Citation Nr: 21063182 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 17-44 236 DATE: October 13, 2021 ORDER Service connection for major depressive disorder (MDD) is granted. Service connection for migraine headaches claimed as secondary to MDD is denied. Service connection for sleep apnea claimed as secondary to MDD is denied. FINDINGS OF FACT 1. The Veteran's MDD is etiologically related to his active-duty service. 2. The Veteran's migraine headaches are not caused or aggravated by his MDD. 3. The Veteran's sleep apnea is not caused or aggravated by his MDD. CONCLUSIONS OF LAW 1. The criteria for service connection of MDD have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection of migraine headaches have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection of sleep apnea have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1987 to July 1990 and from January 1991 to April 1991. This case comes before the Board of Veterans' Appeals (Board) from a December 2015 rating decision from a Department of Veterans Affairs (VA) regional office (RO). In April 2019, this case was remanded for additional development. All ordered development has been substantially achieved. The Veteran was requested to identify and provide releases for private medical records. He did not respond to the request. Outstanding VA records were associated with the claims folder. Examinations for MDD, sleep apnea, and migraine headaches along with nexus opinions were obtained. Service Connection Generally, service connection may be granted for disability or injury incurred in, or aggravated by, active military service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection for a claimed disorder, there must be (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). In order to establish service connection for a claimed disability on a secondary basis, there must be (1) medical evidence of a current disability; (2) a service-connected disability; and (3) medical evidence of a nexus between the service-connected disease or injury and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). 1. Service Connection for MDD is Granted. The Veteran contends that he is entitled to service connection for his MDD. He relates his MDD's development and symptoms to his service in the Gulf War. The Veteran has a diagnosis of MDD as confirmed by the December 2019 Compensation and Pension examiner. The April 2019 Board remand noted reports of diagnoses of depressive disorder, anxiety, and dissociative disorder. The December 2019 examiner was requested to make all applicable diagnoses for the period on appeal and concluded the Veteran's reported symptoms were all related to a single diagnosis of MDD. The Veteran's personnel records confirm his service in the first Gulf War in 1991. Further, the Veteran's mental health treatment records note intrusive thoughts about dead bodies encountered during his service in the Gulf War as well as recurrent nightmares. The reports are reliable as they were made for the purposes of treatment and are generally consistent with the nature of his service. Thus, an in-service event is established. The final element for service connection is a causal nexus. VA has assisted the Veteran in obtaining a competent opinion on this matter. In this case, the opinion comes from a licensed psychologist who provided the Veteran with an examination in December 2019. The examiner opined that the Veteran's current MDD is at least as likely as not related to his in-service service experiences. The examiner indicated the onset and symptoms of the condition are consistent with development of MDD as due to service. There are no other competent opinions in the claims folder. Therefore, a causal nexus is established. As the evidence is at least in equipoise as to the establishment of the three elements necessary to establish direct service connection, service connection for MDD is granted. 2. Service Connection for Migraine Headaches is Denied The Veteran contends he is entitled to service connection for migraine headaches. He asserts they are secondary to his MDD. No other theory of causation has been raised by the record. The Veteran medical records and a December 2019 Compensation and Pension examination confirm a diagnosis of migraine headaches. As a result of this decision, the Veteran's MDD is a service-connected disability. This leaves the causal nexus as the remaining element for service connection on a secondary basis. This may be established by either proximate causation of the current disability or aggravation of the current disability by the service-connected MDD. This is a medically complex question and the Veteran is not competent to render an opinion. The only competent opinion in the claims folder is from a December 2019 examiner who concluded that after reviewing the Veteran's entire claims folder and conducting an in-person examination there was no evidence linking the migraine headache disorder to his MDD or any psychological disorder. The examiner further concluded that there was no evidence to indicate the Veteran's migraines were aggravated by MDD or any other psychological disorder. The examiner acknowledged the Veteran's report of simultaneous on-set of migraines and a psychological disorder and reviewed relevant medical literature. This opinion is complete and consistent with the record, and, thus, entitled to significant probative value. Therefore, the preponderance of the evidence is against establishing a causal nexus between the Veteran's MDD and migraine headaches, as MDD neither caused nor aggravated the migraine headaches. As the weight of the evidence is against finding a causal nexus, service-connection must be denied. 3. Service Connection for Sleep Apnea is Denied The Veteran contends he is entitled to service connection for sleep apnea. He asserts it is secondary to his MDD. No other theory of service connection has been raised by the record. The Veteran's treatment records, including a June 2015 sleep study and a December 2019 Compensation and Pension examination confirm a diagnosis of sleep apnea. As a result of this decision, the Veteran's MDD is service connected. VA provided the Veteran with a Compensation and Pension examination and obtained a competent opinion in December 2019. The examiner stated that there was no evidence support a finding that the Veteran's sleep apnea was caused by MDD. Additionally, there was no evidence that the Veteran's sleep apnea had been aggravated by MDD. The examiner considered the entire record, the in-person examination, and relevant medical literature. The examiner acknowledged the Veteran's report that the onset of symptoms occurred after the reported onset of the psychiatric disorder eventually diagnosed as sleep apnea. However, the evidence did not show a causal relationship. Further, while medical literature notes that sleep apnea may aggravate MDD, it does not support a conclusion that MDD can aggravate sleep apnea. The opinion is complete and consistent with the record and, thus, entitled to a significant weight. Therefore, the preponderance of the evidence is against establishing a causal nexus between the Veteran's MDD and sleep apnea, as MDD neither caused nor aggravated the sleep apnea. (CONTINUED ON NEXT PAGE) As the weight of the evidence is against finding a causal nexus, service-connection must be denied. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Reed, Counsel The Board's decision is only binding on this case. This action is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.