Back to BVA DecisionsMIXEDSpecial Benefit NO SPECIAL BENEFIT Docket No. 250331-523915
MAJOR DEPRESSIVE DISORDER
M. C. WILSON · 2026 · Case ID: A26020023
Summary
The Veteran served from May 1960 to May 1962. The Veteran appeals the denial of service connection for depression and the remand of claims for obstructive sleep apnea (OSA) and paroxysmal atrial fibrillation. Regarding depression, the Board found no objective clinical evidence of a diagnosis during the review period. While the Veteran believed he suffered from depression, the VA examiner diagnosed insomnia disorder and noted the Veteran did not have more than one mental disorder. The Board assigned significant probative weight to the VA examiner's opinion, finding the Veteran's own contentions of depression were not supported by objective evidence. The Board also noted the Veteran's diagnosed insomnia disorder, for which he is service-connected, encompassed his mental health symptoms. A private medical opinion linking tinnitus and insomnia to depression was found inadequate due to a lack of specific rationale. The Board denied service connection for depression. For OSA and paroxysmal atrial fibrillation, the Board found the private medical opinion inadequate due to conclusory statements and lack of specific rationale linking the conditions to service-connected tinnitus and hypertension, respectively. The case was remanded for the AOJ to obtain adequate addendum opinions addressing secondary service connection for OSA due to tinnitus and for the heart condition due to hypertension.
Rationale
No objective clinical evidence of depression diagnosis; VA examiner diagnosed insomnia disorder, not depression; Private medical opinion lacked adequate rationale
Full Decision Text
Citation Nr: A26020023 Decision Date: 03/05/26 Archive Date: 03/05/26 DOCKET NO. 250331-523915 DATE: March 5, 2026 ORDER Entitlement to service connection for depression is denied. REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. Entitlement to service connection for paroxysmal atrial fibrillation with pacemaker status post bradycardia and acute atrial flutter with high grade AV block and left bundle branch block is remanded. FINDING OF FACT The Veteran does not have a diagnosis of depression. CONCLUSION OF LAW The criteria for entitlement to service connection for depression have not been met. 38 U.S.C. §§ 1110, 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 May 1960 to May 1962. The rating decisions on appeal were issued in July 2024 and August 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In July 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of OSA and paroxysmal atrial fibrillation with pacemaker status post bradycardia and acute atrial flutter with high grade AV block and left bundle branch block most recently addressed in a June 2024 rating decision. In July 2024, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision. In the August 2024 decision on appeal, the AOJ denied the Veteran's claim of entitlement to service connection for depression. In the March 31, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On October 21, 2025, the Veteran withdrew the hearing request. Therefore, the Board may only consider the evidence of record at the time of the July 2024 and August 2024 AOJ decisions on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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. However, because the Board is remanding the claims of entitlement to service connection for OSA and paroxysmal atrial fibrillation with pacemaker status post bradycardia and acute atrial flutter with high grade AV block and left bundle branch block, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 C.F.R. § 1110; 38 C.F.R. § 3.303. Generally, the evidence must show: (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. Shedden v. Principi,?381 F.3d 1163, 1166-67?(Fed. Cir. 2004). Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C by active service, even if the disability was initially diagnosed after service. 38 C.F.R. § 1110; 38 C.F.R. § 3.303. Generally, the evidence must show: (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. Shedden v. Principi,?381 F.3d 1163, 1166-67?(Fed. Cir. 2004). Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(b) see also Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead holding that "but for" causation or aggravation is sufficient to show entitlement to secondary service connection). 1. Service connection for depression. The Veteran contends that he has depression due to his service-connected tinnitus. See June 2024 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. Additionally, the Veteran's representative contends that the Veteran should be service connected for his diagnosed insomnia disorder, however, the Board notes that this issue is not before the Board, as the Veteran did not elect to appeal that issue. See 38 C.F.R. § 3.2500(a). The Board finds that service connection for depression is not warranted. There is no indication of a diagnosis of depression close in proximity to, or during, the pendency of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). While the Veteran believes he suffers from depression, there is no objective clinical evidence of record confirming a diagnosis of depression during the review period. In July 2024, the Veteran was afforded a VA examination for his claimed depression. The VA examiner noted a diagnosis of insomnia disorder that conformed to DSM-5 criteria. Additionally, the examiner noted the Veteran did not have more than one mental disorder diagnosed. The examiner's medical findings were based on their full consideration of all pertinent medical records and are supported with complete rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board assigns significant probative weight to the July 2024 medical opinion. Overall, the Board finds the Veteran is already service-connected for his only diagnosed mental health disorder (rated as tinnitus with insomnia), which encompasses his mental health symptoms, such as depressed mood. The Veteran submitted the private medical opinion of Dr. J.H.W., who noted the Veteran had been diagnosed with major depressive disorder. Dr. J.H.W. went on to note that there are strong connections between the Veteran's tinnitus and insomnia, and his depressive disorder. Dr. J.H.W. concluded that it is at least as likely as not that the Veteran's "tinnitus and insomnia are significant contributors to his depressive disorder." However, the opinion is inadequate because the clinician failed to provide any rationale for his conclusion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (indicating that most of the probative value of a medical opinion comes from its reasoning). The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F.3d 1328 (1997). In the absence of proof of a present disability there can be no valid claim. While the Board recognizes the Veteran's general contentions that he has depression, the record does not show, nor does the Veteran contend, that he has specialized education, training, or experience that would qualify him to diagnose such a disability. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for depression is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102 104 F.3d 1328 (1997). In the absence of proof of a present disability there can be no valid claim. While the Board recognizes the Veteran's general contentions that he has depression, the record does not show, nor does the Veteran contend, that he has specialized education, training, or experience that would qualify him to diagnose such a disability. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for depression is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 2. Entitlement to service connection for obstructive sleep apnea (OSA). 3. Entitlement to service connection for paroxysmal atrial fibrillation with pacemaker status post bradycardia and acute atrial flutter with high grade AV block and left bundle branch block. The Veteran contends that he has OSA due to service, including as secondary to his service-connected tinnitus. See June 2024 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. Additionally, the Veteran contends that he has paroxysmal atrial fibrillation with pacemaker status post bradycardia and acute atrial flutter with high grade AV block and left bundle branch block due service, including as secondary to his service-connected hypertension. See, e.g., November 2025 Correspondence. The Veteran is diagnosed with obstructive sleep apnea (OSA). See March 2024 VA examination report. Additionally, the Veteran is diagnosed with paroxysmal atrial fibrillation, pacemaker status post bradycardia, and acute atrial flutter with high-grade AV block and left bundle branch block. See March 2024 VA examination report. Accordingly, the key inquiry is whether the current conditions are related to the Veteran's service, including whether they are secondary to his service-connected tinnitus with insomnia disorder and/or hypertension. The Veteran submitted the November 2025 private medical opinion of M.M., D.N.P., C.N.P., who provided a positive nexus opinion for the Veteran's OSA. As rationale, M.M. noted there are definitive links between tinnitus and cited a meta-analysis that noted "a growing body of evidence indicates a possible association between SA and tinnitus." Additionally, the meta-analysis noted "both aging and chronic systemic inflammation have been identified as factors related to both conditions. Moreover, elevated sympathetic activity, commonly observed in patients with tinnitus, has also been liked to SA." M.M. summarized that "patients with tinnitus get irritated from the constant noise and ringing in the ears, which will lead to elevated sympathetic nervous system activity (the fight or flight system), which has been linked to OSA." M.M. concluded that she had reviewed the Veteran military service records and medical files and "Based upon current scientific research and taking the above into account," it was her professional opinion that it is at least as likely as not that the Veteran's OSA is secondary to his tinnitus. However, the medical opinion is not probative for the following reasons. M.M. noted the elevated sympathetic nervous system activity and its link to OSA, but failed to provide any rationale how this contributed to the Veteran's OSA and relates to the specific facts of the Veteran's case, including his medical history. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (indicating that most of the probative value of a medical opinion comes from its reasoning). Overall, the clinician's report of correlation between the two conditions is speculative, at best. M.M. also provided a positive nexus opinion for the Veteran's paroxysmal atrial fibrillation, pacemaker status post bradycardia, and acute atrial flutter with high-grade AV block and left bundle branch block. As rationale, M.M. referenced an article that reported "high blood pressure is the major independent risk factor for atrial fibrillation." M.M. referenced another article that reported hypertension and atrial fibrillation have increased prevalence and are two conditions that often coexist in the same patient. M.M. went on to note that hypertension increases the risk of atrial fibrillation "because of its high prevalence in the population, it accounts for more cases of AF than other risk factors." M.M. noted that "A central role is expressed by the so-called atrial cardiomyopathy, defined as a complex of structural, architectural, contractile, and electrophysiological changes affecting the atrial with the potential to produce clinically relevant manifestations, which may M.M. referenced an article that reported "high blood pressure is the major independent risk factor for atrial fibrillation." M.M. referenced another article that reported hypertension and atrial fibrillation have increased prevalence and are two conditions that often coexist in the same patient. M.M. went on to note that hypertension increases the risk of atrial fibrillation "because of its high prevalence in the population, it accounts for more cases of AF than other risk factors." M.M. noted that "A central role is expressed by the so-called atrial cardiomyopathy, defined as a complex of structural, architectural, contractile, and electrophysiological changes affecting the atrial with the potential to produce clinically relevant manifestations, which may be induced by predominantly hemodynamic and nonhemodynamic mechanism. The predominantly hemodynamic mechanisms include the increase in left ventricular (LV) wall thickness, the rise in LV stiffness, and the impairment in LV diastolic function associated with hypertension...These processes may lead to a rise in LA stretch and pressure, with subsequent remodeling and dysfunction of the LA, ultimately predisposing to AF." M.M. concluded that she reviewed the Veteran's military service records and medical files and "Based upon current scientific research and taking the above into account," it was her professional opinion that it is at least as likely as not that the Veteran's claimed heart condition (AFIB Paroxysmal Atrial Fibrillation with pacemaker status post bradycardia and acute atrial flutter with high grade AV block and left bundle branch block) is secondary to his service-connected hypertension. However, the medical opinion is not probative as it is conclusory. While several medical articles are referenced, the conclusion fails to provide supportive rationale that discusses the cited articles within the context of the specific facts of the Veteran's case. See Nieves-Rodriguez, supra; see also Walsh, supra. The Board finds remand is required to correct a duty to assist error that occurred prior to the July 2024 rating decision on appeal. 38 C.F.R. § 20.802(a). The AOJ obtained the April 2024 and June 2024 medical opinions prior to the July 2024 rating decision on appeal; however, the opinions are not adequate because they failed to address the theories of secondary service connection that were raised prior to the AOJ decision on appeal. Based on the foregoing, the Board finds the AOJ committed a pre-decisional duty to assist error by failing to obtain an adequate medical opinion regarding secondary service connection. Remand is necessary to obtain an adequate medical opinion that addresses secondary service connection due to tinnitus and hypertension. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (indicating that if VA provides an examination, that examination must be adequate). The AOJ's reliance on these opinions constitutes a duty to assist error that must be remedied on remand. 38 C.F.R. § 20.802(a). The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's OSA. The clinician must address the following questions: (a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's OSA was caused by, or is otherwise due to, his tinnitus with insomnia disorder? (b) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's OSA was aggravated by his tinnitus with insomnia disorder? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. 2. Obtain an addendum medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's paroxysmal atrial fibrillation with pacemaker status post bradycardia and acute atrial flutter with high grade AV block and left bundle branch block (heart condition). The clinician must address the following questions: (c) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's claimed heart condition was caused by, or is otherwise due to, his hypertension? (d) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's claimed heart condition was aggravated by his hypertension? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. In providing block (heart condition). The clinician must address the following questions: (c) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's claimed heart condition was caused by, or is otherwise due to, his hypertension? (d) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's claimed heart condition was aggravated by his hypertension? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. In providing the requested opinions, consider the Veteran's description of his in-service symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the likelihood is at least approximately balanced or nearly equal, if not higher. Note that the lack of documented treatment in service, or a long period after, while probative, cannot serve as the sole basis for a ? negative finding. The Veteran's lay contentions must be considered and weighed in making the determination. M. C. WILSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Griggs 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.