Citation Nr: 18152169 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 17-66 708 DATE: November 21, 2018 ORDER Service connection for migraine headaches is granted. ANALYSIS The Veteran served on active duty from December 1987 to December 1991 in the United States Army, with service in the Southwest Asia theater of operations during the Persian Gulf War. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to show a service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Service connection for certain chronic diseases, including organic diseases of the nervous system, may be established on a presumptive basis by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307 (a). The term "chronic disease" refers to those diseases listed under section 1101(3) of the statute and section 3.309(a) of VA regulations. 38 U.S.C. § 1101 (3); 38 C.F.R. § 3.309 (a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where a chronic disease under 3.309(a) is "shown as such in service" ("meaning clearly diagnosed beyond legitimate question" Walker, 708 F.3d at 1337), or in the presumptive period 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. 38 C.F.R. § 3.303 (b). In cases where a chronic disease is "shown as such in service", the Veteran is "relieved of the requirement to show a causal relationship between the condition in service and the condition for which service connected disability compensation is sought." Walker, 708 F.3d at 1336. Instead, service connection may be granted for subsequent manifestations of the same chronic disease without any evidence of link or connection between the chronic disease shown in service and manifestations of the same disease at a later time. In other words, "there is no 'nexus' requirement for compensation for a chronic disease which was shown in service, so long as there is an absence of intercurrent causes to explain post-service manifestations of the chronic disease." Id. If evidence of a chronic disease is noted during service or during the presumptive period, but the chronic condition is not "shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned," i.e., "when the fact of chronicity in service is not adequately supported," then a showing of continuity of symptomatology after discharge is required to support a claim for disability compensation for the chronic disease. Proven continuity of symptomatology establishes the link, or nexus, between the current disease and serves as the evidentiary tool to confirm the existence of the chronic disease while in service or a presumptive period during which existence in service is presumed." Id. at 1339. The record indicates an onset of migraine headaches during service. Service treatment records (STRs) show that in January 1990, the Veteran sought treatment for dull headaches. In a STR dated from later that month, he reported having a headache that had lasted for seven days. In a February 2016 buddy statement, L.G. stated that he was stationed with the Veteran for almost one year in 1989, and that he complained of headaches frequently. He recalled one instance during a field exercise when the Veteran complained of a headache and then began vomiting in the tent. He stated that after their deployment to Operation Desert Storm, they were placed in different units but stayed in touch and the Veteran continued to complain of frequent headaches. In another February 2016 buddy statement, G.R. stated that he was stationed with the Veteran from 1989 to 1990. He too corroborated that in the fall of 1989, during a field exercise, the Veteran experienced a migraine headache and vomited. The Veteran has consistently reported he has experienced headache symptoms since service. In his October 2015 Notice Of Disagreement, he stated that he had not experienced a migraine headache prior to military service. Rather, he contended, his migraine headaches began in service and persisted ever since. In his November 2017 VA Form 9, he reiterated his report of continuous symptoms since service, and further explained that during service, he did not seek medical treatment each time he had a headache because a high frequency of sick call visits would have been viewed negatively by his superiors. Treatment records spanning over a decade from his private physician, Dr. C., reflect his reports of continuous headache symptoms. Additionally, he reported to a September 2015 VA examiner that his headache symptoms began in 1989 in Saudi Arabia. The Board finds he is permitted to report his symptoms during service and since discharge. Charles v. Principi, 16 Vet. App. 370 (2002); Layno v. Brown, 6 Vet. App. 465 (1994). His statements are also credible as they are internally consistent, and consistent with the record as a whole. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Additionally, post-service medical records support a continuity of headache symptomatology following service. In a July 2015 Disability Benefits Questionnaire (DBQ), Dr. C., indicated an onset of the current headache disability in Saudi Arabia in 1989. In a February 2016 DBQ, Dr. C. again documented an onset of headaches in 1989. In a separate narrative report, Dr. C. explained that he began treating the Veteran in 1996 for a chronic headache disability which had been present for years prior. Dr. C. stated that the disability consists of daily tension headaches, and more severe migraine headaches that occur once per week on average. He submitted his treatment records dating back to 2005; records dated prior to that time had been destroyed in accordance with state law. The Board accepts Dr. C.’s findings regarding the onset and continuity of symptoms despite the fact that he did not begin treating the Veteran until 1996. See Coburn v. Nicholson, 19 Vet. App. 427 (2006) (a medical opinion formed on the basis of the veteran's reported medical history cannot be rejected without the Board first finding that the veteran's allegations are not credible). While the September 2015 VA examiner provided a negative nexus opinion, she had not considered the buddy statements of L.D. or G.R., or the years of treatment records from Dr. C. as these records were received by VA after her report was rendered. See Reonal v. Brown, 5 Vet. App. 458, 460 (1993) (holding medical opinions have no probative value when they are based on an inaccurate factual predicate). (Continued on the next page)   Further, as noted above, a continuity of symptomatology establishes the link, or nexus, between the current disease and serves as the evidentiary tool to confirm the existence of the chronic disease while in service. Walker, 708 F.3d at 1336. Resolving any doubt in the appellant’s favor, the Board finds an onset of chronic headaches during service and a continuity of symptoms since discharge. Service connection is warranted. M. Tenner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Smith, Counsel