Citation Nr: 18140887 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 14-00 241 DATE: ORDER Service connection for depression is granted. FINDING OF FACT Resolving doubt in the Veteran’s favor, his depressive disorder is at least as likely as not related to his service-connected back disability. CONCLUSION OF LAW The criteria for secondary service connection for depression have been satisfied. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from May 1981 to September 1995. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection for a disability requires evidence of: (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 in or aggravated by service. 38 C.F.R. § 3.304; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed Cir. 2004). Alternatively, service connection may be granted for a disability which is proximately due to or the result of a service connected disability. 38 C.F.R. § 3.310(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran contends his depression is proximately due to his service connected disabilities, to include in particular, his service-connected scoliosis with spondylolisthesis of the thoracolumbar spine. See March 2010, May 2010, and November 2011 correspondence from the Veteran. The Veteran is also service-connected in pertinent part for left and right lower extremity radiculopathy, ring finger fracture residuals, residuals of a nasal bone fracture, plantar fasciitis with hammer toe. In the April 2011 psychiatry note, the Veteran complained of depression, which he reported as having for 15 years and had increased with all of his medical issues. The Veteran reported he was in constant pain, and that pain medications for his service connected disabilities were not effective. The Veteran also complained of feeling depressed due to an ankle injury because it limited his ability to interact socially and recreationally. The Board of Veterans’ Appeals (Board) observes that the Veteran’s ankle injury is not service connected, nor does the Veteran contend it should be. The provider, Dr. M.O., diagnosed the Veteran with a mood disorder due to a general medical condition, specifically pain and anxiety. In a May 2011 progress note, the Veteran reported his depression was totally related to his physical pain. In December 2013 correspondence from Dr. M.O., he stated the Veteran was being treated for depression connected to his orthopedic conditions. The Veteran was afforded a VA examination in October 2017 to assess whether his psychiatric disability was caused or aggravated by his service connected back disability. The examiner noted that pain caused by the Veteran’s service connected back and bilateral foot condition was relevant to the understanding or management of his mental health disorder. However, the examiner opined that the Veteran’s depressive disorder was less likely than not proximately due to or the result of the Veteran’s service connected condition. By way of rationale, the examiner stated a belief that Dr. M.O.’s December 2013 correspondence, identifying the Veteran had depression connected to orthopedic conditions, was primarily referring to the Veteran’s ankle injury that is not service connected. Upon review of the file, contrary to the opinion of the October 2017 VA examiner, Dr. M.O. did not identify the ankle injury, exclusively, as the cause of the Veteran’s depressive disorder. In the April 2011 psychiatry note, Dr. M.O. opined that the Veteran’s mood disorder was due to pain and anxiety. While at that assessment, the Veteran reported feelings of depression related to his ankle injury because it limited his ability to interact socially and recreationally, but his report pain was associated with his service connected back and foot disabilities. Significantly, and most recently, at a September 27, 2018 VA Psychiatric Consult, a VA physician specified the Veteran had major depressive disorder secondary to a general medical condition identified as his spinal cord injury. The Veteran has consistently attributed his depression to constant back pain. The Board observes that at a prior November 2010 VA spine examination, the Veteran reported his back pain had increased since service and had begun causing constant and severe daily pain. During the appeal period, the Veteran rated the pain from his back condition as ranging from a seven to nine on a scale of one to ten. See March 2010 correspondence from the Veteran, and April 2011 VA psychiatry note. He hurt his back again in 2017, and indicated that the resulting medical complications have severely increased his depressive symptoms. See a September 27, 2018 VA Psychiatric Consult. In light of the Veteran’s competent observations of increased depressive symptoms with increased back pain, and both the positive and negative medical opinion evidence of record, the Board finds that the evidence of record is at the very least in equipoise as to whether the Veteran’s depressive disorder is due to his service-connected disabilities, to specifically include his service-connected back disability. Resolving all doubt in favor of the Veteran, service connection for a depressive disorder is granted. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Mask, Associate Counsel