Citation Nr: 20006614 Decision Date: 01/28/20 Archive Date: 01/27/20 DOCKET NO. 11-11 954A DATE: January 28, 2020 ORDER Entitlement to service connection for a headache disability, to include migraines is granted. FINDING OF FACT The Veteran’s headache disability is related to his military service. CONCLUSION OF LAW The criteria for service connection for a headache disability have been met. 38 U.S.C. §§ 1110, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from December 1990 to May 1991 and July 2004 to January 2006. This matter comes before the Board of Veterans Appeals (Board) from the March 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. The Veteran appeared at an April 2013 hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. This matter was previously before the Board in May 2018 and the Veteran’s claim for entitlement to service connection for a headache disability was denied. The Veteran appealed this decision to the Court of Veterans Appeals (Court). In July 2019, the Court issued a joint motion for remand. Specifically, the Court found that the Board failed to provide a credibility determination as to the Veteran’s lay statements regarding the evolution of the frequency of his headaches and his lay statements regarding when his headaches began. Additionally, the Court stated that the Board failed to discuss whether the notations of trauma headaches in the record were favorable for the Veteran. The Board has reviewed all of the evidence in the Veteran’s claims file, with an emphasis on the medical and lay evidence for the issue on appeal. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. The Veteran seeks entitlement to service connection for a headache disability, to include chronic headache and migraines. The Veteran attributes his current headaches to hitting his head on a truck during his deployment to Iraq in March 2005. Service connection may be established for a disability due to a disease or injury that was incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In general, in order to prevail on the issue of service connection, the evidence must show: (1) the existence of 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In a March 2006 VA examination, the Veteran was observed to have headaches manifested by pain in the frontal occipital band. At a July 2010 VA examination, the examiner found that the Veteran’s previous headache pain in the frontal occipital band to be “[m]ore closely related to service and likely post-traumatic in origin.” However, at the July 2010 examination, the Veteran reported that his current headaches were characterized by unilateral sharp and stabbing pain, which the examiner determined was more indicative of a migraine. The July 2010 examiner found that this type of migraine headache was thereby less likely related to service because the Veteran’s current condition differed than that shortly after discharge in 2006 (occipital band pain). In April 2014, the Board found the examiner’s discussion persuasive and denied the Veteran’s claim for entitlement to service connection for a headache disability. Subsequently, the Veteran appealed this decision to the Court and in March 2015 the Court vacated and remanded the Board’s decision. Specifically, the Court found that the Board’s reliance on the July 2010 examination report was erroneous because the examiner failed to discuss a January 2010 treatment note that stated that the Veteran was at that time experiencing headaches that started in the neck/occipital area and came around mostly on the left side. The Court held that the Veteran’s January 2010 report of headaches affecting the occipital portion of the head potentially suggested that the Veteran was experiencing headaches similar to those found to be “closely related to service and likely post-traumatic in origin” as the March 2006 VA examiner found. In December 2015, the Board remanded the matter instructing the RO to obtain an addendum opinion from the same, or another qualified, medical professional addressing whether it is at least as likely as not that the Veteran’s headache condition is related to service and to specifically address the Veteran’s January 2010 reports of headaches in the occipital area. Pursuant to the Board’s December 2015 remand, a medical opinion was obtained in January 2016. However, the January 2016 medical professional failed to address the Veteran’s statements in the January 2010 treatment note regarding his headaches starting in his neck/occipital area. The Board notes that a January 2010 VA treatment records contains a diagnosis of TBI with chronic headache. A review of the evidence further reflects that a March 2010 VA neurology note also shows the Veteran experienced headaches that started in his neck/occipital area. The record indicates that the pain was “MOSTLY IN CENTER SECTION - STARTES [sic] IN NECK / OCCIPITAL AREA COMES AROUND MOSTLY ON LEFT SIDE.” The Board notes that this March 2010 record appears to be the record which had been described in the Joint Motion as having been a January 2010 record. Furthermore, a July 2006 dental record indicates that the Veteran experienced frequent headaches and that his “head just starts to hurt for no reason.” None of these relevant medical records were discussed in the January 2016 opinion. In December 2016, the Board again remanded this matter and a medical opinion was obtained in April 2017. However, the April 2017 medical professional failed to address the Veteran’s statements in the March 2010 treatment note regarding his headaches starting in his neck/occipital area. In July 2017, the Board again remanded this matter for a medical opinion which was obtained in July 2017. The July 2017 examiner reiterated that the Veteran’s 2009 headaches are “characteristically different” from those described previously and that onset of headaches years after a presumed traumatic injury makes an association speculative at best. The July 2017 concluded that the Veteran’s band-like mild headaches may have been residuals of post-traumatic headaches, but these appear to have resolved. However, the July 2017 examiner failed to specifically discuss the March 2010 VA treatment note documenting that the Veteran experienced headaches in the occipital area of his head and provide an opinion on whether or not these headaches suggest that the Veteran was experiencing headaches similar to those previously noted to be likely post-traumatic in origin. Therefore, in November 2017, the Board requested a medical opinion that was completed in January 2018. The January 2018 examiner provided a thorough timeline of both the Veteran’s medical and procedural history in this case. Ultimately, the examiner opined that it is less likely than not that the Veteran’s current headache disability is the result of the head injury the Veteran sustained during active duty while deployed to Iraq. The examiner explained that the Veteran’s service treatment records are silent on the matter of a head injury or a chronic headache following a head injury, except for one entry indicating a complaint of headache with normal blood pressure. The examiner noted that the Veteran’s headache complaints do not appear in the veteran’s medical record until March 2006 when he stated that his headaches began in November 2004, prior to his deployment. At this March 2006 visit, the Veteran denied any prior head injuries. The Veteran claimed that his headaches are of varying types ranging from typical muscle contraction or tension type headaches (more compatible with post traumatic headache similar to the March 2006 visit) to throbbing (vascular headache similar to the Veteran’s July 2010 visit) to sharp and stabbing (less likely to represent the Veteran’s post-traumatic visit of July 2010). In response to the Board’s request regarding the examiner’s discussion of the March 2010 visit, the examiner stated that the description of the Veteran’s headaches is less important than “the likelihood that an unreported and apparently mild head injury (not a TBI) can generate headache complaints that appear months after the incident and evolve from infrequent to daily, seemingly present now and forever.” The examiner referenced the Veteran’s February 2009 TBI second level evaluation that rejected the idea that a TBI occurred. Additionally, at the time of the TBI evaluation, the Veteran presented with headaches that were believed to be more consistent with behavioral health issues. The examiner pointed out that post-traumatic headaches do not behave in that manner, further distinguishing the Veteran’s headaches from those that would result from a traumatic head injury. The examiner explained that he based his opinion off of classic and definitive reference texts that discuss chronic post-traumatic headaches. Following this opinion, as discussed above, the Veteran’s claim for entitlement to service connection for a headache disability was denied in May 2018. The Veteran appealed this decision to the Court of Veterans Appeals (Court) and in July 2019, the Court issued a joint motion for remand. The Board finds that after reviewing all of the medical and lay evidence, entitlement to service connection for a headache disability is warranted. In the January 2018 opinion, the physician stated that a head injury can generate headache complaints that appear months after the incident and present forever, which appears to be consistent with the Veteran’s lay statements and medical treatment records. Additionally, the examiner did not take into account the Veteran’s treatment records that note that his headaches were documented as trauma headaches. Thereby, the Board finds that the January 2018 opinion inadequate as it does not appear to rely on accurate facts. Additionally, the Board finds the Veteran credible and competent to provide testimony regarding his headache disability and its symptoms and continuity since his service. Additionally, the Veteran’s treatment records support his assertion. Specifically, a July 2019 treatment note state that the Veteran’s history of migraines began in 2006 when the Veteran got back from Iraq. Furthermore, the Board notes that the Veteran’s treatment records note that the Veteran had “trauma headaches” in September 2009, August 2010, October 2011, and March 2012. Overall, although there are no probative medical opinions addressing whether the Veteran’s headache disability is directly related to his active duty service, the Board finds the Veteran’s lay statements to be sufficient to establish entitlement to service connection in this instance. Accordingly, resolving all reasonable doubt in favor of the Veteran, as is required by law, the Board finds that the Veteran’s headache disability is a result of his active service, and entitlement to service connection is warranted. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 50 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Mountford, Associate Counsel 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.