Citation Nr: 18140080 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 14-36 424 DATE: October 2, 2018 ORDER Service connection for a neck disability is granted. Service connection for a low back disability is granted. Service connection for an acquired psychiatric disorder is granted. Service connection for migraine headaches is granted. REMANDED The issues of (1) entitlement to a rating greater than 10 percent for a right knee disability, and (2) entitlement to a total disability rating based upon individual unemployability (TDIU) are remanded. FINDINGS OF FACT 1. The Veteran’s neck disability was proximately caused by or aggravated by his service-connected right knee disability. 2. The Veteran’s low back disability was proximately caused by or aggravated by his service-connected right knee disability. 3. The Veteran’s acquired psychiatric disorder was aggravated by his service-connected right knee, neck, and low back disabilities. 4. The Veteran’s migraine headaches were proximately caused by or aggravated by his service-connected neck, low back disabilities as well as his service-connected acquired psychiatric disorder. CONCLUSIONS OF LAW 1. The criteria for secondary service connection for a neck disability are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 2. The criteria for secondary service connection for a low back disability are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 3. The criteria for secondary service connection for an acquired psychiatric disorder are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 4. The criteria for secondary service connection for migraine headaches are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1980 to March 1981 with additional service with the Army Reserve and the Louisiana Army National Guard, including periods of active duty for training (ACDUTRA) in May 1981, June 1981, June 1982, June 1983, and June 1984. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. Service Connection Generally, establishing service connection requires competent evidence of: (1) a current disability; (2) an in-service precipitating disease, injury, or event; and (3) a causal relationship, i.e., a nexus, between the current disability and the in-service event. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Additionally, service connection may also be established for a disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). To substantiate secondary service connection, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). As indicated above, the Board finds that the Veteran is entitled to service connection for neck and low back disabilities as well as an acquired psychiatric disorder and migraine headaches, each on a secondary basis. Accordingly, the Board grants the Veteran’s appeal as to these issues. 1. Service Connection for Neck and Low Back Disabilities In support of its determination to grant service connection, the Board first notes that the Veteran has been diagnosed with a low back condition during the course of the appeal. Specifically, an August 2012 VA MRI of the lumbar spine revealed multilevel degenerative changes, most pronounced at the L5-S1 vertebrae. Regarding the Veteran’s neck, reports of neck pain have been repeatedly documented in the Veteran’s medical treatment records associated with the Veteran’s claims file. See, e.g., July 2010 Kaiser Permanente Treatment Record. Although a specific diagnosis was not identified, in Saunders v. Wilkie, the United States Court of Appeals for the Federal Circuit held that pain resulting in functional impairment may constitute a disability for VA purposes, even in the absence of a presently-diagnosed condition. 886 F.3d 1356, 1367-68 (Fed. Cir. 2018). Here, the evidence supports a finding that there is functional impairment associated with the neck pain, such that the Veteran’s consistent neck pain constitutes a current disability for service-connection purposes. Moving to the existence of a service-connected disability to which the claimed disabilities may be causally related, the Board notes that the Veteran is currently service-connected for a right knee disability. Lastly, regarding a nexus between the current neck and low back disabilities and the right knee disability, the Board notes the April 2018 opinion of Dr. Skaggs—a non-VA medical provider. After conducting an interview with the Veteran and reviewing his entire claims file, Dr. Skaggs opined that the Veteran’s neck and low back disabilities were more likely than not caused by or permanently aggravated by his service-connected right knee disability. In support of this determination, Dr. Skaggs cited documentation in the Veteran’s claims file that he walked with an antalgic gait. Dr. Skaggs then cited medical research which demonstrated that limping may cause or aggravate degenerative changes in the disc or facet joints. As this is the only adequate nexus opinion of record, the Board finds that service connection for neck and low back disabilities must be granted as the preponderance of the evidence is in the Veteran’s favor. 2. Service Connection for an Acquired Psychiatric Disorder Regarding the issue of service connection for an acquired psychiatric disorder, the Board notes that the Veteran has received a multitude of mental health diagnoses during the course of the appeal. Specifically, a May 2011 summary from the Alexandria, Louisiana VA Medical Center (VAMC) noted that the Veteran was hospitalized and discharged with, among other things, diagnoses of delusional disorder, mixed type; psychotic disorder not otherwise specified (NOS); and intermittent explosive disorder. Comparatively, an August 2010 VA psychiatry outpatient record noted a diagnosis of adjustment disorder with mixed features. Likewise, a March 2013 VA treatment record documented a diagnosis of schizoaffective disorder NOS. As such, the Board finds the current disability element of service connection to be satisfied. Next, regarding the existence of a service-connected disability to which the claimed disability may be causally related, the Board notes that, in light of the decision above, the Veteran is now service connected for right knee, neck, and low back disabilities. Lastly, moving to a nexus between an acquired psychiatric disorder and current service-connected disabilities, the Board finds that two supportive medical opinions are associated with the Veteran’s claims file. Firstly, in January 2013, Dr. Fink—a non-VA psychologist—interviewed the Veteran and reviewed his claims file. Dr. Fink diagnosed the Veteran with mood disorder due to medical condition, with major depressive features; impulse control disorder NOS; and marijuana dependence. He then noted that the Veteran was already service-connected for a right knee disability and suffered from chronic back pain. Dr. Fink reported that the Veteran had developed the view that the military as an institution had mistreated him, resulting in increasing anger and social difficulties. Dr. Fink explained that the evolution of the Veteran’s mental disorders more likely than not began with the pain and functional difficulties experienced from his service-connected right knee, and was exacerbated by his entrenched belief that he was not appropriately dealt with by the military. Comparatively, in April 2018, Dr. Henderson-Galligan—another non-VA psychologist—interviewed the Veteran and reviewed his entire claims file. Dr. Henderson-Galligan diagnosed the Veteran with schizoaffective disorder, bipolar type. Thereafter, Dr. Henderson-Galligan opined that the Veteran’s disorder began in military service, continued to the present, and was aggravated by his right knee, low back, and neck pain. In support of this conclusion, Dr. Henderson-Galligan cited articles of medical research regarding the emergence of mental health symptoms within service members as well as articles discussing the connection between psychiatric disorders and other medical issues. The Board finds these medical opinions to be adequate for adjudicative purposes. As they are the only adequate nexus opinions of record, the Board finds that service connected for an acquired psychiatric disorder must be granted as the preponderance of the evidence is in the Veteran’s favor. 3. Service Connection for Migraine Headaches Finally, regarding the issue of service connection for migraine headaches, the Board first finds that the Veteran has an active diagnosis of migraine headaches. Specifically, in August 2010, Dr. Capulla from Kaiser Permanente diagnosed the Veteran with migraines after the Veteran complained of a right-sided headache. Next, as to the existence of an already service-connected condition to which the claimed disability may be causally related, as a result of the decisions above, the Veteran is now service-connected for right knee, neck, and low back disabilities as well as an acquired psychiatric disorder. Regarding a nexus between the Veteran’s migraines and a service-connected disability, the Board notes that in April 2018, Dr. Skaggs interviewed the Veteran and reviewed his entire claims file. Dr. Skaggs recorded that the Veteran complained of experiencing several headaches each month brought on by stress as well as neck and back pain. Thereafter, Dr. Skaggs opined that it was more likely than not that the Veteran’s headaches—previously diagnosed as migraines—were caused or permanently aggravated by his mental health condition as well as neck and back pain. In support of this conclusion, Dr. Skaggs cited medical research which demonstrated an increased likelihood of mental health patients to develop headaches. The Board finds Dr. Skaggs’ opinion to be adequate for adjudicative purposes. As it is the only adequate nexus opinion of record, the Board finds that service connected for migraine headaches must be granted as the preponderance of the evidence is in the Veteran’s favor. REASONS FOR REMAND An Increased Rating for a Right Knee Disability and Entitlement to a TDIU In April 2018, Dr. Henderson-Galligan noted in a disability benefits questionnaire (DBQ) that the Veteran was in receipt of Social Security disability insurance benefits (SSDI). In a March 2006 VA treatment record, the Veteran reported that he received these benefits because of knee and low back disabilities. Currently, the Veteran’s claims file does not contain any documentation that the RO attempted to obtain copies of any documents or medical records used by the Social Security Administration (SSA) in making any determinations regarding the receipt of benefits. These underlying documents considered by SSA may be relevant to the issues of the rating of the right knee disability as well as entitlement to a TDIU. Accordingly, remand is warranted so that outstanding SSA records may be obtained. See Golz v. Shinseki, 590 F.3d 1317, 1323 (Fed. Cir. 2010). The matter is REMANDED for the following action: Obtain all records associated with any claim the Veteran submitted for Social Security disability benefits, including copies of any decisions and medical records relied upon concerning that claim. If no such records exist, the claims file should be annotated to reflect as such and the Veteran notified as such. (Signature on Next Page) S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N.S. Pettine, Associate Counsel