Citation Nr: 18142775 Decision Date: 10/16/18 Archive Date: 10/16/18 DOCKET NO. 13-16 860 DATE: October 16, 2018 ORDER Entitlement to service connection for a depressive disorder, not otherwise specified (NOS), is granted. FINDING OF FACT The Veteran’s depressive disorder (NOS) is caused by his service-connected enuresis. CONCLUSION OF LAW The criteria for service connection for depressive disorder (NOS) are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active naval service from March 1990 to July 1994. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. In March 2018, the Board requested an advisory medical opinion from the Veterans Health Administration (VHA), which was received in May 2018. Although the Veteran was not sent a copy of the opinion or given an opportunity to submit further evidence or argument, the Board is fully granting his claim in the decision below. Therefore, there is no prejudice to the Veteran. Entitlement to service connection for major depressive disorder The Veteran asserts that his current psychiatric disorder was incurred in service or is etiologically related to his service-connected enuresis. The Veteran’s service treatment records indicate that he complained of “nervousness” in February 1992. In March 1994, he reported experiencing difficulty sleeping and frequent nervousness. It was noted that he was only able to sleep four to five hours at a time and had depression related to the relationship between his wife and his parents. He also indicated that he had nervous trouble as a result of frequently striking his head on the ship overheads due to his height. He was undergoing screening for isolated duty assignment and was found not fit for isolated duty. At his April 1994 separation examination, his psychiatric evaluation was noted as normal. On his April 1994 Report of Medical History, he indicated that he had frequent problems sleeping and nervous problems when under pressure. Private treatment records from a private psychiatrist, Dr. C.P.M, indicate that the Veteran sought treatment in 2000. A February 2004 VA treatment record indicates that the Veteran reported that he began receiving treatment for a depressive syndrome in 2001, after experiencing an occupational psychosocial stressor. He noted that his depression was aggravated by a lumbar spine condition. He was diagnosed with depressive disorder, NOS. In September 2009, the Veteran indicated that his service-connected enuresis hindered his mood and personality. A VA examination was conducted in January 2017. The diagnosis was depressive disorder, NOS. The examiner opined that it was less likely than not that the Veteran’s depressive disorder was incurred in or caused by his active service. Initially, the examiner noted the lack of psychiatric complaints during service and cited medical records that were outside the time period in which the Veteran served. Thus, it was unclear whether the examiner had access to the correct claims file. In February 2017 and March 2017 addendum opinions, the examiner noted that the complaints cited above were “not related to any in-service injury, event or illness.” However, the examiner did not adequately address whether the in-service complaints were early manifestations of the Veteran’s psychiatric disorder or whether his service-connected enuresis caused or aggravated his psychiatric disorder. In March 2018, the Board requested a VHA opinion, which was received in May 2018. The VHA examiner opined that the Veteran’s depressive disorder did not manifest in service, was not related to service, and was not aggravated by his service-connected enuresis. The examiner provided rationale for those opinions. Notwithstanding the foregoing, the examiner provided a positive opinion on the question of whether the Veteran’s depressive disorder was caused by his service-connected enuresis. The examiner explained that he believed enuresis affected the Veteran’s self-image and self-esteem, caused problems in his marriage, caused him to wear adult diapers, and would contribute to his depression. In addition, the examiner stated that his service-connected erectile dysfunction would amplify this problem. The Board finds the VHA examiner’s opinion highly probative. The examiner relied on his own expertise, training, and experience, and provided rationale for his opinion. Therefore, the Board finds that the Veteran’s service-connected enuresis at least as likely as not causes his depressive disorder, NOS and that service connection is warranted on a secondary basis. 38 C.F.R. § 3.310. Accordingly, the Board finds that the evidence for and against the claim of entitlement to service connection for depressive disorder, NOS is at least in equipoise. Therefore, reasonable doubt must be resolved in favor of the Veteran and entitlement to service connection for depressive disorder, NOS is warranted. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Mishalanie, Counsel