Citation Nr: 18157013 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 13-02 204 DATE: December 11, 2018 ORDER Entitlement to service connection for a neck disability is granted. Entitlement to service connection for headaches is granted. FINDINGS OF FACT 1. The Veteran’s service treatment records (STRs) show that she was involved in motor vehicle accidents (MVAs) in September 1981 and in March 1990 and that she reported neck pain and headaches following these MVAs. 2. The Veteran sought treatment for her neck pain slightly more than a year following her separation from service, and during that treatment, she reported neck pain since service. See April 2001 treatment record. In fact, an MRI performed 18 months postservice showed a diagnosis of cervical nerve root radicular pain, moderate degenerative disc disease, and disc space narrowing. See June 2001 MRI. 3. The Veteran has competently and credibly reported neck pain in and since her service. See August 2008 VA treatment record (wherein the Veteran reported a whiplash accident in the 1990s with this same kind of neck pain for “years now”); see also July 2010 notice of disagreement (Veteran reports injuring her neck during service with constant pain “from then on”; she received ongoing, nonstop medical care for her neck from 2001 to the present); see also June 2013 correspondence (Veteran reports she struggled with neck and back pain since her MVA during service). The Board is aware of the negative April 2010 VA spine examination in which the examiner noted the Veteran’s involvement in several MVAs during service and her treatment for musculoskeletal pain at that time and stated that there was no evidence of chronicity of neck pain in the Veteran’s STRs. However, the Board cannot assign probative weight to this opinion because the examiner failed to consider the Veteran’s statements that she experienced neck pain since service (as well as the diagnosis of moderate DDD 18 months following her separation from service). See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (holding that an examination was inadequate when the examiner did not comment on the Veteran’s report of in-service injury but relied on the service medical records to provide a negative opinion). 4. In light of the foregoing, and resolving reasonable doubt in the Veteran’s favor, and considering her competent and credible reports of neck pain in and since service, the Board finds that the evidence is at least evenly balanced for and against (in “relative equipoise”) a finding that service connection is warranted for a neck disability. 5. Resolving reasonable doubt in the Veteran’s favor, the Board concludes that service connection for headaches is warranted. A September 2008 VA treatment record noted that headaches are a medically acknowledged side effect of the treatments the Veteran takes for her service-connected hepatitis C. Several private treatment records also include headaches as part of the Veteran’s cervical spine history. See generally treatment records from Dr. Aaron Stein. A September 2008 VA treatment record notes that the Veteran’s neck exercises may contribute to her headaches. On May 2012 VA headaches examination, the examiner ultimately opined that the Veteran’s headaches were less likely due to her service-connected hepatitis C (and treatment for such) because headaches are a common side effect associated with hepatitis C treatment in 10 percent of those being treated beyond three months and because the Veteran reported her headaches began in the 1990s, a decade prior to treatment for hepatitis C, have continued since that time, and have not changed in character. In an October 2012 VA opinion, the opinion provider diagnosed cervicogenic headaches and opined that these were less likely due to the Veteran’s service because the headaches she reported in service resolved (as evidenced by her lack of complaints at separation) and because episodic, occasional headaches are not uncommon for the general population. In a September 2013 VA opinion, the opinion provider opined that the Veteran’s headaches would not be aggravated by hepatitis C medications because the Veteran completed her treatment. The Board finds these opinions inadequate because there appears to be a discrepancy between the May 2012 VA examiner’s opinion that side effects persist in 10 percent of patients treated beyond three months and the September 2013 VA opinion provider’s conclusion that treatment for hepatitis only causes side effects, including headaches, during treatment and not after such treatment is completed. Additionally, no examiner addressed the likelihood that the Veteran’s headaches are caused or aggravated by her neck disability. In an undated opinion, the VHA opinion expert contacted in this matter opined that (1) the Veteran’s headaches are at least as likely related to her (now service-connected) neck disability because they are most likely of cervical origin and (2) that neck pain sometimes goes to the back of the head, causing headache symptoms. Accordingly, the Board finds that the evidence is in relative equipoise and that service connection for headaches, as either secondary to the Veteran’s service connected hepatitis C or as secondary to her neck disability, is warranted. CONCLUSIONS OF LAW 1. Service connection for a neck disability is warranted. 38 U.S.C. §§ 1110, 1131, 1153; 38 C.F.R. §§ 3.303, 3.304. 2. Service connection for headaches is warranted. 38 U.S.C. §§ 1110, 1131, 1153; 38 C.F.R. §§ 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from March 1978 to July 1978, from June 1980 to July 1989, and from August 1989 to January 2000. These matters are before the Board of Veterans’ Appeals (Board) on appeal from March and May 2010 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In March 2017, the Board sought a Veterans Health Administration (VHA) medical expert opinion in the matter of entitlement to service connection for headaches; the Board sought an addendum VHA opinion in August 2017; the Veteran and her representative were provided a copy and afforded opportunity to respond. The Board notes that the Veteran requested RO initial consideration of additional evidence she submitted; however, given the favorable nature of the decision herein, there is no prejudice to the Veteran in the Board so proceeding. For the reasons outlined above, service connection for a neck disability and for headaches is granted. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Matta, Counsel