Citation Nr: 1007146	
Decision Date: 02/26/10    Archive Date: 03/05/10

DOCKET NO.  07-10 555	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Atlanta, 
Georgia


THE ISSUES

1.  Entitlement to service connection for a skin rash.

2.  Entitlement to service connection for boils.

3.  Entitlement to service connection for residuals of a head 
injury with nerve damage.

4.  Entitlement to service connection for headaches.

5.  Entitlement to service connection for an acquired 
psychiatric disorder, to include depression and/or 
posttraumatic stress disorder.  


REPRESENTATION

Appellant represented by:	Georgia Department of Veterans 
Services


WITNESS AT HEARING ON APPEAL

Appellant


ATTORNEY FOR THE BOARD

Michael Martin, Counsel


INTRODUCTION

The Veteran had active service from July 1990 to March 1994.  

This matter came before the Board of Veterans' Appeals 
(Board) on appeal from a decision by the Department of 
Veterans Affairs (VA) Atlanta, Georgia, Regional Office (RO).  

A hearing was held at the RO before the undersigned acting 
Veterans Law Judge in October 2009.  

Please note this appeal has been advanced on the Board's 
docket pursuant to 38 C.F.R. § 20.900(c) (2009).  38 U.S.C.A. 
§ 7107(a)(2) (West 2002).

The issues of service connection for a skin rash, boils, a 
head injury with nerve damage and an acquired psychiatric 
disorder are addressed in the REMAND portion of the decision 
below and are REMANDED to the RO via the Appeals Management 
Center (AMC), in Washington, DC.


FINDINGS OF FACT

1.  The Veteran sustained a head injury in service, and was 
subsequently treated for chronic headaches on an ongoing 
basis.

2.  The Veteran has presented a credible account of 
continuity of symptomatology of headaches since service, and 
he has a current diagnosis of headaches.  


CONCLUSION OF LAW

A chronic headache disorder was incurred in service.  
38 U.S.C.A. §§ 1110, 1117, 5107 (West 2002), 38 C.F.R. 
§§ 3.102, 3.303, 3.317 (2009).


REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

In this decision, the Board grants service connection for a 
headache disorder, which constitutes a complete grant of the 
benefit sought on appeal.  As such, no discussion of VA's 
duty to notify and assist is necessary.

Service connection may be established for disability 
resulting from personal injury suffered or disease contracted 
in line of duty, or for aggravation of a pre-existing injury 
suffered or disease contracted in line of duty.  38 U.S.C.A. 
§§ 1110, 1131; 38 C.F.R. § 3.303.  

With chronic disease shown as such in service (or within the 
presumptive period under Sec. 3.307) so as to permit a 
finding of service connection, subsequent manifestations of 
the same chronic disease at any later date, however remote, 
are service connected, unless clearly attributable to 
intercurrent causes.  This rule does not mean that any 
manifestation of joint pain, any abnormality of heart action 
or heart sounds, any urinary findings of casts, or any cough, 
in service will permit service connection of arthritis, 
disease of the heart, nephritis, or pulmonary disease, first 
shown as a clear-cut clinical entity, at some later date.  
For the showing of chronic disease in service there is 
required a combination of manifestations sufficient to 
identify the disease entity, and sufficient observation to 
establish chronicity at the time, as distinguished from 
merely isolated findings or a diagnosis including the word 
``Chronic.''  When the disease identity is established 
(leprosy, tuberculosis, multiple sclerosis, etc.), there is 
no requirement of evidentiary showing of continuity.  
Continuity of symptomatology is required only where the 
condition noted during service (or in the presumptive period) 
is not, in fact, shown to be chronic or where the diagnosis 
of chronicity may be legitimately questioned.  When the fact 
of chronicity in service is not adequately supported, then a 
showing of continuity after discharge is required to support 
the claim.  38 C.F.R. § 3.303(b).

The Veteran's service treatment records show that in June 
1991 he underwent repair of a laceration of the head after 
being cut by a glass bottle.  He received 9 stitches to the 
forehead.  Subsequent records reflect complaints of ongoing 
headaches.  A consultation record dated in September 1991 
notes a diagnosis of probable post traumatic headaches.  A 
record dated in October 1991 notes a diagnosis of post 
concussion syndrome.  In that record it was noted that he had 
given a history of persisting headaches since a head injury 
in June 1991.  A service neurology record dated in December 
1991 notes a diagnosis of post traumatic neuroma right 
forehead.  

During the hearing held in October 2009, the Veteran 
testified that he had experienced headaches ever since the 
head injury in service.  He reported that he constantly had 
head pain which varied in degree.  He said that as he got 
older, the pain increased.  He reported that when he was 
younger he treated it with Tylenol, and that a doctor had now 
given him medication for the pain.  

A letter dated in May 2006 from a VA physician indicates that 
the Veteran suffers from chronic headaches.  It was noted 
that he had a history of post concussion syndrome and chronic 
headaches starting after a head injury in the military in 
1991.  In a letter dated in August 2006, a VA neurology 
resident stated that the Veteran was followed in the 
neurology clinic for daily chronic headaches.  However, this 
physician stated that this was most likely secondary to 
overdose of NSAID medications.  

In adjudicating this claim, the Board must assess the 
veteran's competence to report the onset of symptoms during 
service as well as of suffering from that condition since 
that time, and his credibility.  See Washington v. Nicholson, 
19 Vet. App. 362, 368-69 (2005). The Board is charged with 
the duty to assess the credibility and weight given to 
evidence.  Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 
1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. 
Principi, 15 Vet. App. 362, 367 (2001).  Indeed, in Jefferson 
v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United 
States Court of Appeals for the Federal Circuit (Federal 
Circuit), citing its decision in Madden, recognized that that 
Board had inherent fact-finding ability.  Id. at 1076; see 
also 38 U.S.C.A. § 7104(a).  Moreover, the Court has declared 
that in adjudicating a claim, the Board has the 
responsibility to weigh and assess the evidence.  Bryan v. 
West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 
Vet. App. 614, 618 (1992).  In determining whether lay 
evidence is satisfactory, the Board may consider the demeanor 
of the witness, internal consistency, facial plausibility, 
and consistency with other evidence submitted on behalf of 
the veteran.  See Dalton v. Nicholson, No. 04-1196 (U.S. Vet. 
App. Feb. 16, 2007); Caluza v. Brown, 7 Vet. App. 498, 511 
(1995).  

In light of the foregoing, and resolving all reasonable doubt 
in the Veteran's favor, the Board finds that service 
connection is warranted.  In reaching this conclusion, the 
Board notes that the occurrence of a head injury in service 
followed by the presence of chronic headaches is well 
documented in the service treatment records.  In addition, 
the Veteran's testimony of ongoing headaches since service is 
credible.  Although there is a medical opinion which suggests 
an alternative cause for the headaches (overuse of 
medications) the Board notes that the opinion does not offer 
an explanation of the basis for the conclusion and does not 
reflect consideration of the entire history of the head 
injury in service.  Under the circumstances of this case, the 
Board finds that the record shows that the Veteran currently 
has a chronic headache disorder that initially manifested 
itself in service.  Thus, the criteria for allowance of 
service connection for headaches are met.  Because service 
connection is being granted on a direct basis, an analysis of 
whether the provisions of 38 C.F.R. § 3.317 provide a basis 
for a grant of service connection is unnecessary.  


ORDER

Service connection for headache disorder is granted.  

REMAND

The Board's review of the claims file reveals that additional 
action is required pursuant to the Veterans Claims Assistance 
Act of 2000 (VCAA).  The Veteran was previously provided a 
VCAA notification letter in July 2005, but it did contain any 
mention of the provisions of 38 C.F.R. § 3.317 pertaining to 
qualifying disabilities incurred in Southwest Asia service 
even though the Veteran's DD 214 reflects that he received 
the Southwest Asia Service Medal.  A remand is required to 
correct this deficiency.  

The Board also finds that additional development of evidence 
is required.  The Veteran reported that he applied for 
disability benefits from the Social Security Administration.  
The records of the Veteran's claim for SSA disability 
benefits are not associated with the claims file.  These must 
be obtained because such evidence may be relevant to the 
claims for VA benefits.  See Collier v. Derwinski, 1 Vet. 
App. 413 (1991).

In addition, the duty to assist requires that VA afford a 
Veteran a medical examination or obtain a medical opinion 
when necessary to make a decision on the claim.  See 
38 U.S.C.A. § 5103A(d).  When the medical evidence is not 
adequate, the VA must supplement the record by seeking an 
advisory opinion or ordering another examination.  See 
McLendon v Principi, 20 Vet. App. 79 (2006).  

Regarding the claim for service connection for a skin rash 
and boils, the Board notes that the Veteran's service 
treatment records reflect that he was seen on several 
occasions for treatment of a furuncle on the buttocks in 
August 1991.  The disorder was treated with moist heat and 
antibiotics.  It was noted that he was possibly to be seen 
for incision and drainage, but it is unclear whether this was 
actually performed.  In any event, the Board is of the 
opinion that a VA examination is required to determine 
whether the Veteran currently has any residuals or related 
problems of the skin disorder treated in service.  

Regarding the claims for service connection for residuals of 
a head injury with nerve damage, and a psychiatric disorder, 
the Board notes that the Veteran's service treatment records 
reflect that he was seen on numerous occasions for problems 
relating to a head injury beginning in June 1991.  For 
example, in June 1991 it was noted that he underwent repair 
of a laceration of the head after being cut by a glass 
bottle.  He received 9 stitches to the forehead.  

Subsequent records reflect complaints of ongoing headaches.  
A consultation record dated in September 1991 notes a 
diagnosis of probable post-traumatic headaches.  A record 
dated in October 1991 notes a diagnosis of post-concussion 
syndrome.  A service neurology record dated in December 1991 
notes a diagnosis of post traumatic neuroma right forehead.  
The Board is of the opinion that a VA examination is required 
to determine whether the Veteran currently has any residuals 
of the head injury treated in service.  

Accordingly, the case is REMANDED for the following action:

(Please note, this appeal has been advanced on the Board's 
docket pursuant to 38 C.F.R. § 20.900(c) (2009).  Expedited 
handling is requested.)

1.  The RO should send a revised duty-to-
assist notice regarding the claims for 
service connection.  The notice letter 
must also address the provisions of 
38 C.F.R. § 3.317.  The Veteran should 
then be afforded an appropriate period of 
time to respond.  The RO should attempt 
to obtain any additional evidence 
identified by the Veteran, as well as all 
recent VA treatment records.  

2.  The Veteran's SSA disability 
benefits records should be obtained and 
associated with the claims file.  If 
these records cannot be obtained, then 
evidence of attempts to obtain them 
should be associated with the claims 
file.

3.  The Veteran should be afforded a VA 
dermatology examination for the purpose 
of determining the nature and etiology of 
any skin disorder which the Veteran may 
have.  The claims file must be made 
available to the examiner for review.  
The examiner should comment as to the 
likelihood that any currently found skin 
disability is attributable to a known 
clinical diagnosis.  If the symptoms are 
attributable to a known clinical 
diagnosis, the examiner must opine as to 
whether it is least as likely as not 
related to any symptoms noted in service 
treatment records, which include a 
furuncle on the buttocks.  

4.  The Veteran should be afforded a VA 
head injury examination for the purpose 
of determining the nature and etiology of 
any disability which the Veteran may 
have.  The claims file must be made 
available to the examiner for review.  
The examiner should comment as to the 
likelihood that any currently found 
disability is attributable to a known 
clinical diagnosis.  If the symptoms are 
attributable to a known clinical 
diagnosis, the examiner must opine as to 
whether it is least as likely as not 
related to any symptoms noted in service, 
which include a documented head injury 
with multiple complaints on various 
dates.  In particular, the examiner 
should address whether the Veteran has a 
scar on the forehead, whether the Veteran 
has a neurological impairment at the site 
of the injury (such as numbness) and 
whether there are any other residuals of 
the head injury in service in addition to 
the headaches for which service 
connection has already been granted.  

5.  The Veteran should be afforded a VA 
psychiatric examination to determine the 
nature and etiology of any psychiatric 
disabilities which the Veteran may 
currently have.  The claims file, 
including the service treatment records 
should be made available to and reviewed 
by the examiner before the examination.  
The examiner should record the full 
history of the claimed disorders.  The 
examiner must state whether the Veteran's 
symptoms are attributable to a known 
clinical diagnosis.  If so, the examiner 
should specifically comment as to the 
likelihood that any currently found 
disability is related to or had its onset 
in service, to specifically include to 
any the head injury noted in service 
treatment records.  The examiner should 
also address whether the criteria for a 
diagnosis of PTSD are met.  

6.  Then the RO should readjudicate the 
appeal.  If the benefits sought on appeal 
remain denied, the appellant should be 
provided a supplemental statement of the 
case (SSOC).  An appropriate period of 
time should be allowed for response.

The appellant has the right to submit additional evidence and 
argument on the matter or matters the Board has remanded.  
Kutscherousky v. West, 12 Vet. App. 369 (1999).  This claim 
must be afforded expeditious treatment.  The law requires 
that all claims that are remanded by the Board of Veterans' 
Appeals or by the United States Court of Appeals for Veterans 
Claims for additional development or other appropriate action 
must be handled in an expeditious manner.  See 38 U.S.C.A. §§ 
5109B, 7112 (West Supp. 2009).



______________________________________________
STEVEN D. REISS 
Acting Veterans Law Judge, Board of Veterans' Appeals


 Department of Veterans Affairs