Citation Nr: 18145850 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 15-21 390 DATE: October 30, 2018 ORDER Entitlement to service connection for cluster headaches is granted. FINDING OF FACT It is at least as likely as not that the Veteran’s cluster headaches are etiologically related to his active duty service. CONCLUSION OF LAW The criteria for service connection for cluster headaches have been met. 38 U.S.C. §§ 1101, 1110, 1111, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1961 to September 1965. He received the Air Force Good Conduct Medal, Air Force Outstanding Unit Award, and Air Force Longevity Service Award. In October 2018, a videoconference hearing was held and the Veteran testified before the undersigned Veterans Law Judge. Service Connection for Cluster Headaches Direct service connection generally requires credible and competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). The Veteran has submitted evidence of a diagnosis of cluster headaches. See November 2014 C&P Examination, p. 1. Accordingly, the Board finds that the first element of service connection is established. See Holton, 557 F.3d at 1366. The Board also finds that the evidence supports a finding of an in-service injury. Specifically, the Veteran stated that he was exposed to trichlorethylene (TCE) in closed quarters for about three years during his active duty service. See November 2014 Correspondence, pp. 3-5. The Veteran maintains that this chemical was present in cleaning products that he was required to use in his work, and the exposure routinely resulted in a “woozy” feeling while in service. The Veteran was seen during service on one documented occasion for headaches. See December 2014 STRs, p. 7. The Board finds the Veteran’s accounts regarding his TCE exposure to be both competent and credible. Thus, the Board finds that the second element of service connection is established. See Holton, 557 F.3d at 1366. Regarding nexus, the evidence is at least in equipoise. The Veteran underwent a VA examination in March 2015. The examiner opined that the Veteran’s cluster headaches were not caused by or the result of his service. In support of this opinion, the examiner noted that the Veteran only had one episode of nonspecific headache and that the circumstances of the headache were not characteristic of a classic cluster headache. The examiner also pointed to the fact that the Veteran was not diagnosed until 1994 and that there was no indication of a headache condition at separation. However, the examiner did not consider the Veteran’s contentions and the long-term effects of exposure to TCE. Consequently, the March 2015 examination contains little probative value. In November 2014, the Veteran submitted a private opinion which offered that it is more likely than not that the Veteran’s exposure to TCE in service is linked to his ongoing headache symptoms. See November 2014 Private Treatment Records, p. 1. In support of his opinion, the physician noted that literature states that repeated, frequent overexposure to TCE can have long-lasting and permanent effects on the nervous system. The Board finds the November 2014 opinion to be probative. The evidence regarding nexus is at least in equipoise. When the evidence for and against a claim is in relative equipoise, the Board has an obligation to resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In resolving all reasonable doubt in the Veteran’s favor, the Board finds that the third element of service connection is established. See Holton, 557 F.3d at 1366. Thus, service connection for cluster headaches is warranted. Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD W.V. Walker, Associate Counsel