Citation Nr: 20003092 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 14-31 861A DATE: January 14, 2020 ORDER Entitlement to service connection for a migraine disorder is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has a migraine disorder due to a disease or injury in service. CONCLUSION OF LAW The criteria for entitlement to service connection for a migraine disorder have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the Marines from December 2000 to December 2004. He is a Combat Action Ribbon recipient. This appeal was previously remanded by the Board in November 2017 for further development. This case is before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 Regional Office (RO) rating decision. Service Connection The law provides that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) 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. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). 1. Entitlement to service connection for a migraine disorder The Veteran asserts that he has a chronic migraine headaches disability that was first manifested during his period of active service. He contends that he experienced migraines while in service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of migraine headaches, and evidence shows that the Veteran reported experiencing migraines during service, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of migraine headaches began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). A review of the Veteran’s service treatment records show the Veteran complained of migraine headaches in August 2001 and October 2001. The Veteran’s October 2001 treatment note shows the Veteran reported a history of 1½ years of headaches controlled with Midrin. However, the Veteran’s October 2004 separation examination was silent for complaints of headache symptoms. Following service, a November 2013 psychologist note indicated that the Veteran suffered from progressive cephalgia and now suffers from daily headaches that last from two to 24 hours. The psychologist diagnosed the Veteran with cephalgia secondary to cervical spondylosis. While the Veteran is competent to report having experienced symptoms of headaches during or since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a chronic headache disability as opposed to a symptom of a different disability. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Next, service connection may also be granted when the evidence establishes a medical nexus between active duty service and current complaints. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran’s claimed migraine disorder to active duty, despite his contentions to the contrary. A VA examination report dated April 2014 shows that the Veteran reported headaches since the Marines which were treated with ibuprofen. The Veteran reported he experiences headaches 2-3 times per week with pain in the back of his head that feels like his head will explode and his attitude changes. He further reported that Advil helps. The VA examiner stated that the Veteran’s reported current headache was not due to migraines, but is due to his service spine strain. However, the examiner did not provide medical support and adequate rationale for the conclusion reached. During an August 2014 VA examination for evaluation of TBI residuals, the examiner opined that Veteran's current headache disability is less likely than not the result of the conceded IED explosion during active duty. In support of his opinion, the examiner stated that the Veteran's separation physical was silent for a report of past TBI/head trauma and was silent for complaints of headaches. In January 2019, a medical opinion was provided as to whether the Veteran’s migraine disorder is related to or a result of his back disorder. The examiner stated that less likely than not that the Veteran’s migraine disorder is related to his back disorder. In support of his opinion, the examiner stated that he believes that there is neither peer reviewed evidence in the medical literature, consensus in the medical community or evidence in this specific case that supports a causal/aggravation relationship between DJD thoracolumbar spine and cluster type headaches. Further, he stated that this does not even make sense that a low back disability would cause cluster/migraine headaches as they are different organ systems far apart anatomically and there is no evidence for this. The Board notes the nexus opinion provided by the Veteran’s neurologist in November 2015 which indicated that the Veteran’s migraines were most likely caused by or a result of head trauma as the head trauma either started or significantly aggravated his migraines. However, the neurologist did not provide a reasoned medical explanation or cite to the Veteran’s medical records to support his conclusion. The Board finds the opinions of the August 2014 and January 2019 VA examiners to be probative, as they are based on an accurate medical history and provide explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran has not provided any competent medical evidence to rebut the opinions against the claim or otherwise diminish their probative weight. While the Veteran believes his migraine, headaches are related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion in this case. This issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the stated VA examination reports. As a result, the Board concludes that the preponderance of the evidence is against the claim for service connection for a migraine headache disorder, and there is no doubt to be otherwise resolved. Therefore, the claim for service connection is denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Vample, Associate Counsel