MAJOR DEPRESSIVE DISORDER

Summary

The Veteran served from September 1974 to January 1993. This case involves appeals for service connection for Major Depressive Disorder (MDD), pseudofolliculitis barbae, and left foot plantar fasciitis. The Veteran claimed MDD was secondary to service-connected hearing loss and lumbar degenerative joint disease. Pseudofolliculitis barbae was claimed as having an in-service onset, and left foot plantar fasciitis was claimed as a result of in-service foot injuries and favoring the left foot due to right foot pain. Key evidence included a private medical opinion from January 2021, which found the Veteran's hearing impairment and lumbar degenerative joint disease likely contributed to his MDD. A VA examiner in April 2021 opined less likely than not that MDD was related to service-connected disabilities, but the Board found this opinion applied the wrong standard of proof and gave substantial weight to the private opinion, applying the benefit of the doubt doctrine to grant service connection for MDD. For pseudofolliculitis barbae, the Board found in-service treatment and onset, granting service connection. For left foot plantar fasciitis, the Board noted the Veteran's testimony about bilateral foot pain and the VA examiner's opinion that right foot plantar fasciitis was a progression of an in-service condition, concluding this logic should extend to the left foot, granting service connection. Service connection for MDD, pseudofolliculitis barbae, and left foot plantar fasciitis were all granted.

Rationale

Secondary service connection granted; Private medical opinion found persuasive; Benefit of the doubt applied

Full Decision Text

Citation Nr: A26033138
Decision Date: 04/09/26	Archive Date: 04/09/26

DOCKET NO. 210621-167087
DATE: April 9, 2026

ORDER

Entitlement to service connection for Major Depressive Disorder (depressive disorder) is granted.

Entitlement to service connection for pseudofolliculitis barbae is granted.

Entitlement to service connection for left foot plantar fasciitis is granted.

FINDINGS OF FACT

1. The Veteran's depressive disorder was caused by his service-connected bilateral hearing loss and degenerative joint disease of the lumbar spine. 

2. The Veteran's pseudofolliculitis barbae had its onset in service.

3. The Veteran's left foot plantar fasciitis was caused by in-service foot injuries.

CONCLUSIONS OF LAW

1. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for depressive disorder, secondary to bilateral hearing loss and degenerative joint disease of the lumbar spine have been met.? 38?U.S.C. §§1110, 5107(b); 38?C.F.R. §?3.102, 3.303, 3.310.?? 

2. The criteria for service connection for pseudofolliculitis barbae have been met. 38?U.S.C. §§ 1110; 5107(b); 38?C.F.R. § 3.102, 3.303. 

3. The criteria for service connection for left foot plantar fasciitis have been met. 38?U.S.C. §§ 1110; 5107(b); 38?C.F.R. § 3.102, 3.303. 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1974 to January 1993. The Board appreciates his lengthy service to our country, and the sacrifices it necessarily entailed.  

This case comes before the Board of Veterans' Appeals (Board) from an April 2021 rating decision by the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).  In that decision, the AOJ denied entitlement to service connection for depressive disorder, pseudofolliculitis barbae, and left foot plantar fasciitis after the Veteran filed a December 2020 VA Form 21-526EZ.

In the June 21, 2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on April 8, 2025.

Therefore, the Board may only consider the evidence of record at the time of the April 2021 AOJ decision on appeal, as well as any evidence provided during or within 90 days following the hearing. 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. 

General Legal Principles 

A disability is service connected if it resulted from an in-service injury, disease, or event. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. If a disability's onset occurs during service, it is service connected based simply on the timing of the disability. 38 C.F.R. § 303(a); Flynn v. Brown, 6 Vet. App. 500, 503 (1994) (noting "a simple temporal relationship between the incurrence of the disability and the period of active duty" establishes service connection).  

If onset occurs after separation from service, then the Veteran must show a "but-for" relationship between their service and a present disability-that is, if not for their military service, they would not have the disability in question. 38 U.S.C. § 1110; Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023).

The link between a disability and service may be demonstrated in a variety of ways, but the simplest is known as "direct" service connection, which is established by evidence of three elements: (1) an in-service injury, disease, or event; (
 of the disability and the period of active duty" establishes service connection).  

If onset occurs after separation from service, then the Veteran must show a "but-for" relationship between their service and a present disability-that is, if not for their military service, they would not have the disability in question. 38 U.S.C. § 1110; Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023).

The link between a disability and service may be demonstrated in a variety of ways, but the simplest is known as "direct" service connection, which is established by evidence of three elements: (1) an in-service injury, disease, or event; (2) a present disability; and, (3) a cause-and-effect relationship, or nexus, between the two.  38 C.F.R. § 3.303(d); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

When a service-connected disability causes another disability, the second disability is also service connected. Thus, this is referred to as "secondary service connection," and it is established by showing three elements: (1) the existence of a disability that is already service connected; (2) the existence of another disability; and, (3) a cause-and-effect relationship between the service-connected, or primary, disability and the claimed, or secondary, disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7?Vet. App.?439, 448 (1995) (en banc). 

1. Entitlement to service connection for depressive disorder is granted.

The Veteran contends that his depressive disorder is caused by his bilateral hearing loss and degenerative joint disease of the lumbar spine. In the February 2012 rating decision, the Veteran was granted service connection for bilateral hearing loss and degenerative joint disease of the lumbar spine.

Additionally, in the April 2021 rating decision, the AOJ favorably found that the Veteran had a diagnosis of depressive disorder.  Consequently, the first two criteria?for secondary?service?connection?have been met.? 

In a January 2021 private medical opinion, an examiner opined that it was at least as likely as not that it was is at least as likely as not that the Veteran's hearing impairment and degenerative joint disease of the lumbar spine contributed his depressive disorder.

In contrast, in an April 2021 VA opinion, the examiner found that it was less likely than not that the Veteran's depressive disorder was related to his service-connected disabilities. In coming to his conclusion, the examiner acknowledged the Veteran's statements indicated that his symptoms began after back surgery, though they were exacerbated after the death of his wife. The examiner also noted a previous psychiatric evaluation indicated Veteran's hearing loss contributed to his symptoms. 

The Board assigns substantial probative weight?to both the January 2021 private opinion and the April 2021 VA opinion as both examiners based their rationale in the context of the evidence of record.?Nieves-Rodriguez v. Peake,?22?Vet. App.?295, 304?(2008) (most of the probative value of a medical opinion comes from its reasoning);?Acevedo v. Shinseki,?25?Vet. App.?286, 294?(2012) (medical reports must be read as a whole and in the context of the evidence of record). 

However, it appears the VA examiner applied the wrong standard of proof in drawing his ultimate conclusions, in that under a but-for causation standard, a disability may have multiple causes, and thus establishing one but-for cause does not inherently eliminate other potential but-for causes. Spicer, 61 F.4th at 1364, citing Bostock v. Clayton Cnty., Ga., 590 U.S. 644, 656 (2020). 

Moreover, the benefit of the doubt doctrine does not require a definitive conclusion that requires a certain level of confidence or that the depressive disorder be conclusively attributed?to?one specific cause. Wise v. Shinseki, 26?Vet. App.?517, 531 (2014) ("in keeping" with the benefit of the doubt rule, which is the standard of proof for veterans benefits, "Congress has not mandated that a medical principal must have reached the level of scientific consensus to support a claim for veterans benefits").? Rather, the evidence need only be nearly equal or approximately balanced as?to?whether the Veteran's bilateral hearing loss and degenerative joint disease of the lumbar spine are each one cause of the Veteran's depressive disorder.?38 U.S.C. § 5107(b);?38 C.F.R. § 3.
 the depressive disorder be conclusively attributed?to?one specific cause. Wise v. Shinseki, 26?Vet. App.?517, 531 (2014) ("in keeping" with the benefit of the doubt rule, which is the standard of proof for veterans benefits, "Congress has not mandated that a medical principal must have reached the level of scientific consensus to support a claim for veterans benefits").? Rather, the evidence need only be nearly equal or approximately balanced as?to?whether the Veteran's bilateral hearing loss and degenerative joint disease of the lumbar spine are each one cause of the Veteran's depressive disorder.?38 U.S.C. § 5107(b);?38 C.F.R. § 3.102. The January 2021 medical opinion meets this standard.? 

This appeal is granted.

2. Entitlement to service connection for pseudofolliculitis barbae is granted.

The March 2021 VA examination contains a diagnosis of pseudofolliculitis barbae.  The current disability requirement has thus been met.

During the Veteran's April 2025 hearing, the Veteran testified that when he began his service he started shaving and then began having symptoms of pseudofolliculitis barbae to include ingrown hairs and painful bumps. Further, the Veteran reported that he was given a shaving profile during service. However, later on in his military career he began using Magic Shave to facilitate his ability to shave without experiencing painful razor burn. The use of Magic Shave resulted in burning and skin discoloration. The Veteran reported after service he maintained a short beard up to the present time to avoid painful razor bumps and the use of Magic Shave. The Veteran indicated that without maintaining a beard his symptoms of pseudofolliculitis barbae would return. 

In the April 2021 rating decision, the AOJ favorably found the Veteran was treated for pseudofolliculitis barbae during service. 

In-service onset of a present disability has thus been established, warranting service connection under 38 C.F.R. § 3.303(a), Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006), and Flynn, 6 Vet. App. at 503.

This appeal is granted.

3. Entitlement to service connection for left foot plantar fasciitis is granted.

During the Veteran's April 2025 hearing the Veteran reported his military occupational specialty (MOS) was infantryman. Further, the Veteran reported that during his more than eighteen-year military career he frequently performed twelve-mile marches and performed physical training every morning. As a result, his right foot developed pain and he switched to favoring his left foot. The Veteran reported that he developed similar symptoms of pain and tenderness in his left foot that have continued to the present. Further, the Veteran noted that during service and to the present he began wearing orthopedic shoes to help mediate his symptoms. 

The Board emphasizes at the outset of its analysis that the Veteran has bilateral plantar fasciitis.  See April 2021 Rating Decision Narrative. See also April 2005 Internal Medicine Outpatient Note from the Fayetteville, NC, VA Medical Center, which is included in a document labelled as "March 2021 C&P Exam" in the record.

Consistent with the 2005 diagnosis, during the March 2021 examination, the examiner found identical symptoms for each foot in terms of pain and tenderness. The Veteran experienced pain in both feet during active motion, passive motion, and weight bearing.  Both feet were subject to identical frequency and severity of flare ups.  Most importantly, the history provided by the Veteran did not differentiate between his two sides-he described aching and throbbing pain in both feet beginning in 1993 while serving as a drill instructor. See March 2021 Foot Conditions Disability Benefits Questionnaire (DBQ).  

The similarities between the Veteran's feet are critically important here because he has been granted service connection for plantar fasciitis of the right foot.  See April 2021 Rating Decision Narrative.  The same examiner who completed the March 2021 DBQ also provided a medical opinion. That opinion was limited, however, to the Veteran's right foot only-there is no mention whatsoever in that opinion of the left foot. Thus, the examiner did not opine that that Veteran's left foot plantar fasciitis was unrelated to service-they were silent as to the issue, and their logic that led to their conclusion that the right foot plantar fasciitis was service connected was at least partly applicable to both feet. Specifically, they wrote, "Records showed that the veteran was diagnosed with plantar fasciitis and treated with shoe inserts while on active duty. The current diagnosis of plantar fasciitis
 Rating Decision Narrative.  The same examiner who completed the March 2021 DBQ also provided a medical opinion. That opinion was limited, however, to the Veteran's right foot only-there is no mention whatsoever in that opinion of the left foot. Thus, the examiner did not opine that that Veteran's left foot plantar fasciitis was unrelated to service-they were silent as to the issue, and their logic that led to their conclusion that the right foot plantar fasciitis was service connected was at least partly applicable to both feet. Specifically, they wrote, "Records showed that the veteran was diagnosed with plantar fasciitis and treated with shoe inserts while on active duty. The current diagnosis of plantar fasciitis is at least as likely as not a progression of the same foot condition diagnosed while veteran was in military service." See March 2021 C&P Exam.

Based on the Veteran's testimony and supporting medical records, the VA examiner's conclusions as to service connection for the Veteran's right foot plantar fasciitis should have been applied to both feet.  Service connection for plantar fascitis of the left foot is therefore warranted.

This appeal is granted. 

 

Timothy Cothrel

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J.D. Strain, Associate Counsel

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.