MAJOR DEPRESSIVE DISORDER

A. ISHIZAWAR · 2026 · Case ID: A26025436

MIXED

Summary

The Veteran, who served in the U.S. Navy from July 1985 to May 1987 and again from January 1991 to April 1991, including service in Saudi Arabia during Operation Desert Storm, appeals the denial of service connection for a persistent depressive disorder and insomnia, and seeks service connection for diabetes mellitus. The Board granted service connection for a persistent depressive disorder, finding it etiologically related to service. The decision noted that while service treatment records were silent for mental health complaints, the Veteran's testimony about emotional distress due to separation from her child and the hostile environment in Saudi Arabia, combined with a favorable January 2020 VA examination opinion, supported the grant. The VA examiner opined the depressive disorder was at least as likely as not related to service, and that the Veteran's insomnia was a component of the depressive disorder, not a separate disability. Consequently, the separate claim for insomnia was denied. The claim for diabetes mellitus was remanded for a TERA (Toxic Exposure Risk Activity) medical opinion, as the Veteran is considered a toxic-exposed veteran under the PACT Act due to her service in the Southwest Asia theater of operations, and this exposure may aid in substantiating the diabetes claim.

Rationale

Resolving reasonable doubt in favor of the Veteran.; Positive January 2020 VA medical opinion linked depression to service.; Service treatment records silent for mental health complaints, but consistent with testimony of not seeking clinical help.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210319-148290

Full Decision Text

Citation Nr: A26025436
Decision Date: 03/20/26 Archive Date: 03/20/26

DOCKET NO. 210319-148290
DATE: March 20, 2026

ORDER

Service connection for an acquired psychiatric disorder, to include a persistent depressive disorder, prior to January 15, 2025, is granted.

Entitlement to service connection for insomnia is denied.

REMANDED

Entitlement to service connection for diabetes mellitus is remanded.

FINDINGS OF FACTS

1. Resolving reasonable doubt in favor of the Veteran, the medical evidence suggests that her current persistent depressive disorder is related to her military service.

2. The Veteran does not have a diagnosed insomnia disorder; rather, the persuasive evidence shows her insomnia is a symptom or a component of her now service-connected acquired psychiatric disorder.

CONCLUSIONS OF LAW

1. The criteria for service connection for an acquired psychiatric disorder, to include persistent depressive disorder, prior to January 15, 2025, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for insomnia have not been met. 38 U.S.C. §§ 1110, 1155, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.14.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1985 to May 1987 and from January 1991 to April 1991.

These matters are on appeal to the Board of Veterans' Appeals (Board) from a March 2020 rating decision.

In the March 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held before the undersigned on February 3, 2025.

Therefore, the Board may only consider the evidence of record at the time of the March 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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 claims, 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 claim for diabetes mellitus, 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).

Finally, the Board notes that, while this appeal was pending, the Veteran submitted a VA Form 21-526EZ, Fully Developed Claim, in February 2025 and requested service connection for "Mental Disorders; Anxiety Disorders; Posttraumatic stress disorder." The AOJ adjudicated this claim in a July 2025 rating decision and granted service connection for an unspecified trauma or stressor-related disorder, rated 30 percent, effective January 15, 2025 (the date of an Intent to File that was received prior to the February 2025 claim). All mental disorders, no matter how they are diagnosed, are evaluated under the General Rating Formula for Mental Disorders found under 38 C.F.R. § 4.130. Although the Veteran is now service-connected for an acquired psychiatric disorder, diagnosed as unspecified trauma or stressor-related disorder, from January 15, 2025, the Board finds that the issue of entitlement to service connection for an acquired psychiatric disorder prior to that date remains on appeal. See Concepcion-Maldonado v. Collins, 38 Vet. App. 294, 302 (2025) ("mootness if a case-specific inquiry requiring the Court to reckon with the individual circumstances of the appeal and the implications for appellant's ability to obtain full relief."). In
mental disorders, no matter how they are diagnosed, are evaluated under the General Rating Formula for Mental Disorders found under 38 C.F.R. § 4.130. Although the Veteran is now service-connected for an acquired psychiatric disorder, diagnosed as unspecified trauma or stressor-related disorder, from January 15, 2025, the Board finds that the issue of entitlement to service connection for an acquired psychiatric disorder prior to that date remains on appeal. See Concepcion-Maldonado v. Collins, 38 Vet. App. 294, 302 (2025) ("mootness if a case-specific inquiry requiring the Court to reckon with the individual circumstances of the appeal and the implications for appellant's ability to obtain full relief."). In this regard, the present appeal stems from a VA Form 21-526EZ that was filed on October 7, 2019, in which the Veteran requested service connection for depression and insomnia. Therefore, the Board must still address whether from October 7, 2019, to January 15, 2025, the Veteran is entitled to service connection for an acquired psychiatric disorder.

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).

A Persian Gulf veteran is defined as a veteran who served on active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(e)(1). The Southwest Asia theater of operations refers to Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. Id. § 3.317(e)(2). The period of the Persian Gulf War is from August 2, 1990, through the present. See 38 C.F.R. § 3.2(i).

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, was enacted on August 10, 2022. Section 405 of the PACT Act reduces the threshold for establishing eligibility when considering presumptive service connection for Persian Gulf War veterans. Presumptive conditions under 38 C.F.R. § 3.317(a) and (b) may now manifest to any degree at any time. There is no longer a requirement for a chronic disability to manifest to a degree of 10 percent or more prior to December 31, 2026. The end date is no longer applicable and will be removed in a forthcoming regulation.

In this case, the Veteran's military personnel records shows that she served in Saudi Arabia in 1991. Thus, participation in a toxic exposure risk activity has been conceded.

Persistent Depressive Disorder

The Veteran contends that she developed a persistent depressive disorder with insomnia during her period of active duty. See October 2019 VA 21-526EZ, Fully Developed Claim.

In an October 2019 statement, the Veteran indicated she had to leave her 3-year-old child behind with family due to her deployment to Saudi Arabia. It was hard for her to cope with missing out on his growth and development. More recently, she began seeking help from counselors to resolve her emotions.

The Veteran's service treatment records are silent for any treatment or diagnosis of a mental health condition. Reports of medical history in March 1989 and April 1990 showed that the Veteran denied problems relating to depression, excessive worry, nervousness, or trouble sleeping.

At the February 2025 Board hearing, the Veteran testified that she experienced symptoms such as depression, anxiousness, feelings of withdrawal from others, and difficulty sleeping. The feelings stemmed from being away from her young child and having to sign her parental rights over to her parents. Despite sharing her feelings with her peers, it did not alleviate her depression. All was made worse by the hostile environment in Saudi Arabia. After returning from deployment, the Veteran attempted to return to a normal lifestyle, but she never felt the same.

Post service, the Veteran was provided with a VA examination in January 2020. There, the examiner found that the Veteran exhibited persistent depressive disorder due to longs standing feelings of hopelessness, low mood, low self-esteem, and low energy. She also experienced chronic insomnia as part of her depressive disorder. As background, the Veteran reported that she was raised by her mother's friend through an informal adoption arrangement. She described her childhood as positive. She joined the United States Navy at the age of 18 and participated in Operation Desert Storm. There, she began having trouble sleeping and became very sad and homesick due to the separation from her young son. Post service, she continued to experience depression and insomnia which began during her deployment in the middle east. In conclusion, the examiner opined that it was at least as likely as not that the Veteran's current depression was related to her military service. As rationale, the examiner found that the Veteran likely developed early symptoms of persistent depression disorder, such as sadness, hopelessness and feeling down during her deployment. While these symptoms had waxed and waned over the years, the general diagnosis had been persistent. Additionally, the examiner noted that the Veteran suffered from insomnia, which also began during service; however, the examiner concluded that the insomnia was a component of the persistent depressive disorder and did not require a separate diagnosis.

Considering all the evidence of record and resolving reasonable doubt in favor of the Veteran, the Board concludes that the Veteran's persistent depressive disorder is etiologically related to service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

The Board notes that while the Veteran's service treatment records are silent for documented complaints, diagnosis, or treatment pertaining to a mental health condition, this is consistent with the Veteran's testimony that during service, she only confided in her fellow service members rather than seeking clinical help. The negative evidence is balanced by the positive January 2020 VA medical opinion, which linked the Veteran's current depressive disorder to her service. The record does not contain a contrary negative nexus opinion.

In considering the Veteran's service treatment records, competent and credible lay statements, and the positive January 2020 VA medical opinion, the Board resolves all reasonable doubt in favor of the Veteran and finds that service connection for an acquired psychiatric condition, to include a persistent depressive disorder, prior to January 15, 2025, is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Insomnia

In her pursuit of her service connection claim for a psychiatric condition, the Veteran filed a separate service connection claim for insomnia, which she also relates to her military service.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have a current diagnosis of an insomnia disorder and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

As discussed above, the Veteran's service treatment records are silent for any complaints or treatment relating to insomnia or chronic sleep problems. Reports of medical history in March 1989 and April 1990 showed that the Veteran denied problems relating to excessive worry, nervousness, or trouble sleeping.

Post service, the Veteran was provided with a VA examination in January 2020, wherein she was diagnosed with persistent depressive disorder related to her military service. During the examination, the Veteran recalled having trouble sleeping in service and that she was also sad and homesick because of her separation from her young son. She also reported that at present she got about 4-5 hours of sleep at night and never felt well-rested. On mental status evaluation, the examiner endorsed that the Veteran had chronic sleep impairment. The examiner concluded, however, that although the Veteran experienced chronic insomnia
sleep problems. Reports of medical history in March 1989 and April 1990 showed that the Veteran denied problems relating to excessive worry, nervousness, or trouble sleeping.

Post service, the Veteran was provided with a VA examination in January 2020, wherein she was diagnosed with persistent depressive disorder related to her military service. During the examination, the Veteran recalled having trouble sleeping in service and that she was also sad and homesick because of her separation from her young son. She also reported that at present she got about 4-5 hours of sleep at night and never felt well-rested. On mental status evaluation, the examiner endorsed that the Veteran had chronic sleep impairment. The examiner concluded, however, that although the Veteran experienced chronic insomnia this was a part of her depressive disorder and did not require a separate diagnosis. Thus, a separate diagnosis of insomnia disorder was not rendered.

Overall, the Board finds that the medical evidence persuasively shows that the Veteran's claimed insomnia is a symptom or component of her persistent depressive disorder rather than a standalone disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board emphasizes that while a separate service connection claim may not be granted for insomnia, the symptom or component of insomnia has been encompassed in the Veteran's now service-connected acquired psychiatric disorder, to include persistent depressive disorder. Thus, the separate claim for service connection for insomnia is denied.

REASONS FOR REMAND

Diabetes mellitus

The Veteran seeks service connection for diabetes mellitus as a result of her military service. However, the Board finds that a remand is necessary to correct a regulatory/statutory duty to assist error.

At the February 2025 Board hearing, the Veteran testified that she believed her diabetic symptoms had their onset in service. She recalled often feeling thirsty and having blurry vision during active duty. However, she was never tested for high blood sugar in service. It is her belief that she developed diabetes mellitus long before her official diagnosis.

The Veteran's service treatment records are silent for any complaints suggestive of diabetes mellitus. Her glucose levels were not indicative of abnormal levels. Her separation examination in March 1991 was silent for any abnormalities pertaining to her endocrine system.

Post service, the Veteran was diagnosed with diabetes mellitus and placed on a diabetic diet in November 2013. She was provided with a VA examination in January 2020 in which her diagnosis was affirmed. However, the examiner opined that it was less likely than not that the Veteran's diabetes mellitus was related to her military service because she was not clinically diagnosed with diabetes until 21 years after her separation. Despite the January 2020 VA medical opinion, a remand is necessary for a TERA medical opinion.

Generally, a remand by the Board in the AMA is proper for the correction of (1) duty to assist errors occurring prior to the date of the AOJ decision on appeal (i.e., pre-decisional duty to assist errors) and (2) AOJ errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802(a).

Here, a remand is warranted because, during the pendency of this appeal, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act), was enacted. Pub. L. No. 117-168, 136 Stat. 1759 (2022). The PACT Act defines a "toxic exposed veteran" as, in pertinent part, any veteran who served in a theater of combat operations during a period of war after the Persian Gulf War. 38 U.S.C. § 101(38); 38 C.F.R. § 1710(e)(1).

The AOJ has confirmed that the Veteran served in the Southwest Asia theater of operations during the Gulf War and is therefore a Persian Gulf Veteran as defined in 38 U.S.C. § 1117 and participated in a toxic exposure risk activity (TERA) from August 1990 to July 1991. See December 2020 VA Memo. Thus, he is defined as a "toxic exposed veteran" under the PACT Act, and the Veteran is presumed to have a toxic exposure unless there is affirmative evidence to establish no toxic exposure. There is no affirmative evidence to the contrary. Indeed, based on the ILER- Individual Longitudinal Exposure Record found that due to her participation with Operations Desert Shield and Desert Storm, she may have been exposed to a variety of environmental and chemical hazards that carried potential health risks.

Given the Veteran's TERA exposure due to her service in the Southwest Theater of Operations, a remand is warranted to satisfy the statutory duty that now exists to
A) from August 1990 to July 1991. See December 2020 VA Memo. Thus, he is defined as a "toxic exposed veteran" under the PACT Act, and the Veteran is presumed to have a toxic exposure unless there is affirmative evidence to establish no toxic exposure. There is no affirmative evidence to the contrary. Indeed, based on the ILER- Individual Longitudinal Exposure Record found that due to her participation with Operations Desert Shield and Desert Storm, she may have been exposed to a variety of environmental and chemical hazards that carried potential health risks.

Given the Veteran's TERA exposure due to her service in the Southwest Theater of Operations, a remand is warranted to satisfy the statutory duty that now exists to obtain a TERA opinion, as it may aid in substantiating the Veteran's claim. 38 U.S.C. § 1168.

The matter is REMANDED for the following action:

Obtain a new medical opinion pertaining to the Veteran's diabetes mellitus. The examiner is asked to address the following:

Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's diabetes mellitus had its onset in or is otherwise etiologically related to his military service to include her exposure to environmental hazards associated with service in the Southwest Asia Theater of Operations? Why or why not?

In rendering this opinion, the examiner must consider (1) the total potential exposure through all applicable deployments; and (2) the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

A. ISHIZAWAR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Yeh, Nicole

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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