Citation Nr: 18157565 Decision Date: 12/12/18 Archive Date: 12/12/18 DOCKET NO. 12-29 774 DATE: December 12, 2018 ORDER Entitlement to service connection for a headache disorder is granted. FINDING OF FACT The weight of the competent and credible evidence of record shows that the Veteran’s headache disorder was caused or aggravated by her service-connected sinus disability. CONCLUSION OF LAW A headache disability was caused or aggravated by a service-connected sinus disability. 38 U.S.C. §§ 1110, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 2000 to November 2005. The Veteran testified at a hearing before the undersigned Veterans Law Judge in October 2015. A transcript of that hearing is associated with the claims file. Without deciding whether notice and development requirements have been satisfied in the present case, the Board is not precluded from adjudicating the issue involving the Veteran’s claim for service connection for a headache disorder. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326. This is so because the Board is taking action favorable to the Veteran by granting the issue at hand. As such, this decision poses no risk of prejudice to the Veteran. See, e.g., Bernard v. Brown, 4 Vet. App. 384 (1993); see also Pelegrini v. Principi, 17 Vet. App. 412 (2004); VAOPGCPREC 16-92, 57 Fed. Reg. 49, 747 (1992). Entitlement to service connection for a headache disorder The Veteran contends that service connection is warranted for a headache disorder. Service connection may be established for a disability resulting from diseases or injuries which are clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 3 8 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection may be established on a secondary basis for a disability which is shown to be proximately due to, the result of, or chronically aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc) (additional disability resulting from aggravation of a nonservice-connected disorder by a service-connected disorder is also compensable under 38 C.F.R. § 3.310). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The benefit of the doubt rule is inapplicable when the preponderance of the evidence is against the claim. Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). After thorough consideration of the evidence of record, the Board concludes that service connection for a headache disorder is warranted. There are current diagnoses of a headache disorder, identified variously as a sinus headache disorder and a migraine headache disorder. Degmetich v. Brown, 104 F.3d 1328, 1333 (Fed. Cir. 1997) (holding that the existence of a current disability is the cornerstone of a claim for VA disability compensation). In addition, the weight of the medical evidence of record reflects that the Veteran’s headache disorder is related to her service-connected sinus disability. 38 U.S.C. § 1113(b); 38 C.F.R. §§ 3.303; see Allen, 7 Vet. App. 439 (holding that secondary service connection requires that evidence is sufficient to show that the current disability was either caused or aggravated by a service-connected disability). In that regard, the Board observes that there are several medical opinions in the claims file discussing the etiology of the Veteran’s headaches. An April 2012 VA opinion reflects a diagnosis of migraine headaches and notes that chronic nasal obstruction caused by septal deviation resulting in significant rhinitis and mouth breathing can result in headaches. A March 2015 private medical opinion from C.B., M.D. reflects that the Veteran’s migraine and headache problems were etiologically related to her active duty service, and that the Veteran’s asthma, nasal septum deviation, and sinusitis likely contributed to her headaches. Dr. C.B. provided a supplemental opinion in October 2015 in which he explained that the Veteran’s current headaches were caused and/or aggravated by sinusitis. Last, an August 2018 VA opinion states that the Veteran has sinus headaches which are “at least as likely as not” caused by or secondary to her chronic rhinosinusitis. The examiner explained that there is documented evidence of sinus headaches in the medical records and a diagnosis of chronic rhinosinusitis, and per the American Academy of Otolaryngology, headaches are a minor symptom of chronic rhinosinusitis. The August 2018 VA examiner’s opinion is based upon a clinical examination of the Veteran, a review of the evidence contained in the claims file, and consideration of the pertinent medical literature. Additionally, the August 2018 VA examiner provided supporting rationale for the opinion. Accordingly, the Board affords the August 2018 VA opinions great probative value. The Board acknowledges the March 2016 VA opinion which concluded that the Veteran’s migraine headaches were not etiologically related to her active duty service and the August 2017 and January 2018 VA opinions which opined that the Veteran’s headaches were not etiologically linked to asthma. However, the March 2016, August 2017, and January 2018 VA examiners did not address the likelihood that the Veteran’s headaches were caused or aggravated by her service-connected sinusitis. The Board also acknowledges the June 2018 VA opinion which states that “acute or chronic sinusitis appears to be an uncommon cause of recurrent headaches.” However, the Board does not afford this opinion significant probative value, as the examiner provided no real rationale pertinent to the Veteran’s specific case aside from a list of citations to some medical articles suggesting that there may be a difference between head pain related to sinus conditions and migraine headaches. (Continued on the next page)   As the weight of the probative evidence of record relates the Veteran’s headache disability to her service-connected sinusitis, service connection for a headache disability is warranted. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Katz, Counsel