entitled to VA medical examination or medical opinion regarding direct service connection at the time of the January 2020 rating decision on appeal.  Thus, there is no pre-decisional duty to assist error in the AOJ not affording the Veteran such examination and/or medical opinion.  

Consequently, service connection for an acquired psychiatric disorder on a direct basis is not warranted.  

Secondary Service Connection 

Regarding service connection on a secondary basis, as previously noted, the Veteran was diagnosed with an acquired psychiatric disorder in an August 2024 private Psychological Evaluation.  Therefore, there is evidence to support a current disability.  Additionally, the claimed primary disabilities, right and left knee disabilities, are service connected.  

Thus, the remaining question is whether the Veteran's acquired psychiatric disorder is proximately caused or aggravated by his service-connected right and/or left knee disabilities.  In this instance, the Board finds that the Veteran's acquired psychiatric disorder is neither caused nor aggravated by his service-connected knee disabilities.  

During the May 2024 Board hearing, the Veteran testified that he constantly feels pain in his knees and that the pain in his knees interferes with him sleeping at night and contributes to his lack of patience and aggressive behavior.  He further testified that it deteriorates his quality of life and that he would be happier if he did not have pain.  

An August 2019 VA treatment records show that the Veteran has a history of traumatic brain injury and focal dysc
 the remaining question is whether the Veteran's acquired psychiatric disorder is proximately caused or aggravated by his service-connected right and/or left knee disabilities.  In this instance, the Board finds that the Veteran's acquired psychiatric disorder is neither caused nor aggravated by his service-connected knee disabilities.  

During the May 2024 Board hearing, the Veteran testified that he constantly feels pain in his knees and that the pain in his knees interferes with him sleeping at night and contributes to his lack of patience and aggressive behavior.  He further testified that it deteriorates his quality of life and that he would be happier if he did not have pain.  

An August 2019 VA treatment records show that the Veteran has a history of traumatic brain injury and focal dyscognitive epilepsy with generalization.  He was seen for a speech pathology consultation for an evaluation of cognitive communication and for education/training on functional cognitive strategies in the setting of mild cognitive impairment diagnosis following a recent neuropsychological evaluation.  He reported that his mood tends to be more depressed and anxious first thing in the morning and right before sleep.  The provider documented that the Veteran experiences frequent disorientation upon waking, then becomes depressed upon remembering his diagnosis.  He also experiences anxiety before sleeping along with severe fatigue.  The Veteran was also noted as being very easily frustrated by communication/memory/attention deficits and will often "shut down" or withdraw from situations or conversations as a result.

A January 2020 VA treatment record notes that the Veteran sleeps an average of four to five hours per night mostly due to anxiety, nightmares, and pain "through the roof" for neck/shoulders and back.  He reported not liking the side effects of medications but takes it to manage severe pain.

An October 2019 in-person VA examination report documents the Veteran's symptoms as chronic sleep impairment and mild memory loss.  The examiner indicated that the Veteran's sleep issues were due to his sleep apnea, for which he is not service connected.  The Veteran did not report his service-connected knee disabilities or any other service-connected disability as contributing to his psychiatric symptoms.   

In an August 2024 private Psychological Evaluation based upon a review of the Veteran's VA treatment records and an interview, Dr. Niazmand, PsyD, notes that VA treatment records suggest that the Veteran complained about having depression, anxiety, and frustration.  Dr. Niazmand states that the Veteran underwent comprehensive neuropsychological testing in 2019.  He subsequently opines that it is at least as likely as not that the physical injuries the Veteran sustained during service which led to his inability to work and difficulties with activities of daily living, played a role in the development of his psychosocial condition.  Dr. Niazmand states that research and literature suggest that individuals with chronic pain develop anxiety and depression.  Dr. Niazmand notes that chronic pain evokes a response, which can be physical and emotional.  He further provides that chronic pain or pain that does not go away and can lead to stress, anxiety, irritation, agitation, and sleep disturbance.  Dr. Niazmand states that over time, these feelings can result in symptoms of depression, all stemming from the stress and anxiety of dealing with chronic pain.  He additionally notes that due to overlapping symptoms, it is unclear how the Veteran's reported TBI has been affecting his overall psychological condition.

The Board affords Dr. Niazmand's opinion minimal probative value.  Specifically, the Board finds the opinion generalized and thus, speculative as to the exact relationship, if any, between the Veteran's psychiatric symptoms, and his service-connected disabilities.  Dr. Niazmand's positive opinion is based largely on a general understanding of chronic pain and mental disorders without an individualized assessment of how this relationship manifests in the Veteran.  The examination, which was not conducted in person or over video and does not include any behavioral observations, relies heavily on information reported by the Veteran.  For example, the opinion includes numerous statements that begin with the phrase, "it is reported to me."  As noted, Dr. Niazmand's positive opinion, which is based on a generalized relationship between chronic pain and mental conditions, does not account for the fact that the Veteran's VA treatment records and 2019 VA examination do not support a relationship between the Veteran's service-connected disabilities and his psychiatric symptoms.  In fact, the Veteran's VA treatment records establish that the times in which the Veteran's depression and anxiety symptoms have been discussed, have all been in the context of the Veteran's neurological disorders, none of which are service connected.  Notably, Dr. Niazmand references the fact that the Veteran underwent neuropsychological testing in 2019, during which time he reported symptoms of depression, anxiety, and frustration.  

In light of the above, given that the August 2024 private medical opinion is inadequate and that there is no other competent medical evidence
 does not account for the fact that the Veteran's VA treatment records and 2019 VA examination do not support a relationship between the Veteran's service-connected disabilities and his psychiatric symptoms.  In fact, the Veteran's VA treatment records establish that the times in which the Veteran's depression and anxiety symptoms have been discussed, have all been in the context of the Veteran's neurological disorders, none of which are service connected.  Notably, Dr. Niazmand references the fact that the Veteran underwent neuropsychological testing in 2019, during which time he reported symptoms of depression, anxiety, and frustration.  

In light of the above, given that the August 2024 private medical opinion is inadequate and that there is no other competent medical evidence upon which to grant service connection on a secondary basis, there is insufficient evidence of record to find that the Veteran's acquired psychiatric disorder is caused or aggravated by a service-connected disability.  Thus, service connection for an acquired psychiatric disorder on a secondary basis is not warranted. 

The Board notes that the August 2024 private medical opinion also includes a positive medical opinion regarding the Veteran's psychiatric disorder's impact on his ability to work.  Because the Board is denying the Veteran's service-connection claim, the associated claim for a total disability rating based upon individual unemployability (TDIU) is moot.  

For these reasons, the persuasive weight of the evidence is against the service-connection claim.  Therefore, the benefit-of-the-doubt doctrine is not for application, and the claim is denied.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

 

 

A. P. SIMPSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	P.C.

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.