Citation Nr: A25041256 Decision Date: 05/06/25 Archive Date: 05/06/25 DOCKET NO. 210927-188112 DATE: May 6, 2025 ORDER Entitlement to service connection for an acquired psychiatric disorder, including major depressive disorder (MDD) and panic disorder, is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, the Veteran's acquired psychiatric disorder, including MDD and panic disorder, at least as likely as not onset during service. 2. Resolving reasonable doubt in the Veteran's favor, the Veteran's acquired psychiatric disorder, including MDD and panic disorder, is at least as likely as not aggravated by her service-connected disabilities including headaches, joint pain, and muscle pain due to undiagnosed illness. CONCLUSIONS OF LAW 1. The criteria for service connection for acquired psychiatric disorder, including MDD and panic disorder, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for acquired psychiatric disorder, including MDD and panic disorder, as secondary to headaches, joint pain, and muscle pain due to undiagnosed illness are 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 had active service from May 1990 to February 1993. This matter comes before the Board of Veterans' Appeals (Board) on the appeal of a November 2020 rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO), which is the agency of original jurisdiction (AOJ). In the September 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. In June 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a July 2019 supplemental claim rating decision. In November 2020, the AOJ issued the HLR decision on appeal, which considered the evidence of record at the time of the prior July 2019 supplemental claim decision and found that new and relevant evidence had been received. Therefore, the Board may only consider the evidence of record at the time of the July 2019 AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or her representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Based on the evidence, the claim for entitlement to service connection for MDD has been expanded to entitlement to service connection for an acquired psychiatric disorder, including MDD and panic disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Entitlement to service connection for an acquired psychiatric disorder, including MDD and panic disorder, is granted. The Veteran contends that her mental health symptoms began in service and were aggravated by various physical conditions due to her service which caused her chronic pain. The Veteran is currently service connected for headaches, joint pain, and muscle pain due to undiagnosed illness, among other disabilities. Service treatment records do not contain complaints of mental health symptoms. The Veteran's enlistment and discharge examinations reflect no mental health related issues. See 08/31/2001 STR - Medical, p. 3 (01/29/1993 discharge examination), p. 30 (01/03/1990 enlistment examination). Treatment records post-service show a history of treatment for depression related symptoms, commencing with one occasion the year after discharge and a few years later due to marital issues. See 06/03/2001 Medical Treatment Record (MTR), p. 49 (12/22/1994 feeling run down, weight gain, and depressed), p. 1 (12/22/1997 depression associated with marital issues). The Veteran began regular treatment for mental health symptoms in 2001 related to chronic pain and was diagnosed at the time with chronic pain disorder associated with both psychological factors and a general medical condition and major depressive episode, single episode moderate. See 10/29/2001 CAPRI, p. 11 (09/18/2001), p. 16 (08/17/2001 low back pain and assessment of probable mild depression); 03/20/2002 CAPRI, pp. 26-27 (09/07/2001 attributes depression to impact of medical problems). In an April 2002 VA examination, the Veteran reported onset of depression symptoms in service due to her husband sending her "hate mail" communicating his intent to divorce and sexual harassment by her sergeant and fellow servicemembers, as one of very few females in her role. Subsequent treatment records reflect worsening of the Veteran's mental health symptoms over the years. In 2012, the Veteran was diagnosed with major depressive episode moderate, adjustment disorder with anxiety and panic attacks. See 12/05/2016 CAPRI, p. 28 (08/24/2012 diagnosis). Depression secondary to being a caregiver for the Veteran's ill mother was also found during at that time. See id., p. 23 (01/08/2013). A July 2019 VA examination provided diagnoses of panic disorder and MDD, single episode mild, with anxious distress. The examiner found the diagnoses to be independent of each other and resulting from separate etiologies, concluding that panic symptoms began in 2013 for unknown reasons, while symptoms of adjustment disorder with mixed anxiety and depressed mood began in 2016 when the Veteran fell ill and lost her employment. The examiner noted the diagnosis relevant to the understanding or management of the mental health disorder was unclear, but may be related to fibromyalgia or an autoimmune disorder. The examiner noted outpatient mental health treatment, including prescribed medications, with VA began in 2010 and has been consistent since that time. The Veteran reported that her husband cheating on her while she was in training, led to their divorce upon her return from service. She endorsed present symptoms of depressed mood, anxiety, panic attacks weekly or less often, chronic sleep impairment, disturbances of mood and motivation, difficulty establishing and maintaining effective work and social relationships, sleep problems, low energy, poor concentration and low self-esteem. The Veteran attributed significant symptoms of depression and anxiety to her illness and inability to work. The VA examiner did not provide an opinion regarding service connection. In September 2021, the Veteran submitted a private expert examination and opinion. See 09/29/2021 VA Examination. The private expert made a diagnosis of MDD with anxious distress. Upon examination, the Veteran endorsed symptoms of depressed mood, anxiety, panic attacks, near continuous panic or depression affecting ability to function independently, appropriately and effectively, chronic sleep impairment, difficulty understanding complex commands, disturbance of mood and motivation, difficulty establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work, inability to establish and maintain effective relationships, and suicidal ideation. The expert reviewed the Veteran's history of service and mental health treatment, noting onset during service due to marital troubles and incidents of sexual harassment. The Veteran reported that when her pain is greater, her anxiety worsens. The expert asserted that the Veteran's pain levels exacerbate her mental health symptoms, citing a body of medical literature finding that depression typically follows the onset of chronic pain, and that depression and pain may share a common pathophysiology as distinct but correlated syndromes. The expert also cited medical studies finding that entry level servicemembers are more susceptible to depression due to unique stressors, including prolonged separation from loved ones and difficulty communicating with primary support system. The expert opined that: 1) the Veteran's MDD with anxious distress more likely than not began in service and has continued uninterrupted to the present; and 2) it is more likely than not that the Veteran's mental health symptoms have been aggravated by her multiple medical conditions. The Veteran also submitted in September 2021 buddy statements from her daughter and partner. Her daughter observed that the Veteran's anxiety increased with pain from her physical health issues. Her partner, who has known the Veteran since shortly after service, asserted that her anxiety was high when they met but worsening with more frequent panic attacks over time, self-isolation, mood swings, anxiety over getting headaches (brought on by anxiety/stress), memory issues, trouble sleeping and nightmares since her time in service. He observed that her physical pain in her muscles and joints were a large source of frustration and sadness for the Veteran. Based on the evidence, the Board finds that the Veteran's acquired psychiatric disorder at least as likely as not onset during service and is aggravated by her service-connected disabilities, including headaches, joint pain, and muscle pain due to undiagnosed illness. The Board finds the private expert's report to be credible and probative. The expert examined the Veteran, reviewed her mental health and medical history, service history, and took into account the Veteran's lay statements regarding her symptoms and onset, as well as the buddy statements of her daughter and partner. Based on this, the expert provided a positive nexus opinion, which applied valid medical analysis to the facts of the Veteran's case to reach an opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Moreover, the expert cited medical literature addressing the predictive relationship between chronic pain, as experienced by the Veteran due to her service-connected conditions, and depression, as well as literature regarding higher levels of depression among entry level servicemembers under similar circumstances to the Veteran when her depression onset in service. On the contrary, the VA examiner provided no nexus opinion for consideration in this matter. Accordingly, after resolving all doubt in the Veteran's favor, the Board finds that the Veteran's acquired psychiatric disorder, including MDD and panic disorder, at least as likely as not onset during service and is at least as likely as not aggravated by her service-connected disabilities, including headaches, joint pain, and muscle pain due to undiagnosed illness. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.310. R. Bisignani Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Brown, Janet A. 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.