Citation Nr: 22018671 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 19-06 157 DATE: March 30, 2022 ORDER Entitlement to service connection for a psychiatric disorder other than posttraumatic stress disorder (PTSD), diagnosed as depressive disorder, as secondary to service-connected left ankle, acute tenosynovitis, osteochondral defect and osteoarthritis is granted. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis of PTSD under the DSM-5 criteria. 2. The Veteran's psychiatric disorder other than PTSD, diagnosed as depressive disorder, is attributable to his service-connected left ankle, acute tenosynovitis, osteochondral defect and osteoarthritis. CONCLUSIONS OF LAW 1. The criteria to establish entitlement to service connection for PTSD have not been met. 38 U.S.C. § 1101, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 4.125. 2. The criteria to establish entitlement to service connection for a psychiatric disorder other than PTSD, diagnosed as depressive disorder, as proximately due to, or the result of, service-connected left ankle, acute tenosynovitis, osteochondral defect and osteoarthritis have been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in the United States Army from March 1971 to June 1971. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2016 rating decision. The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in November 2021. A transcript from that proceeding is associated with the claims file. 1. Entitlement to service connection for a psychiatric disorder, to include PTSD, and as due to service-connected left ankle, acute tenosynovitis, osteochondral defect and osteoarthritis. 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). 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. 2009) (quoting Shedden v. Principi, 38 F.3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in denial of service connection. Service connection may also be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 48 (1995) (en banc). Similar to the requirements for service connection outlined above, service connection for PTSD requires (1) medical evidence establishing a diagnosis of the disorder, (2) credible supporting evidence that the claimed in-service stressor occurred, and (2) a link established by medical evidence between the current symptoms and an in-service stressor. 38 C.F.R. § 3.304(f). 38 C.F.R. § 4.125(a) provides that all psychiatric diagnoses must conform to the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 38 C.F.R. § 3.304(f). Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations that define the term "psychosis" to remove outdated references to the DSM-IV and replace them with references to the recently updated DSM-5. See 79 Fed. Reg. 45, 094 (August 4, 2014). VA adopted as final, without change, this interim rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board on or before August 4, 2014. See Schedule for Rating Disabilities - Mental Disorders and Definition of Psychosis for VA Purposes, 80 Fed. Reg. 14,308 (March 19, 2015). The Board notes that the DSM-5 is applicable in the present case. The pertinent regulation provides that, if the evidence establishes that the Veteran engaged in combat with the enemy and that the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(f)(1). For stressors unrelated to combat that are not based on fear of hostile military or terrorist activity, credible supporting evidence is necessary in order to grant service connection. Such evidence may be obtained from service records or other sources. See Moreau v. Brown, 9 Vet. App. 389 (1996). The United States Court of Appeals for Veterans Claims (Court) has held that the regulatory requirement for "credible supporting evidence" means that "the appellant's testimony, by itself, cannot, as a matter of law, establish the occurrence of a non-combat stressor." Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). Therefore, the Veteran's lay testimony, is insufficient, standing alone, to establish service connection. Cohen v. Brown, 10 Vet. App. 128, 147 (1997). If a stressor claimed by a veteran is related to the Veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. For purposes of this paragraph, "fear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device (IED); vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304(f)(3). Analysis The Veteran contends that he has a psychiatric disorder, to include PTSD, that is related to his active service. The record has also raised the theory that the Veteran has a psychiatric disorder other than PTSD that is secondary to his service-connected left ankle disability. In terms of the Veteran's claimed PTSD, the Veteran has identified an in-service stressor event that involved an explosion occurring while the Veteran was standing outside and having a cigarette during basic training in April 1971. See July 2016 VA Form 21-0781, Statement in Support of Claim for Service Connection for PTSD; October 2018 VA examination. The Veteran reported sustaining a hearing injury and burn to part of his face and eye area as a result of the explosion. The Veteran's service treatment records (STRs) do not show any complaint, treatment, or diagnosis related to a psychiatric disorder. STRs dated in April 1971 indicated that the Veteran complained of burns to both eyes in relation to a heater or stove blowing up. After service, a January 1972 VA general medical examination indicated that the Veteran had normal neurological and psychiatric functioning. Later in December 2014, a VA treatment record noted that a depression and PTSD screening were negative. In an April 2015 VA treatment record, the Veteran reported having chronic left ankle pain for many years and experiencing pain in the medial and lateral ankle joint with ambulation. In a June 2016 VA Form 9 related to the Veteran's separate appeal of his service connection claim for his left ankle disability, he indicated that he experienced left ankle pain on a daily basis. A subsequent February 2016 VA mental health triage note authored by Dr. P., PhD, a graduate psychologist, and cosigned by Dr. S., PhD, a clinical psychologist, stated that it was the Veteran's first in-person mental health appointment, and he had experienced multiple losses recently, including his father and brother. The Veteran also reported a history of traumatic exposure during service related to the fuel burner explosion. The provisional diagnoses were rule out adjustment disorder with mixed anxiety and depression; rule out bereavement versus major depressive disorder; and psychosocial stressors. The assessment noted that it appeared that the Veteran's current depressed mood and anxiety symptoms were most likely attributable to his recent traumatic loss of his brother and additional ongoing psychosocial stressors. A separate February 2016 VA primary care progress note authored by Dr. J., MD, a staff physician, noted an assessment of mood struggles/death of brother. A subsequent March 2016 VA telephone contact signed by Dr. P. and Dr. S. noted that the Veteran attributed his anxiety and episodes of chest pressure to difficulties managing his pain and his wife. The Veteran also believed he had PTSD. The assessment noted that the Veteran appeared to remain focused on external stressors and the use of avoidant coping. The record added that as the Veteran requested a resource that he could read prior to engaging in additional treatment, they discussed the title of a workbook he could order for himself. The assessment did not include a diagnosis for PTSD. Later in March 2016, a VA a primary care telephone contact note from Dr. J. noted "stressors" under "Diagnosis/counseling discussed." The record stated that the Veteran had been seen by Dr. P and was planning to his brother's memorial. The record noted that PTSD was discussed at some length, and the Veteran shared that he was going to obtain a book about PTSD at the recommendation of Dr. P. However, it does not appear that the record noted a diagnosis of PTSD. In a subsequent April 2016 VA mental health note authored by Dr. P. and cosigned by Dr. S., Dr. P. noted diagnoses of unspecified anxiety disorder, psychosocial stressors, and stress management. In June 2016, Dr. P. stated that the Veteran reported an increase in stressor following his cousin's death. The Veteran continued to be concerned about his symptoms of anxiety and believed he might have PTSD. Although the Veteran indicated he wanted to come in and see Dr. P. for an evaluation to assess whether he had PTSD, Dr. P. provided clarification regarding her role in the service connection process and informed the Veteran that the purpose of her evaluation would be to inform treatment planning. After evaluating the Veteran later in a June 2016 mental health initial evaluation note cosigned by Dr. S., Dr. P. noted under the assessment that the Veteran appeared to be experiencing symptoms of depression and anxiety, and bereavement. Dr. P. considered the details of the Veteran's reported stressor and stated that while the Veteran's exposure to an explosion with medical injuries in the military had likely contributed to his overall anxiety and pattern of avoidance, it did not appear that this event contributed to the symptoms that met the full criteria for PTSD. The Board notes in consideration of the fact that Dr. P. was a mental professional and as this conclusion was provided after the May 2013 release of the DSM-5, the Board presumes that it was made in accordance with the DSM-5 criteria. See Cohen v. Brown, 10 Vet. App. 128, 140 (1997). The provisional diagnostic impressions were rule out insomnia, rule out trauma or stressor disorder versus adjustment disorder with mixed anxiety and depression, rule out bereavement, unspecified personality features, and psychosocial stressors. Dr. P. further stated in an addendum that while symptoms may be consistent with PTSD secondary to the Veteran's history of exposure to an explosion, given the context of the Veteran's self-report, these symptoms were likely consistent with distress and anxiety in response to a variety of ongoing psychosocial stressors. Dr. P. stated in a subsequent July 2016 VA mental health note cosigned by Dr. S. that the diagnoses treated during that visit were adjustment disorder with mixed anxiety and depression secondary to psychosocial stressors, rule out trauma or stressor disorder, rule out obsessive compulsive personality disorder, and psychosocial stressors. The assessment indicated that the Dr. P. reviewed the distinction between PTSD versus anxiety with the Veteran. A subsequent September 2016 VA primary care progress note from Dr. J. noted under "stressors/mood" and "mood struggles/death of brother" that the Veteran discussed PTSD and/or had talked about his PTSD with Dr. P. However, Dr. P. did not indicate that the Veteran received a diagnosis for PTSD during this visit. In March 2017, a VA primary care progress note signed by Dr. J. documented mood, PTSD/alcohol under the chief complaint/history of present illness. The record stated that the Veteran continued with stressors. He talked about his brother and his friend who had recently been diagnosed with cancer. The assessment was mood struggles/PTSD. Dr. J. noted that the Veteran had multiple stressors, and he was aware of mental health contacts and had the phone number for Dr. P. Dr. J. added that she engaged in empathic listening as the Veteran discussed PTSD/Vietnam and home struggles. In October 2017, a VA mental health note authored by Dr. P., now a clinical psychologist, noted that the diagnoses treated during that visit were rule out trauma or stressor disorder secondary to stressors and history of explosion, obstructive sleep apnea, and psychosocial stressors. Dr. P. did not document a diagnosis for PTSD. In November 2017, a VA psychology evaluation note indicated that K.A., MA, a psychology intern, met with the Veteran for 1 hour for the second session of a comprehensive assessment. A November 2017 addendum from Dr. P. noted that the Veteran had a diagnosis per the DSM-5 of adjustment disorder with anxiety and depression and chronic knee pain. Dr. P. stated that although she had not met with the Veteran, Dr. P. discussed the case conceptualization and treatment plan; reviewed the note; and concurred with the session summary, clinical formulation, and treatment approach. The associated comprehensive assessment report reflects that the Veteran's current symptoms and his history of stressors were considered. The history of stressors was noted to include bereavement related to the loss of family members and a friend in the past 3 to 4 years, caregiving related to the Veteran's bedridden wife, and the military stressor discussed above concerning the field burner explosion during service. The record noted that the Veteran believed that he had PTSD from this in-service event. The report stated that the administered assessments included a Patient Health Questionnaire, a Generalized Anxiety Disorder 7-Item Scale, a Trial Making Tests A and B, a Repeatable Battery for the Assessment of Neuropsychological Status; and a Test of Memory Malingering. The record noted that with regard to PTSD, although the explosion that the Veteran experienced met the criteria for a Criterion A trauma according the DSM-5, the Veteran did not appear to be experiencing the intrusive symptoms related to the traumatic event. Although the Veteran did demonstrate persistent avoidance of emotional stimuli, negative alterations in cognition and mood, and longstanding alterations in arousal and reactivity, it was unclear that these symptoms were related to the traumatic event and appeared to reflect his response to other psychosocial social stressors (e.g., caregiving, grief, and loss). This pattern was inconsistent with a diagnosis of PTSD and was better described as a stressor-related disorder. The diagnostic impression was adjustment disorder with mixed anxiety and depressed mood, psychosocial stressors, and rule out mild neurocognitive disorder. The assessment was signed by K.A. and Dr. P. Later in a November 2017 VA mental health note co-signed by Dr. P., K.A indicated that she gave the Veteran feedback on the results of the comprehensive assessment as well as the diagnostic impressions and treatment recommendations. The Veteran reported that he did not believe that his memory difficulties were exacerbated by various stressors in his life (e.g., loss, chronic pain, caregiving responsibilities) and was rejecting the provider's treatment recommendations. The Veteran was adamant that he had PTSD and repeatedly requested information about a support group for individuals with PTSD. K.A. indicated under the assessment that she explained why the Veteran's symptoms were inconsistent with a PTSD diagnosis. A subsequent November 2017 VA non-visit consult report noted the Veteran's report that he would go into a room and forget why he went in, he had difficulty concentrating at work, and he felt stressed. The Veteran discussed experiencing trauma during service and feeling frustrated for not being service-connected for PTSD. However, the Veteran also reported that one stressor was chronic pain that included severe ankle, back, and neck pain that worsened after fall a few months ago. The Veteran had experienced chronic pain for over 20 years. Additional stressors included caring for his bedridden wife and the previously discussed losses of family members and a friend. With respect to PTSD, the Veteran reported that he occasionally had flashbacks and endorsed hypervigilance and possible nightmares. The record noted that there were several confounding factors that were likely contributing to the Veteran's memory issues, including sleep, stress, chronic pain/pain medication, and depression. The record did not note a diagnosis for PTSD. In January 2018, a VA primary care telephone contact note authored by Dr. J. noted PTSD under the "Diagnosis/counseling discussed" and only added that Dr. J. encouraged follow up with Dr. P. Ankle, knee, and back pain were also noted as continued issues. On November 13, 2019, a VA treatment record noted that the Veteran had a positive screen for PTSD and a positive primary screen for risk of suicide. A followup note from Dr. J. on November 13, 2019 stated that based on Dr. J.'s review of the mental health screens and evaluation of the Veteran, the Veteran was to be evaluated by mental health. A November 13, 2019, mental health triage evaluation note authored by Dr. P. noted that the Veteran's primary concerns related to the recent death of his wife. The provisional diagnoses were uncomplicated bereavement - disappearance and death of family member; chronic pain syndrome; and depressive disorder, unspecified - major depressive disorder, single episode, unspecified. Dr. P. noted under the assessment that the Veteran had a longstanding history of depression (rule out persistent depressive disorder). The death of the Veteran's wife a few months ago and the Veteran's recent retirement appeared to be significant stressors contributing to an increase in symptom severity. The Veteran's longstanding difficulties with chronic pain also appeared to be exacerbating his difficulties in engaging in pleasurable activities outside of the house. The Veteran was initially afforded a VA examination in connection with his claim in August 2016, and the report indicates that the examiner considered the details from the stressor described above. However, the examiner found that the Veteran did not have a diagnosis for PTSD or any psychiatric disorder under the DSM-5 criteria. The examiner explained that the Veteran did not meet any of the criteria in Criterion C, D, E, or G for a diagnosis of PTSD. Consequently, the August 2016 examiner provided a negative medical opinion. Although the examiner checked the box in the form to indicate that the negative opinion was addressing secondary service connection, the rationale focused on explaining why the Veteran did not meet the DSM-5 criteria for PTSD or any other psychiatric disorder. The examiner noted in a rationale that after an extensive review of the records provided, an interview with the Veteran, and using the standards of the DSM-5; the Veteran did not meet the full DSM-5 diagnostic criteria for PTSD. While his reported stressor might qualify for a diagnosis of PTSD, the Veteran was not reporting the subsequent required symptomatology to meet the criteria for a DSM-5 diagnosis of PTSD. Furthermore, he was not reporting any mental health symptom at a level that would be considered clinically significant and qualify for a diagnosis. He denied ever seeking treatment for a mental health condition. While the Veteran's VA treatment records stated that the Veteran believed he had PTSD, the only provided actual assessment for PTSD from mental health was negative. The examiner noted that the Veteran reported a ten-year career in commercial fishing post-service and successful ownership of his own business for 36 years. He also reported a lifetime of participation in hunting expeditions where he reported that he hunted with a bow and was almost killed multiple times. The Veteran was later provided with an additional VA examination related to his claim in October 2018. Although the examiner considered the Veteran's reported stressor, the examiner determined that the Veteran did not have a diagnosis of PTSD that conformed to the DSM-5 criteria. The examiner noted that the Veteran's symptoms did not meet these diagnostic criteria for PTSD. However, the Veteran did meet the criteria for a diagnosis of depressive disorder due to chronic pain syndrome. The examiner did not diagnose any other psychiatric disorder. Under the section of the report for medical diagnoses that were relevant to the understanding or management of the mental health disorder, the examiner identified different issues from the Veteran's active problem list, including ankle instability. Under the evidence comments, the examiner noted that a review of the VA treatment records showed that the Veteran had participated in mental health treatment. Although VA treatment records showed that the Veteran did not meet the criteria for a diagnosis of PTSD, the Veteran continued to believe that he had PTSD. Examination and testing in November 2017 failed to show that the Veteran met the criteria for a diagnosis of PTSD. The examiner observed that the provider diagnosed adjustment disorder with mixed anxiety and depressed mood related to psychosocial stressors, including loss/grief and caregiving. However, the provider also indicated a possible stressor-related disorder. The examiner additionally considered the negative findings from the August 2016 VA examination. The examiner provided a negative opinion for direct service connection. The examiner noted in the rationale that the Veteran did not meet the DSM-5 criteria for PTSD. However, the Veteran did experience depression with incumbent social and occupational impairment secondary to chronic pain. Therefore, the depressive disorder due to chronic pain syndrome was less likely due to the in-service stressor as this psychiatric disorder was due to the Veteran's chronic pain of other medical conditions. In considering the findings from the appeal period, the Board finds that the conclusions from the August 2016 and October 2018 VA examiners that the Veteran did not meet the DSM-5 criteria for PTSD are highly probative as they made these determinations in consideration of clinical findings, the Veteran's contemporaneous treatment records, and their medical expertise. These findings are also consistent with the conclusions made by the mental health professionals in the Veteran's VA treatment records. Although the Board has considered the notations from Dr. J. in March 2017 and January 2018 suggesting that the Veteran had a diagnosis for PTSD, the Board finds that these records are significantly less probative than the findings from the August 2016 and October 2016 VA examiners as they did not appear to be based on as thorough an evaluation as the examination conducted by these VA examiners. Moreover, the VA treatment records identify Dr. J. as a staff physician treating the Veteran in the course of his primary care and do not indicate that Dr. J. specializes in mental health. The Board finds it significant that the contemporaneous evaluations from the Veteran's VA mental health providers, including the evaluation conducted in November 2017, consistently indicated that the Veteran did not meet the DSM-5 criteria for PTSD. The Board also acknowledges that while the Veteran had a positive PTSD screen in November 2019, the associated VA mental health triage evaluation note reflects that Dr. P. ultimately suggested that provisional diagnoses other than PTSD were consistent with the Veteran's symptoms. The record also shows that although the Veteran initially indicated in a June 2016 statement that his VA doctor told him he had all the markers for PTSD, the Veteran later testified during the November 2021 Board hearing that his providers told him he did not have PTSD when he sought treatment. Consequently, the most probative evidence of record reflects that the Veteran has not received a diagnosis for PTSD that conforms to the DSM-5 at any time during the appeal period or within close proximity thereto. See Martinez-Bodon v. McDonough, No. 2021-1328, 2022 U.S. App. LEXIS 6559 (Mar. 15, 2022); McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). The existence of a current disorder is a required element of a claim for VA disability compensation. 38 U.S.C. § 1110, 1131; Degmetich v. Brown, 104 F.2d 1328, 1332 (1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). To the extent that the Veteran has contended that he currently has PTSD, the Board finds that the Veteran is not competent to provide a diagnosis for such a disorder. Although it is error to categorically reject a lay person as competent to provide a diagnosis, not all questions of diagnosis are subject to non-expert opinion. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Whether a layperson is competent to provide a diagnosis depends on the facts of the particular case. In Davidson, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) drew from its earlier decision in Jandreau v. Nicholson to explain its holding. Id. In that earlier decision, the Federal Circuit stated as follows: "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Federal Circuit provided an example, stating that a layperson would be competent to identify a simple condition such as a broken leg, but not competent to provide evidence as to a more complex medical question such as a form of cancer. Id. at n.4. Also of note is that the Veterans Court has explained that non-expert witnesses are competent to report that which they have observed with their own senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Taking Davidson, Jandreau, and Layno together, leads the Board to the conclusion that the complexity of the question and whether a diagnosis could be rendered based on personal observation are factors in determining whether a non-expert nexus opinion or diagnosis is competent evidence. In the instant case, the question of the whether the Veteran has PTSD is not something that can be determined by mere observation. Nor is this question simple. While the Veteran is competent to report psychological symptoms, the question of the cause of those symptoms is not an observable fact. It requires clinical testing to assess and diagnose the underlying condition and training to make the appropriate interpretations and conclusions about what the testing demonstrates in conjunction with the symptoms reported to determine the cause. Therefore, the Board finds that the Veteran's statements as to the etiology of his current complaints are not competent evidence of nexus or a diagnosis. Based on the above discussion, the Board finds that the evidence persuasively weighs against the Veteran's service connection claim for PTSD. As such, the benefit-of-the-doubt rule does not apply, and the claim is denied. However, the Board finds that the record supports granting entitlement to a psychiatric disorder other than PTSD, diagnosed as depressive disorder, as secondary to his left ankle disability. The October 2018 VA examiner's opinion supports the conclusion that this psychiatric disorder is attributable to the Veteran's chronic pain. In addition, the records discussed above demonstrate that the Veteran's chronic pain includes pain associated with his left ankle disability. Consequently, the October 2018 VA examiner's opinion constitutes probative evidence of an association between the Veteran's depressive disorder and his left ankle disability when considered with the other evidence of record as it addresses the relevant medical question at issue, and it was based on the examiner's understanding of the Veteran's relevant history as well as the examiner's medical expertise. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (providing that an examination is not rendered inadequate where the rationale provided by an examiner did not explicitly lay out the examiner's journey from facts to a conclusion,"); see also Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (stating that medical reports must be read as a whole in the context of the evidence of record). There is also no negative evidence to specifically weigh against such an association. The weight of the evidence therefore supports finding that the Veteran's depressive disorder is at least partly attributable to, or the result of, pain related to his left ankle disability. Consequently, service connection for a psychiatric disorder other than PTSD, diagnosed as depressive disorder, is granted as secondary to service-connected left ankle, acute tenosynovitis, osteochondral defect and osteoarthritis. 38 C.F.R. § 3.310. In reaching this decision, the Board acknowledges that the Veteran has been diagnosed with various psychiatric disorders other than PTSD during the appeal period. However, the benefit sought on appeal is granted in a manner consistent with the fact that the most probative evidence shows that the proper DSM-5 diagnosis for the Veteran's current psychiatric symptoms is depressive disorder. As the Board is granting service connection on this basis, it is unnecessary to address any other theory of entitlement that has been advanced. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.C. Spragins, Counsel 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.