Citation Nr: 18160429
Decision Date: 12/26/18	Archive Date: 12/26/18

DOCKET NO. 17-04 106
DATE:	December 26, 2018
Entitlement to service connection for major depressive disorder, to include as secondary to service-connected right hip stress fracture is denied.
The preponderance of the evidence is against finding that the Veteran has major depressive disorder.
The criteria for entitlement to service connection for major depressive disorder have not been met.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 
The Veteran served on active duty from June 2004 to April 2005.
The Veteran is currently service-connected for a right hip stress fracture and asserts that he has major depressive disorder due to pain from his service-connected disability.  
Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110.  Service connection can also be established on a secondary basis for a disability that is proximately due to, or the result of, a service connected disease or injury.  38 C.F.R. § 3.310(a).
The Board concludes that the preponderance of the evidence weighs against finding that the Veteran has major depressive disorder or any other mental health disability as a result of his service-connected right hip fracture.  38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d).
There are conflicting opinions about whether the Veteran has a current mental health disability.  At this juncture, the Board, as finder of fact, must determine, both the weight and credibility of all the evidence of record.  To this end, equal weight is not accorded to each piece of evidence contained in a record; and every item is not considered to have the same probative value.  Rather, the Board must account for the evidence which it finds to be persuasive or unpersuasive, analyze the credibility and probative value of all material evidence submitted by and on behalf of a claimant, and provide the reasons for its rejection of any such evidence.  See Struck v. Brown, 9 Vet. App. 145, 152 (1996).  Here, two medical opinions are of record both provided by medical professionals who are presumed to be competent to provide the opinions rendered.  As such, the Board must determine which evidence is the most probative.
In June 2015 Dr. Uzzell diagnosed the Veteran with major depressive disorder, recurrent.  Dr. Uzzell found that the Veteran’s defining symptom was “depressed mood nearly all day, every day.”  The Veteran was also noted to avoid others because they did not understand his pain and depression, or experience loss of interest in activities he once enjoyed.  Dr. Uzzell found that it was at least as likely as not that the Veteran’s service-connected hip pain contributed to, caused, or aggravated his depression.  As rationale for the opinion, Dr. Uzzell noted that Veteran’s negative outlook about his physical and mental conditions, feelings of hopelessness about the future, and feelings of missing out on things in life.  However, it is noted that Dr. Uzzell gave no indication that the Veteran’s treatment records had been reviewed, nor did Dr. Uzzell suggest any baseline for the depression prior to the hip condition aggravating it.   
An October 2015 VA examiner concluded that the Veteran does not have a mental health diagnosis, to include depression.  The Veteran was noted to spend his time resting and working at night.  He was also noted to spend time with his daughter as often as possible as well as relaxing with friends.  The examiner noted that the Veteran had never taken medications for psychiatric reasons, had no history of mental health treatment, no pending mental health appointments, and no medical history indicating depressive symptoms.  The examiner found that the Veteran did not demonstrate any symptoms of a mental illness, including depression, but over endorsed on questionnaires for various mental health disorders.  Based on responses to depression inquiries, the examiner found the Veteran unable to coherently discuss or endorse major depressive disorder or depressive symptoms.  The examiner found that the Veteran may experience some periods of depression, but had no clinically significant impairment or severity of symptoms to warrant a diagnosis. 
The Board finds the VA examiner’s opinion highly probative and affords it great weight.  The VA examiner’s opinion is grounded in an accurate medical history, the VA claims file, the Veteran’s lay assertions, and objective medical examination.  The rationale also provides an explanation that contains clear conclusions and supporting data.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  Conversely, Dr. Uzzell’s opinion indicates it is grounded in the Veteran’s lay assertions without consideration of the objective medical history or the VA claims file.   
This is important in this case, as VA treatment records document several instances when depression screens were found to be negative between December 2007 and May 2015.  These negative depression screens, including one completed shortly before Dr. Uzzell’s opinion, weigh against finding that the Veteran has a current depressive condition.  Moreover, Dr. Uzzell’s failure to account for the negative screens diminishes the probative value of the opinion.  Also significant, the Veteran’s right hip stress fracture is currently rated as 10 percent disabling, suggesting that disability causes mild impairment, rather than the significant impairment suggested by the Veteran during the June 2015 mental health evaluation.  Finally, the fact remains that the Veteran has experienced his right hip problem since service, but only recently has been alleging that the condition had caused depression.  
While the Veteran believes that he has major depressive disorder related to his service-connected right hip disability, he is not competent to provide an opinion in this case.  The issue is medically complex, requiring knowledge of the body systems and medical diagnostic procedures.  The Veteran has not been shown to possess the training or knowledge necessary to make a medical determination in this case.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).  Consequently, the Board gives more probative weight to the VA examiner’s conclusions.
In this case, the Veteran’s medical records and the VA medical opinion weigh against finding that the Veteran has a current depressive condition.  Accordingly, service connection for major depressive disorder is denied.  

Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	R. I. Sims, Associate Counsel 

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