Citation Nr: 18147027
Decision Date: 11/02/18	Archive Date: 11/02/18

DOCKET NO. 14-17 425
DATE:	November 2, 2018
ORDER
Service connection for major depressive disorder as secondary to chronic pain from service-connected disabilities is granted.
FINDING OF FACT
The Veteran’s chronic pain from service-connected disabilities is at least as likely as not a cause of his major depressive disorder.
CONCLUSION OF LAW
The criteria for service connection for major depressive disorder have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran served on active duty from November 1977 to November 1980 and from July 1981 to May 1990.  
The case is on appeal from a February 2013 rating decision.
In March 2017, the Veteran and his spouse testified at a Board hearing.
Service connection for major depressive disorder.
Legal Criteria
Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service.  See 38 U.S.C. § 1131; 38 C.F.R. § 3.303.  “To establish a right to compensation for a present disability, a veteran must show: “(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 or aggravated during service”—the so-called “nexus” requirement.”  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).
Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury.  See 38 C.F.R. § 3.310.
Analysis
The Veteran is currently service connected for physical disabilities involving the left ankle, both knees, and left hip.  He is claiming that his diagnosed major depressive disorder has been caused or aggravated by his service-connected disabilities.  Specifically, he contends that the pain he experiences because of those disabilities has made him unable to help around the house, keep up with family activities, or work consistently.  Though the Veteran has been diagnosed with posttraumatic stress disorder (PTSD), he is not claiming service connection for PTSD.
VA treatment records show that the Veteran has undergone mental health treatment since April 2010.  In these sessions, he has discussed coping with pain for service-connected disabilities, along with financial concerns, worries related to his (non-service-connected) stroke, and the death of his son in the 1990s.
In June 2012, the Veteran was afforded a VA examination.  The diagnoses recurrent, mild, major depressive disorder and personality disorder NOS with antisocial traits.  The examiner stated that the Veteran’s major depression was not connected to his ankle injury, but rather his personality disorder not otherwise specified with antisocial traits.  However, the Veteran is also service connected for several other disabilities and additional mental health treatment records are now in the claims file.  
Thereafter, in May 2018, the Board obtained an expert medical opinion from the Veterans Health Administration (VHA) to address the Veteran’s claim.  The VA clinical psychologist who provided the medical opinion stated that, based on the medical records and lay statements, the Veteran continues to endorse depression as due to chronic pain, but that the Veteran’s depression also has other causes including nonservice-connected disabilities and financial concerns.  
Although the Veteran’s major depressive disorder appears to have multiple causes, when resolving reasonable doubt in his favor, the Board finds that his chronic pain from service-connected disabilities is at least as likely as not a cause of his major depressive disorder.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  Accordingly, service connection for major depressive disorder is warranted on a secondary basis.  If there is a question as to which specific symptoms manifesting from major depressive disorder are due to service-connected disability or nonservice-connected causes, it will be addressed as a downstream issue when the RO assigns a rating.

 
RYAN T. KESSEL
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. George