MAJOR DEPRESSIVE DISORDER

Summary

The veteran, who served in the United States Army from November 1977 to November 1980, appeals the denial of service connection for an acquired psychiatric disorder, also claimed as unspecified insomnia disorder. The Board reviewed the evidence of record at the time of the agency of original jurisdiction's decision. The veteran had previously been denied service connection for a nervous condition, including insomnia, anxiety, depression, memory loss, and PTSD, as secondary to tinnitus. The RO had favorably found a current diagnosis of unspecified insomnia disorder. The Board previously remanded the issue of acquired psychiatric disorder, including as secondary to tinnitus, for an opinion on etiology. A November 2024 VA examination diagnosed the veteran with OSA and a breathing disorder, but found no current psychiatric condition. The examiner opined that the Veteran's insomnia was less likely than not proximately due to his service-connected OSA, stating that insomnia is a symptom of sleep apnea and that the Veteran's insomnia symptomatology is encompassed within his OSA diagnosis. The Board found this opinion adequate, noting that the Veteran's insomnia is part of his OSA, for which he is already compensated at 50%. The Board also noted that other VA examinations and the Veteran's medical evidence did not support a separate acquired psychiatric disorder. Therefore, the Board denied service connection for the acquired psychiatric disorder, finding that the evidence persuasively weighed against service connection and the benefit of the doubt doctrine was not applicable.

Rationale

No separate psychiatric disorder diagnosed; Insomnia symptoms subsumed by OSA diagnosis; Evidence weighs against service connection

Full Decision Text

Citation Nr: A26017819
Decision Date: 02/26/26	Archive Date: 02/26/26

DOCKET NO. 250414-534627
DATE: February 26, 2026

ORDER

Entitlement to service connection for an acquired psychiatric disorder, also claimed as unspecified insomnia disorder, a nervous condition, anxiety, depression, memory loss, and posttraumatic stress disorder and to include as secondary to tinnitus, is denied.

FINDING OF FACT

The Veteran is already compensated for his insomnia symptomatology by means of his already service-connected obstructive sleep apnea (OSA); no separate and distinct symptoms from those already contemplated by the OSA rating criteria have been demonstrated, and the Veteran is not diagnosed with any other psychiatric disorder.

CONCLUSION OF LAW

The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.14.

REASONS AND BASES FOR FINDING AND CONCLUSION 

The Veteran served in the United States Army from November 1977 to November 1980. 

This matter comes to the Board of Veterans' Appeals (Board) from a March 2025 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). 

In the April 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the December 2024 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 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).

1. Entitlement to service connection for an acquired psychiatric disorder is denied. 

The Veteran states that he is entitled to service connection for an acquired psychiatric disorder, also claimed as unspecified insomnia disorder. After a careful review of the record, the Board determines that the matter must be denied. The reasons follow. 

The first element of service connection is a current disability. The evidence of record persuasively demonstrates that the Veteran does not have a disability with symptomatology distinct from that for which he is already being compensated for pursuant to his service connection for OSA. 

By way of background, in a September 2021 rating decision, the RO denied service connection for a nervous condition, which had previously been claimed as insomnia, anxiety, depression, memory, and PTSD, as secondary to tinnitus. The RO made the favorable finding that the Veteran had a current diagnosis of an unspecified insomnia disorder. In a December 14, 2021, VA Form 10182, the Veteran appealed to the Board. In an August 2024 Board decision, the Board remanded the issue of whether the Veteran was entitled to service connection for an acquired psychiatric disorder, to include as secondary to tinnitus. The RO was instructed to obtain an opinion addressing the etiology of the Veteran's acquired psychiatric disorder, which was diagnosed as unspecified insomnia disorder.

In November 2024, the Veteran was afforded a VA examination. The Veteran was diagnosed with a breathing disorder and OSA. The VA examiner was asked to opine as to whether the Veteran's insomnia/anxiety was at least as likely as not proximately due to, or the result of
 disorder. In a December 14, 2021, VA Form 10182, the Veteran appealed to the Board. In an August 2024 Board decision, the Board remanded the issue of whether the Veteran was entitled to service connection for an acquired psychiatric disorder, to include as secondary to tinnitus. The RO was instructed to obtain an opinion addressing the etiology of the Veteran's acquired psychiatric disorder, which was diagnosed as unspecified insomnia disorder.

In November 2024, the Veteran was afforded a VA examination. The Veteran was diagnosed with a breathing disorder and OSA. The VA examiner was asked to opine as to whether the Veteran's insomnia/anxiety was at least as likely as not proximately due to, or the result of, the Veteran's service-connected disabilities, to include OSA, chronic sinusitis, allergic rhinitis, lumbar strain with degenerative arthritis, right lower extremity radiculopathy, left lower extremity radiculopathy, gastroesophageal reflex disease, right knee strain, left knee patellofemoral pain syndrome, and tinnitus.

In a November 19, 2024, VA opinion, the VA examiner stated that the claimed condition is less likely than not proximately due to, or the result of, the Veteran's service-connected conditions. The VA examiner stated that she could not furnish any opinion since there is no diagnosis. The VA examiner stated that there is no medical evidence finding a psychiatric condition at this time. Therefore, the VA examiner stated that OSA was the diagnosed condition, which is not a mental disorder per se.  

The VA examiner referred to the remarks section of the VA examination, in which she stated that according to the medical literature, insomnia is the milestone of sleep apnea. Insomnia is not a mental disorder, per se, but is a sign or symptom that usually forms part of different medical and mental disorders. The VA examiner noted that in this case, the Veteran was officially diagnosed with sleep apnea since October 2021. The VA examiner stated that OSA is a common sleep disorder characterized by repeated upper airway obstruction during sleep. While respiratory pauses followed by loud snoring and daytime sleepiness are the main symptoms of OSA, patients complain of sleep disruption, headaches, mood disturbance, irritability, and memory impairment. However, the VA examiner stated that the association of OSA with anxiety and depression is not completely understood. The VA examiner stated that adherence to continuous positive airway pressure may be influenced by physiological conditions, especially claustrophobia.  

The Board finds the VA opinion to be adequate as it is a well-reasoned discussion of the Veteran's symptomology and thoroughly explains why no disability is present. The VA examiner also explains why the Veteran's insomnia symptomatology is encompassed in the symptomatology for OSA, stating that sleep disruption is a symptom of OSA. The Board notes that in an October 2022 rating decision, the RO granted the Veteran entitlement to service connection for obstructive sleep apnea (OSA). 

During the course of his claim, the Veteran was afforded several other VA examinations which also opined that the Veteran did not have an acquired psychiatric disorder or found that the Veteran's symptoms were subsumed in the OSA diagnosis. 

On April 17, 2021, the Veteran filed a supplemental claim seeking service connection for anxiety, secondary to the Veteran's service-connected tinnitus. In June 2021, the Veteran was afforded a VA examination and diagnosed with unspecified insomnia disorder. No other mental health condition was diagnosed. The VA examiner stated that the condition was less likely than not proximately due to, or the result of, the Veteran's service-connected tinnitus. 

In August 2021, the VA examiner issued an addendum opinion in which she stated that the Veteran was diagnosed with unspecified insomnia disorder, and no other formal mental disorder was found. The VA examiner stated that there are many potential causes of insomnia and in many cases, multiple factors can be involved. She stated that insomnia can be the primary problem, or it can be associated with other conditions. The VA examiner stated that chronic insomnia is usually the result of stress, life events, or habits that disrupt sleep or related medical conditions. She went on to state that it is well-documented in literature that underlying medical disorders predisposing an individual to insomnia include sleep-related disorders such as sleep apnea, which causes one to stop breathing during the night, interrupting their sleep. The VA examiner noted that in July 2021, the Veteran was suspected of having obstructive sleep apnea and stated that he was a candidate for a sleep study. Therefore, the VA examiner opined that suspected obstructive sleep apnea could be a possible, related, predisposing factor that can be considered until further sleep testing is done. 

Here, the VA examiner explained that insomnia can be associated with other conditions and disorders including OSA which predispose
 or habits that disrupt sleep or related medical conditions. She went on to state that it is well-documented in literature that underlying medical disorders predisposing an individual to insomnia include sleep-related disorders such as sleep apnea, which causes one to stop breathing during the night, interrupting their sleep. The VA examiner noted that in July 2021, the Veteran was suspected of having obstructive sleep apnea and stated that he was a candidate for a sleep study. Therefore, the VA examiner opined that suspected obstructive sleep apnea could be a possible, related, predisposing factor that can be considered until further sleep testing is done. 

Here, the VA examiner explained that insomnia can be associated with other conditions and disorders including OSA which predispose an individual to insomnia. Therefore, any insomnia symptomatology is subsumed in the Veteran's service-connected OSA diagnosis. 

In October 2024, the Veteran filed a supplemental claim for insomnia and/or anxiety aggravated by all of his service-connected disabilities. 

In a November 7, 2024 VA opinion, the VA examiner was asked to opine as to whether the Veteran's insomnia/anxiety was at least as likely as not proximately due to, or the result of, the Veteran's service-connected disabilities, to include OSA, chronic sinusitis, allergic rhinitis, lumbar strain with degenerative arthritis, right lower extremity radiculopathy, left lower extremity radiculopathy, gastroesophageal reflex disease, right knee strain, left knee patellofemoral pain syndrome, and tinnitus. 

The VA examiner opined that the claimed condition is at least as likely as not proximately due to, or the result of the Veteran's service-connected condition. The VA examiner stated that based on a review of the record and performing a mental health examination in 2021, there is evidence that the Veteran has an established sleep disorder. The VA examiner stated that there is no evidence that the Veteran has any other formal mental disorder. Therefore, the VA examiner stated that she could not render an opinion regarding other mental health disorders. 

The VA examiner went on to state that there is no evidence in the literature of a direct physiological consequence between the Veteran's service-connected OSA, chronic sinusitis, allergic rhinitis, lumbar strain with degenerative arthritis, right lower extremity radiculopathy, left lower extremity radiculopathy, GERD, right knee strain, left knee patellofemoral pain syndrome, tinnitus, and the unspecified insomnia disorder. The VA examiner stated that however, it is well-known that a chronic medical condition causing chronic pain can increase the risk, exacerbate or aggravate a depressive condition. The VA examiner stated that chronic pain is highly comorbid with sleep that is deficient in duration or quality, such as seen in sleep disorders. She stated that the pain-sleep relationship is a bidirectional one in that pain can disrupt sleep, and short or disturbed sleep in turn lowers pain thresholds and increases spontaneous pain. The VA examiner stated that sleep deficiency affects various systems known to influence nociceptive processing, including endocannabinoid systems, the hypothalamus pituitary adrenal axis, and adenosine and nitric oxide signaling. She stated that the current knowledge on the interplay between sleep and pain apparently plays a role in enhancing pain in various clinical acute and chronic conditions.  

The VA examiner found that, after a careful review of the record, there was no evidence of psychiatric complaints, psychiatric findings, and psychiatric treatment prior to/during/or one year after separation. The VA examiner noted that the Veteran had a psychiatric evaluation in 1981 and no mental disorders were found. The VA examiner noted that, although a private provider documented a neuropsychiatric diagnosis, a completed mental status examination is needed for a diagnostic assessment, which was not found in the private provider's report. The VA examiner noted that, per a psychologist's note in October 2023, the Veteran's chronic pain is documented as identified related stressors. She went on to note that, pursuant to a VA back examination from December 2021, and a knee and lower leg VA examination from January 2024, the Veteran's back and knee and lower leg condition impact the Veteran's ability to perform any type of occupational task. The VA examiner stated that there was no evidence showing any aggravation of a Veteran established mental condition. Therefore, the VA examiner opined that there was a link between the Veteran's neuropsychiatric sleep disorder and his service-connected knee and lower leg and back. 

As such, the VA examiner stated that, while the Veteran had a sleep disorder, there was no evidence that the Veteran had any other mental disorder. 

The existence of a current disability is the cornerstone of a claim for VA disability compensation. Where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can
2024, the Veteran's back and knee and lower leg condition impact the Veteran's ability to perform any type of occupational task. The VA examiner stated that there was no evidence showing any aggravation of a Veteran established mental condition. Therefore, the VA examiner opined that there was a link between the Veteran's neuropsychiatric sleep disorder and his service-connected knee and lower leg and back. 

As such, the VA examiner stated that, while the Veteran had a sleep disorder, there was no evidence that the Veteran had any other mental disorder. 

The existence of a current disability is the cornerstone of a claim for VA disability compensation. Where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. See Degmetich v. Brown, 104 F.3d 1328, 1332 (1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Any current sleep disruptions symptoms are subsumed by the Veteran's already service-connected OSA. 

The Board notes that the RO made a favorable finding that the Veteran was diagnosed with unspecified insomnia disorder. The Board will not disturb this favorable finding. However, the Board finds that, although there is a favorable finding that the Veteran has insomnia, such symptoms have already been adequately contemplated by the Veteran's disability rating for OSA. In the VA examiner's November 19, 2024, opinion, she stated that insomnia is the milestone of sleep apnea. She stated that insomnia is usually a sign of another condition, and here, the Veteran has already been diagnosed with OSA. Although the VA examiner notes that the association of OSA with anxiety and depression is not completely understood, the VA examiner made no diagnosis for any other acquired psychiatric disorder. 

As of October 2022, the Veteran has been assigned a 50 percent disability rating for OSA. In a June 2021 VA examination, in which the Veteran was diagnosed with unspecified insomnia disorder, the Veteran reported sleep difficulties, noting that he was only sleeping four hours per night. He stated that he often feels tired during the day. He reported feelings of anxiety and concentration difficulties. The VA examiner stated that the Veteran had chronic sleep impairment. 

This 50 percent rating for OSA encompasses the 30 percent rating for persistent daytime hypersomnolence. Under VA regulations, a veteran may not be doubly compensated for the same disability. The evaluation of the same disability under various diagnoses is to be avoided, as is the evaluation of the same manifestation under different diagnoses. 38 C.F.R. § 4.14; Amberman v. Shinseki, 570 F. 3d 1377 (Fed. Cir. 2009).  

As a result of the above, the Board finds that the Veteran's claim of entitlement to service connection for an unspecified insomnia disorder is not warranted. While the RO made the favorable finding that the Veteran has been diagnosed with unspecified insomnia disorder, the Veteran has already been service-connected for OSA with a rating that specifically contemplates his inability to sleep, and as noted by the November 19, 2024 VA examiner, the Veteran's insomnia disorder is part and parcel of his OSA rather than a separate and distinct disability. Absent evidence of a disability with distinct symptomatology from his service-connected OSA disability, consideration of service connection for, or a separate rating for, an unspecified insomnia disorder is not warranted. Such an action would amount to impermissible pyramiding, and VA is prohibited from awarding disability benefits for two separate diagnoses that produce the same manifestations of a disability. 38 C.F.R. § 4.14. Further, as noted by multiple VA examiners consistent with the Veteran's other medical evidence of record, the Veteran has not been diagnosed with any other acquired psychiatric disorder. Accordingly, entitlement to a service connection for unspecified insomnia disorder is denied.  

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For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for an acquired psychiatric condition is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. §5107(b), is therefore not for application. 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); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). Thus, the claim for service connection for an acquired psychiatric condition is denied.

 

L.M. YASUI

Veterans Law Judge

Board of Veterans' Appeals

Attorney
 the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. §5107(b), is therefore not for application. 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); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). Thus, the claim for service connection for an acquired psychiatric condition is denied.

 

L.M. YASUI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Fleming, Shelley M.

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.