How the Board ruled on depression and other psychiatric claims, 2021–2025

Depression / psychiatric disorder (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

53.3% granted of 7,620 decided cases (margin of error 52.2–54.5%). 4,064 granted, 3,556 denied, 11,033 sent back to VA (remanded, not decided), 1,445 dismissed.

What convinced the Board in granted cases

• The Board accepted the veteran's consistent, credible account of an in-service event (combat, a crash, an attack) or of psychiatric symptoms that began in or right after service and continued. (7 of 12 decisions read; e.g. A25002752, 22004555, 22060543)
• The Board favored private or treating doctors' opinions based on an interview, the veteran's statements, a full record review, and a clear rationale (sometimes with medical literature), over VA opinions that were internally inconsistent or missed an in-service depression diagnosis. (6 of 12 decisions read; e.g. 24007006, 24009163, 22002779)
• The Board granted when a VA examiner or VA treating psychiatrist tied the diagnosis to service or to the veteran's credible history. (3 of 12 decisions read; e.g. A25038701, 23040850, 22060543)

Common reasons in denied cases

• The Board denied because there was no current psychiatric diagnosis during the claim period, often relying on a VA exam or treatment records that found no diagnosable disorder. (12 of 18 decisions read; e.g. 24009974, A24058447, 21054148)
• The Board found the veteran's own belief about his diagnosis or its cause not competent medical evidence, with no medical opinion supporting a link to service. (5 of 18 decisions read; e.g. A24049417, A21000398, 23017344)
• For PTSD, the Board denied when the veteran did not serve in combat and nothing backed up the claimed in-service stressor. (2 of 18 decisions read, few decisions; e.g. 23036171, 23057696)

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Depression / psychiatric disorder secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

55.6% granted of 888 decided cases (margin of error 52.3–58.9%). 494 granted, 394 denied, 1,475 sent back to VA (remanded, not decided), 64 dismissed.

What convinced the Board in granted cases

• The Board granted when a medical opinion explained how a service-connected condition caused or worsened the mental condition, such as chronic pain from back or joint problems, or lost sleep from tinnitus. (7 of 7 decisions read; e.g. A24001901, 22002725, A21003184)
• Several favorable opinions came from VA examiners themselves, based on an accurate history and the veteran's statements. (2 of 7 decisions read, few decisions; e.g. A25027402, 21043752)
• The veteran's consistent, credible account of how the mental condition began and worsened also supported grants. (2 of 7 decisions read, few decisions; e.g. 21043752, 21020732)

Common reasons in denied cases

• A thorough VA opinion found the mental condition came from something else, such as grief, family stress, an accident, or addiction, and outweighed weaker evidence. (6 of 11 decisions read; e.g. 21019987, 21059946, 21040512)
• There was no current psychiatric diagnosis that met the required criteria. (4 of 11 decisions read; e.g. A24031319, A21010593, A24055163)
• The condition claimed as the cause was not service-connected. (2 of 11 decisions read, few decisions; e.g. 22020670, A24031319)

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Depression / psychiatric disorder secondary to low back (lumbar spine)

Secondary (caused or worsened by a service-connected condition)

63.6% granted of 129 decided cases (margin of error 55.0–71.4%). 82 granted, 47 denied, 127 sent back to VA (remanded, not decided), 6 dismissed.

What convinced the Board in granted cases

• The Board credited medical opinions that explained how the veteran's chronic back pain and physical limits (lost activities, poor sleep, social withdrawal, reduced quality of life) caused or worsened the depression. (7 of 17 decisions read; e.g. A24000682, A21001129, 21040454)
• Positive opinions, often from private or treating providers, got more weight because they reviewed the full record, gave a detailed rationale, and in some cases cited medical literature or test results. (9 of 17 decisions read; e.g. A21006208, 21003084, A24010369)
• Negative VA opinions lost weight when they were conclusory, leaned on a gap in treatment records, skipped the question of aggravation, or used a stricter standard than 'at least as likely as not.' (4 of 17 decisions read; e.g. 21000569, 24026399, 21003084)

Common reasons in denied cases

• The Board found no current psychiatric diagnosis that met DSM-5 criteria during the claim period, so there was no disability to connect to the back. (6 of 17 decisions read; e.g. 22053349, A24027430, A22001624)
• The only support for a link was a private opinion with no explanation, or the veteran's own belief, which the Board said needed medical expertise. (5 of 17 decisions read; e.g. A21004342, 21016567, A24015110)
• A thorough VA opinion went unrebutted and pointed to another cause, such as depression that started before the back problem, a personality disorder, or a major life loss. (4 of 17 decisions read; e.g. 21019987, A21002911, A23017228)

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Depression / psychiatric disorder secondary to tinnitus

Secondary (caused or worsened by a service-connected condition)

54.8% granted of 73 decided cases (margin of error 43.4–65.7%). 40 granted, 33 denied, 119 sent back to VA (remanded, not decided), 9 dismissed.

What convinced the Board in granted cases

• The Board gave strong weight to private opinions from psychologists or psychiatrists who reviewed the file, interviewed the veteran, and explained how tinnitus led to depression or anxiety, such as through lost sleep, sometimes citing research. (7 of 10 decisions read; e.g. 21076162, 24000651, A21003184)
• Favorable opinions often went unrebutted, and negative VA opinions lost weight when they rested on a wrong premise, such as no depression diagnosis, or did not address aggravation. (5 of 10 decisions read; e.g. A21003184, A23000552, 22001709)
• Some grants also drew on VA treatment notes or a VA examiner linking anxiety and insomnia to tinnitus, and on credible statements from family and friends about mood symptoms. (3 of 10 decisions read; e.g. A21008605, 21037160, A24015417)

Common reasons in denied cases

• The most common reason for denial was no current psychiatric diagnosis; the veteran's reports of sadness or stress could not stand in for a diagnosis by a professional. (5 of 11 decisions read; e.g. A22015556, A25010519, A24033045)
• Some denials rested on reasoned VA opinions against a link, or on a private report that lost weight because it skipped an interview and ignored long-standing substance abuse. (3 of 11 decisions read; e.g. 21024120, 21050961, 21027404)
• Other claims failed on a direct theory with no in-service mental health event, or where the veteran missed the exam and only his own belief about the cause remained. (3 of 11 decisions read; e.g. A25024531, A24016806, 24008010)

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Depression / psychiatric disorder secondary to knee

Secondary (caused or worsened by a service-connected condition)

60% granted of 45 decided cases (margin of error 45.5–73.0%). 27 granted, 18 denied, 79 sent back to VA (remanded, not decided), 5 dismissed.

What convinced the Board in granted cases

• The Board granted when a medical opinion explained that chronic knee pain or the knee's limits on walking and standing caused or worsened the veteran's depression. (6 of 11 decisions read; e.g. 21030878, A24027001, A24045918)
• A private opinion outweighed a negative VA opinion when it rested on a psychological evaluation, record review, and the veteran's account, while the VA opinion focused on other causes or missed key findings. (4 of 11 decisions read; e.g. A24045918, A24010369, A25003639)
• VA's own examiners or treating clinicians sometimes supplied the link, tying depression to knee pain, at times with cited medical literature. (3 of 11 decisions read; e.g. A24014984, A24027001, 23025056)

Common reasons in denied cases

• Most denials turned on no current psychiatric diagnosis; VA examiners found no DSM-5 disorder, and the veteran's belief that he had depression was not competent to establish one. (5 of 12 decisions read; e.g. 22045298, 21044641, 21007140)
• No probative medical opinion linked the condition to the knee; opinions in the file were conclusory, lacked rationale, or did not rest on accurate facts. (3 of 12 decisions read; e.g. 21016567, 23002094, 21031400)
• Some claims failed because the knee itself was not service-connected, so there was nothing for the depression to be secondary to. (2 of 12 decisions read, few decisions; e.g. 21031400, 22020670)

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Depression / psychiatric disorder secondary to PTSD

Secondary (caused or worsened by a service-connected condition)

72.7% granted of 33 decided cases (margin of error 55.8–84.9%). 24 granted, 9 denied, 25 sent back to VA (remanded, not decided), 1 dismissed.

What convinced the Board in granted cases

• Where PTSD was service-connected or granted, the Board granted depression or another mood disorder alongside or secondary to it when medical evidence linked them, sometimes with the evidence evenly balanced. (3 of 11 decisions read; e.g. 21009304, 21064600, 21039730)
• Medical opinions carried weight when they were in-depth and used the records and the veteran's statements; a negative VA opinion was rejected when it wrongly assumed there was no current diagnosis. (3 of 11 decisions read; e.g. A24047818, 22002778, A24020443)
• Consistent, credible accounts from the veteran, such as of military sexual trauma or symptom onset, and buddy statements supported grants. (4 of 11 decisions read; e.g. A24047596, 21009304, 21043752)

Common reasons in denied cases

• The Board denied when thorough VA opinions, reviewing the full record, found no link or pointed to other causes, and outweighed brief private remarks. (4 of 11 decisions read; e.g. 21020011, 21059483, 23047537)
• The evidence showed no current psychiatric diagnosis during the claim period. (4 of 11 decisions read; e.g. 21007140, 21064511, 22041178)
• The veteran's own belief about the diagnosis or its cause was not competent medical evidence. (4 of 11 decisions read; e.g. 21054339, 21007140, 21008646)

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Depression / psychiatric disorder secondary to traumatic brain injury (TBI)

Secondary (caused or worsened by a service-connected condition)

Small sample: 23 decided cases, too few for a reliable percentage. 12 granted, 11 denied, 46 sent back to VA (remanded, not decided), 0 dismissed.

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Depression / psychiatric disorder secondary to cancer (other)

Secondary (caused or worsened by a service-connected condition)

Small sample: 22 decided cases, too few for a reliable percentage. 12 granted, 10 denied, 27 sent back to VA (remanded, not decided), 2 dismissed.

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Depression / psychiatric disorder secondary to foot (flat feet / plantar fasciitis)

Secondary (caused or worsened by a service-connected condition)

Small sample: 20 decided cases, too few for a reliable percentage. 9 granted, 11 denied, 27 sent back to VA (remanded, not decided), 1 dismissed.

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Depression / psychiatric disorder secondary to hearing loss

Secondary (caused or worsened by a service-connected condition)

Small sample: 18 decided cases, too few for a reliable percentage. 8 granted, 10 denied, 33 sent back to VA (remanded, not decided), 1 dismissed.

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Depression / psychiatric disorder secondary to sleep apnea

Secondary (caused or worsened by a service-connected condition)

Small sample: 18 decided cases, too few for a reliable percentage. 10 granted, 8 denied, 20 sent back to VA (remanded, not decided), 1 dismissed.

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Depression / psychiatric disorder secondary to Parkinson's disease

Secondary (caused or worsened by a service-connected condition)

Small sample: 15 decided cases, too few for a reliable percentage. 13 granted, 2 denied, 6 sent back to VA (remanded, not decided), 0 dismissed.

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Depression / psychiatric disorder secondary to shoulder

Secondary (caused or worsened by a service-connected condition)

Small sample: 14 decided cases, too few for a reliable percentage. 9 granted, 5 denied, 19 sent back to VA (remanded, not decided), 2 dismissed.

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Depression / psychiatric disorder secondary to skin condition

Secondary (caused or worsened by a service-connected condition)

Small sample: 14 decided cases, too few for a reliable percentage. 3 granted, 11 denied, 13 sent back to VA (remanded, not decided), 1 dismissed.

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Depression / psychiatric disorder secondary to migraine / headaches

Secondary (caused or worsened by a service-connected condition)

Small sample: 13 decided cases, too few for a reliable percentage. 11 granted, 2 denied, 24 sent back to VA (remanded, not decided), 1 dismissed.

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Depression / psychiatric disorder secondary to prostate cancer

Secondary (caused or worsened by a service-connected condition)

Small sample: 13 decided cases, too few for a reliable percentage. 8 granted, 5 denied, 13 sent back to VA (remanded, not decided), 2 dismissed.

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Depression / psychiatric disorder secondary to heart disease

Secondary (caused or worsened by a service-connected condition)

Small sample: 12 decided cases, too few for a reliable percentage. 6 granted, 6 denied, 22 sent back to VA (remanded, not decided), 2 dismissed.

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Depression / psychiatric disorder secondary to asthma / COPD / lung condition

Secondary (caused or worsened by a service-connected condition)

Small sample: 12 decided cases, too few for a reliable percentage. 6 granted, 6 denied, 15 sent back to VA (remanded, not decided), 1 dismissed.

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Depression / psychiatric disorder secondary to diabetes

Secondary (caused or worsened by a service-connected condition)

Small sample: 11 decided cases, too few for a reliable percentage. 6 granted, 5 denied, 14 sent back to VA (remanded, not decided), 1 dismissed.

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