MAJOR DEPRESSIVE DISORDER

RAY BARTO SLABBEKORN, JR. · 2026 · Case ID: A26039336

DENIED

Summary

The veteran, who served in the U.S. Army from March 2000 to December 2004, appeals the denial of service connection for an acquired psychiatric disorder, claimed as major depressive disorder, anxiety, sleep disorder, and polysubstance dependence, and for hypertension, claimed as both directly related to service and secondary to the psychiatric disorder. The Board found that the veteran has a current diagnosis of major depressive disorder and that a qualifying in-service event occurred, as noted in service treatment records. However, the Board determined that no medical nexus existed between the veteran's psychiatric condition and his military service. Both the VA C&P examiner and the veteran's own private treatment records pointed to childhood trauma as the primary cause of his psychiatric difficulties. The Board found the VA examiner's opinion persuasive, concluding that the veteran's symptoms were not linked to military experiences. For hypertension, the Board found no evidence of an in-service diagnosis, chronic manifestation, or continuity of symptomatology. The veteran's service treatment records were silent regarding hypertension, and his post-service treatment began years after separation, well outside any presumptive period. The Board also found no evidence of herbicide exposure to support a presumptive claim for hypertension. Direct service connection for hypertension also failed due to lack of in-service evidence or nexus. The Board acknowledged the veteran's testimony regarding in-service stress but found it insufficient without medical corroboration. The benefit-of-the-doubt rule was considered but not applied as the evidence persuasively weighed against service connection for both claims. The claim for polysubstance dependence was not addressed as a primary condition, as it was not service-connected.

Rationale

No competent medical evidence linking acquired psychiatric disorder to active service.; VA and private medical opinions, as well as veteran's testimony, point to childhood trauma as origin.; No evidence establishing acquired psychiatric disorder was caused or aggravated by service.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210830-181561

Full Decision Text

Citation Nr: A26039336
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 210830-181561
DATE: April 28, 2026

ORDER

Entitlement to service connection of an acquired psychiatric disorder, claimed as major depressive disorder, anxiety, sleep disorder, and polysubstance dependence, is denied.

Entitlement to service connection of hypertension, to include as secondary to an acquired psychiatric disorder, is denied.

FINDINGS OF FACT

1. The Veteran's acquired psychiatric disorder is not resultant from active military service.

2. The Veteran's hypertension was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise medically resultant from active service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection of an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

2. The criteria for entitlement to service connection of hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from March 2000 to December 2004.

Procedural History

On September 1, 2020, the Veteran filed a VA Form 21-526EZ claim requesting service connection of, inter alia, a mental condition with depression, anxiety, and sleep disorder, and hypertension, to include as secondary to a mental condition. In an October 2020 Rating Decision, the claims were denied upon finding a lack of medical nexus to active service or to service-connected disability.

In July 2021, the Veteran filed a VA Form 20-0996 Request for Higher Level Review seeking review of the October 2020 Rating Decision. In an August 2021 HLR Rating Decision, the Veteran's claims were again denied based on no nexus to military service.

In an August 2021 VA Form 10182, Decision Review Request: Board Appeal, (Notice of Disagreement), the Veteran elected the Hearing docket. As an appeal in which the Veteran requested, on the Notice of Disagreement, a Board hearing, the Board's decision is based on a review of the evidence of record at the time of the decision on the issue on appeal, evidence submitted by the Veteran or his representative at the hearing, to include testimony provided at the hearing, and evidence submitted by the Veteran or his representative within 90 days following the hearing. 38 C.F.R. § 20.302(a).

Upon review of the record, the Board finds that evidence relevant to the pending appeals was not added during the time frame which the Board may not consider. See Cook v. McDonough, 36 Vet. App. 175 (2023). If the Veteran would like VA to consider any evidence 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.

In June 2025, the Veteran testified at a hearing before the undersigned. This decision reflects the Board's consideration of the testimony, evidence, and information presented at the hearing, and a transcript of the hearing is in the claims file.

Service Connection

Service connection may be established for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection requires evidence showing: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a nexus between the current disability and the disease or injury incurred or aggravated in service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C
in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection requires evidence showing: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a nexus between the current disability and the disease or injury incurred or aggravated in service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d).

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Additionally, service connection may be granted on a presumptive basis for certain diseases associated with exposure to herbicide agents if they manifest to a compensable degree any time after service, in a veteran who had active military, naval, air, or space service, during the period beginning on January 9, 1962, and ending on May 7, 1975, in the Republic of Vietnam. The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, enacted on August 10, 2022, added hypertension to the list of diseases, which are presumptively related to exposure to herbicide agents.

The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Acquired Psychiatric Disorder

The Veteran contends that he suffers from a mental condition with depression, anxiety, and sleep disorder due to the stressful environment of the military post 9/11, DEFCON threat conditions, and fear for his infant son's future in a post 9/11 world. See June 2025 Hearing Transcript. To provide the Veteran with the most favorable reading of his claim, the Board has recharacterized his claim for service connection of a mental condition with anxiety, depression, and sleep disorder, as a claim for service connection of an acquired psychiatric disorder. See Clemons v. Shinseki, 23 Vet. App.1 (Fed. Cir. 2009).

The RO favorable found and the record reflects that the Veteran has a current diagnosis of major depressive disorder. See September 2020 VA Compensation and Pension (C&P) Examination. The RO also favorably found that a qualifying event, injury, or disease had its onset during active service. A July 30, 2004, Report of Medical History dated notes that the Veteran checked yes to trouble sleeping, depression or excessive worry, and that he received drug counseling. In an August 5, 2004, Medical Evaluation Board Report of Medical Examination, the examiner noted mild depression and history of polysubstance abuse. Accordingly, element two is established.

As to a medical nexus, VA treatment records show symptoms and treatment of depression and anxiety and contain a brief medical opinion, provided as part of treatment, as to the genesis of his psychiatric disability. In a September 2012 psychiatric note, the VA provider reported that the Veteran described environmental and developmental stressors as being the most likely cause of mood disturbance, as well as poor familial structure.

In a September 2020 VA medical opinion, the examiner reported that the Veteran did not have significant trauma exposure while in the military. He opined that although the Veteran has significant symptoms of depression, his symptoms cannot
Board Report of Medical Examination, the examiner noted mild depression and history of polysubstance abuse. Accordingly, element two is established.

In a September 2020 VA medical opinion, the examiner reported that the Veteran did not have significant trauma exposure while in the military. He opined that although the Veteran has significant symptoms of depression, his symptoms cannot be linked in any obvious way to military experiences or dynamics. Rather, the examiner concluded that the better explanation is that the many situations the Veteran found himself in as well as the "contributions of a traumatic childhood explain his mood related problems (meaning that the nexus between issues in the service and current issues is less likely than not)."

In support of his claim, the Veteran submitted private mental health treatment records which reflect childhood trauma including physical and psychological abuse and neglect underpinning his psychiatric difficulties. See November 2019 Private Treatment Records. Additionally, the Veteran testified that it was determined that his anxiety, manic depression, and hypertension disabilities are childhood related. See June 2025 Hearing Transcript. He further described experiencing stress during active service with exacerbated periods in the days immediately following the 9/11 terror attacks. The Veteran explained that he did not deploy after 9/11 because he injured his knee prior to deployment and was essentially not deployable.

The Board finds no competent medical evidence linking his acquired psychiatric disorder to active service. The VA medical opinions of record, as well as the Veteran's own testimony, connect his mental health struggles to childhood trauma. The Board recognizes that the Veteran believes his mental health disability is the result of service, but he is not qualified to provide a medical opinion. To be sure, the medical evidence, including his own private treatment records, points to a history of significant childhood trauma as the origin of his psychiatric obstacles.

While the Board does not doubt the Veteran's contentions regarding in-service stress and the military environment post 9/11, there is no evidence establishing his acquired psychiatric disorder is medically resultant from service. In sum, there is no medical evidence of record establishing that the Veteran's acquired psychiatric disorder was caused or aggravated by his active-duty service. Thus, the Board finds that element three is not established and service connection is not warranted.

In reaching this conclusion, the Board has considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38?U.S.C. §?5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch, 21 F.4th at 776; see also Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Here, the evidence persuasively establishes that the Veteran's acquired psychiatric disorder is not the result of active service. Thus, the benefit-of-the-doubt rule does not change the outcome on the issue.

One final note on the Veteran's polysubstance abuse contentions. Alcoholism or drug abuse as a primary condition is not a basis for granting or increasing monetary benefits for compensation or pension under the laws administered by VA. However, if alcoholism or drug abuse is determined to be secondary to service-connected disability, any disease or disability resulting from polysubstance abuse may be eligible for service connection. See 38 C.F.R. § 3.310(a). As the Board has denied the Veteran's claim for service connection of an acquired psychiatric disorder, there is no avenue for consideration of polysubstance abuse. The Board does however recognize that the Veteran has been granted service connection for treatment purposes under 38 U.S.C. Chapter 17 for polysubstance dependence and that award remains undisturbed.

Hypertension

The Veteran alternatively contends that his hypertension is directly resultant from active service, or secondary to an acquired psychiatric disorder. See September 2020 VA Form 21-526EZ, June 2025 Hearing Transcript.

For Veterans who served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as hypertension, are presumed to have been incurred in service if they become manifest to a
disorder, there is no avenue for consideration of polysubstance abuse. The Board does however recognize that the Veteran has been granted service connection for treatment purposes under 38 U.S.C. Chapter 17 for polysubstance dependence and that award remains undisturbed.

Hypertension

For Veterans who served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as hypertension, are presumed to have been incurred in service if they become manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. For chronic diseases listed in 38 C.F.R. § 3.309(a), nexus to service may be established by showing continuity of symptomatology. Walker, 708 F.3d at 1338-40 (Fed. Cir. 2013). The use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. Id.

Service connection may also be established on a presumptive basis for certain diseases including hypertension, if a veteran was exposed to an herbicide agent, such as Agent Orange, during service. See 38 U.S.C. § 1116(a)(1); 38 C.F.R. §§ 3.307, 3.309(e). A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, to include Agent Orange, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. See 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii).

The availability of presumptive service connection for a disability, based on exposure to contaminants does not preclude a veteran from establishing service connection with proof of direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Presumptive Service Connection

The RO favorably found and the record confirms that the Veteran has a current diagnosis of hypertension. As the Board is bound by this determination, element one has been established. 38 C.F.R. § 3.108.

As to eligibility for presumptive service connection under 38 C.F.R. § 3.307(a)(6)(iii), the Board finds no evidence that the Veteran served in the Republic of Vietnam at any point during his period of active service, or that he served in any theater in which exposure to Agent Orange or herbicide agents could be presumed. See DD-214. As the evidence does not support a finding that the Veteran served in Vietnam, the Board cannot concede that the Veteran was exposed to herbicides, to include Agent Orange. The Board finds that the evidence persuasively weighs against finding that the Veteran was exposed to herbicides, to include Agent Orange in service. Therefore, presumptive service connection for diseases associated with herbicide exposure, including hypertension, is not warranted. 38 C.F.R. §§ 3.307(a)(6), 3.309(e).

The next question before the Board is whether the Veteran's currently diagnosed hypertension was shown as chronic in service, manifested to a compensable degree within one year of separating from service, or was noted in service with attributable continuity of symptomatology. The Veteran's service treatment records are absent any notations for complaints of, or treatment for hypertension or related condition. A July 2004 Report of Medical History does not note any diagnosis or defect related to hypertension. See STRs. While the Veteran testified that he experienced hypertension in service, there are no diagnostic findings to support his testimony, and he has not been shown to have medical expertise to provide a hypertension diagnosis. See June 2025 Hearing Transcript. The Veteran's post-service treatment records reflect that the earliest notation of elevated blood pressure in March 2018, with treatment in December 2018.

Accordingly, the Board finds that the Veteran's hypertension was not shown as
with attributable continuity of symptomatology. The Veteran's service treatment records are absent any notations for complaints of, or treatment for hypertension or related condition. A July 2004 Report of Medical History does not note any diagnosis or defect related to hypertension. See STRs. While the Veteran testified that he experienced hypertension in service, there are no diagnostic findings to support his testimony, and he has not been shown to have medical expertise to provide a hypertension diagnosis. See June 2025 Hearing Transcript. The Veteran's post-service treatment records reflect that the earliest notation of elevated blood pressure in March 2018, with treatment in December 2018.

Accordingly, the Board finds that the Veteran's hypertension was not shown as chronic in service, did not manifest to a compensable degree within one year following separation from service, and was not noted in service with attributable continuity of symptomatology. The Veteran's medical records show that the Veteran was diagnosed with hypertension years after his separation from service and well outside the applicable presumptive period. Thus, presumptive service connection for hypertension pursuant to 38 C.F.R. §§ 3.307(a)(3) or 3.309(a) is not warranted.

Direct Service Connection

Having determined that the Veteran has current hypertension the Board now considers direct service connection. The Veteran's STRs contain no complaints of or treatment relating to hypertension or possible manifestation thereof. As noted above, the Veteran testified that he experienced hypertension while in service and self-medicated with exercise, PT and relaxation. Based on the competent evidence in the record, the Board is unable to find that the Veteran incurred an in-service incident, illness, or injury to which the present disability can be medically linked. The Veteran's entrance and medical board examination reports contain no indicia of hypertension. On the contrary, the Veteran's STRs reflect an individual with no evidence of hypertensive impairment.

Post-service treatment records contain a December 2018 diagnosis of hypertension. However, these records do not contain any medical opinions linking the diagnoses with active service. Thus, the Board cannot find any in-service indication of complaint for or treatment for hypertension and on that basis concludes that element two of service connection is not established. The Veteran's report of in-service onset is not established by competent medical evidence, nor does the record contain medical evidence to support an in-service incurrence or continuation of treatment for hypertension. Ultimately, the claim fails based on the second criteria of service connection, namely, there is no evidence of any in-service incident, or injury to which the present disability may be medically linked.

As to element three, a medical nexus, the claims file contains no medical opinion linking the Veteran's hypertension with active service. Moreover, such a large temporal gap in treatment after separation from service weighs heavily against the Veteran's claim. See Kahana v. Shinseki, 24 Vet. App. 428, at 439-40 (2014). Given the absence of medical evidence to establish a relationship between active duty and the Veteran's current symptoms, the Board finds his hypertension is not amenable to service connection. Accordingly, entitlement to direct service connection of hypertension or to presumptive service connection under 38 C.F.R. § 3.309(a) is not warranted and the claims are denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

The Board acknowledges that the Veteran was not afforded a VA examination; however, based on the evidence of record, a VA examination was not warranted. Under McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006), a VA medical examination must be provided when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (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) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). Here, the Veteran has not provided competent evidence establishing that his hypertension occurred in service, that his hypertension manifested during an applicable presumptive period, or that his disability may be associated with service.

The Board recognizes that the evidence required to meet the third element in McLendon is low. Nevertheless, at least an indication must be provided that
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) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). Here, the Veteran has not provided competent evidence establishing that his hypertension occurred in service, that his hypertension manifested during an applicable presumptive period, or that his disability may be associated with service.

The Board recognizes that the evidence required to meet the third element in McLendon is low. Nevertheless, at least an indication must be provided that the currently diagnosed hypertension may be resultant from service. Here, there is no such competent evidence. As the second and third elements of McLendon have not been met, a VA examination is not warranted.

Based on the Board's finding above that the Veteran is not entitled to service connection of an acquired psychiatric disorder, his claim for service connection of hypertension as secondary to an acquired psychiatric disorder fails as a matter of law. Without the psychiatric disability being service connected, hypertension cannot, as a matter of law, be granted service connection as secondary to the psychiatric disability.

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In reaching the above conclusions, the Board has again considered the benefit-of-the-doubt rule. Lynch, 21 F.4th at 776. Here, the evidence persuasively weighs against finding that the Veteran's hypertension disability is the result of active service. Thus, the benefit-of-the-doubt rule does not change the outcome on the issue. Finally, the Board notes that neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017).

RAY BARTO SLABBEKORN, JR.

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Regnart, Glenda 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.

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