Citation Nr: 20023083 Decision Date: 04/03/20 Archive Date: 04/03/20 DOCKET NO. 19-25 725 DATE: April 3, 2020 ORDER Entitlement to service connection for headaches, to include migraines, and as secondary to PTSD, is granted. REMANDED Entitlement to service connection for right knee iliotibial band syndrome, to include as secondary to posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for right shoulder condition, to include as secondary to PTSD, is remanded. Entitlement to service connection for elbow condition, to include as secondary to PTSD, is remanded. FINDING OF FACT The Veteran has experienced continuity of symptomatology related to his currently diagnosed migraine headaches condition since his separation from service. CONCLUSION OF LAW The criteria for entitlement to service connection for headaches, to include migraines are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from November 2010 to November 2015. This matter comes before the Board of Veterans’ Appeals (Board) from November 2018 and May 2019 rating decision(s) issued by a Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Here, the Board notes that under § 3.309(a), “Other organic diseases of the nervous system” includes migraine headaches, as claimed for by the Veteran. 1. Entitlement to service connection for headaches, to include migraines, and as secondary to PTSD, The question before the Board is whether the Veteran’s claimed for migraine headache condition is at least as likely as not related to an in-service injury, event, or disease. As to the first element of Shedden, for service connection the Veteran must show a current disability. Per the Veteran’s March 2019 VA examination, he has a currently diagnosed migraine headache condition. Thus, the Board finds that the Veteran’s claim meets the first Shedden element for service connection. As to the second element of Shedden, for service connection the Veteran must show an in-service incurrence or aggravation of a disease, event, or injury. Here, the Veteran has provided lay statements alleging that during service he was required to wear heavy helmets, and as a result thereof, he has experienced headaches since 2013. See March 2019 VA examination. Additionally, the Veteran claims that while he was deployed, he was driving a Humvee, and was involved in a minor accident. See Attachment to June 2019 VA Form 21-526EZ (“my Kevlar was secure to my head and I bumped my head on the window hard. Ever since I've been getting migraines (very frequent) where light is sensitive and feel nausea/sound”). The Board is able to corroborate the Veteran’s lay statements to the extent that he was deployed to Afghanistan, as well as to Kosovo. See DD Form 214 (“served in a designated imminent danger pay area”); military personnel records; December 2018 VA PTSD medical examination. Additionally, there is no evidence of record contradicting the Veteran’s lay testimony. Therefore, the Board concedes the in-service event(s) as alleged. The Board also notes that the Veteran’s Service Treatment Records (STRs) evidence that he reported experiencing increased headaches during service. See May 14, 2015 STR; June 19, 2015 STR. Thus, the Veteran’s claim meets the second Shedden element for service connection. As to the last element of Shedden, for service connection the Veteran must show a causal relationship between the current disability and the in-service disease, event or injury. Here, the Board notes that there are no probative medical opinions of record that address direct service connection for the Veteran’s claimed for migraine headache condition; however, the Board finds probative that the VA medical examination assessing his condition notes the onset of his headaches as being during service. See March 2019 VA examination. In addressing the Veteran’s secondary service connection theory of entitlement, the VA examiner found it less likely than not that his currently diagnosed migraine headaches condition is related to his service-connected PTSD disability. Id. The VA examiner did not address as to whether the Veteran’s condition is directly related to service, and therefore the Board affords the March 2019 medical opinion less probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Of record are complaints of headaches during service as evidenced by the Veteran’s STRs. See May 14, 2015 STR; June 19, 2015 STR. These STRs tend to corroborate the Veteran’s lay testimony, namely that he experienced migraine headaches in-service, and ever since service. See Form 9; June 2019 NOD; Attachment to June 2019 VA Form 21-526EZ. The Board finds the Veteran competent to report the same. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Thus, the evidence of record shows a currently diagnosed migraine headache condition, with noted headaches in-service, as well as attributable continuity of symptomatology since service. Given the Veteran's competent and credible testimony, the Board resolves all doubt in his favor, and finds that service connection for migraine headaches is warranted. The claim is granted. REASONS FOR REMAND 1. Entitlement to service connection for right knee iliotibial band syndrome, to include as secondary to posttraumatic stress disorder (PTSD), is remanded. Under McLendon, the VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (citing 38 U.S.C. § 5103A and C.F.R. § 3.159(c)(4)). Additionally, in affording the Veteran VA medical opinion(s) and examination(s), they must be adequate. See Barr v. Nicholson, 21 Vet. App. 303 (2007). While the Veteran was afforded a VA examination in March 2019 to assess his claimed for condition, the VA examiner did not address the Veteran’s direct service connection theory of entitlement, namely that his claimed for condition was directly caused by physical training during his military service where he was required to carry 70 pounds during ruck marches, uphill for miles at a time, as well as having to carry heavy weapons in jumping on and off of Humvees. See Attachment to June 2019 VA Form 21-526EZ. Rather, the VA examiner only addressed the Veteran’s secondary service connection theory of entitlement, specifically as due to the Veteran’s service-connected PTSD. See March 2019 VA medical opinion. As the Board is required to weigh all theories of entitlement reasonably raised by the record, and as the March 2019 VA medical examiner did not address the Veteran’s direct service connection theory of entitlement, the Board finds that a remand for an addendum medical opinion is in order prior to the adjudication of the present appeal. Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009). Entitlement to service connection for right shoulder condition, to include as secondary to PTSD, is remanded. The Board finds that although the Veteran was afforded a VA examination in March 2019 to assess his claimed for right shoulder condition, the VA examiner did not address the Veteran’s direct service connection theory of entitlement, namely that his claimed for condition was directly caused by carrying heavy weapons and ammunition on his shoulders and then onto Humvees during military training. See Attachment to June 2019 VA Form 21-526EZ. Rather, the VA examiner only addressed the Veteran’s secondary service connection theory of entitlement, specifically as due to the Veteran’s service-connected PTSD. See March 2019 VA medical opinion. As the Board is required to weigh all theories of entitlement reasonably raised by the record, and as the VA medical examiner did not address the Veteran’s direct service connection theory of entitlement, the Board finds that a remand for an addendum medical opinion is in order prior to the adjudication of the present appeal Entitlement to service connection for elbow condition, to include as secondary to PTSD, is remanded. The Board finds that although the Veteran was afforded a VA examination in March 2019 to assess his claimed for elbow condition, the VA examiner did not address the Veteran’s direct service connection theory of entitlement, namely that his claimed for condition was directly caused by constant training in the field and holding the weapon, as well as raising the weapon up and down when necessary, thereby resulting in weakness/tenderness and limited flexion in his forearm, as well as flare ups. See Attachment to June 2019 VA Form 21-526EZ. Rather, the March 2019 VA examiner only addressed the Veteran’s secondary service connection theory of entitlement, specifically as due to the Veteran’s service-connected PTSD. See March 2019 VA medical opinion. As the Board is required to weigh all theories of entitlement reasonably raised by the record, and as the VA medical examiner did not address the Veteran’s direct service connection theory of entitlement, the Board finds that a remand for an addendum medical opinion is in order prior to the adjudication of the present appeal. The matters are REMANDED for the following action: 1. Associate with the Veteran’s claims file any and all outstanding VA treatment records. 2. Obtain addendum opinions regarding the claim right knee, right shoulder and right elbow condition. The Board leaves it to the discretion of the VA examiner in deciding whether additional examinations of the Veteran’s claimed for conditions are needed in order to provide the herein requested addendum medical opinions. The VA examiner should review the Veteran’s claims file, as well as a copy of this remand. Thereafter, opine as to all of the following: a). Is it at least as likely as not (50 percent probability or greater) that the Veteran’s claimed for right knee condition was directly caused by, or is otherwise related to, service? The Veteran has stated that the condition was caused by physical training during his military service where he was required to carry 70 pounds during ruck marches, uphill for miles at a time, as well as having to carry heavy weapons in jumping on and off of Humvees. During the period on appeal the Veteran has been diagnosed with multiple right knee conditions. See March 2019 VA examination (diagnosed with right knee strain); November 2018 VA contract medical examination (diagnosed with bilateral iliotibial band syndrome). Whereas the Veteran’s most recent August 2019 VA medical examination did not include a right knee diagnosis, and therefore the VA examiner is asked to specifically address the conflicting nature of the aforesaid medical evidence of record in opining as to whether the Veteran has a right knee condition related to service. b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s currently diagnosed right shoulder condition was directly caused by, or is otherwise related to, service? See March 2019 VA examination (diagnosed with bilateral rotator cuff tendonitis). The Veteran has stated that the condition was caused by carrying heavy weapons and ammunition on his shoulders and then onto Humvees during military training. c.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s currently diagnosed right elbow condition was directly caused by, or is otherwise related to, service? See March 2019 VA examination (diagnosed with right elbow lateral epicondylitis). The Veteran has stated that the condition was caused by constant training in the field and holding the weapon, as well as raising the weapon up and down when necessary, thereby resulting in weakness/tenderness and limited flexion in his forearm, as well as flare ups. Additionally, the VA examiner’s attention is drawn to the Veteran’s contentions this his claimed for conditions are directly related to service. See Attachment to June 2019 VA Form 21-526EZ. A rationale is requested for all opinions. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.R. Fey, 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.