Citation Nr: 20034430 Decision Date: 05/18/20 Archive Date: 05/18/20 DOCKET NO. 12-21 136 DATE: May 18, 2020 ORDER Entitlement to service connection for a headache and/or equilibrium disability is denied. FINDING OF FACT The Veteran’s headache and/or equilibrium disability was not proximately due to or aggravated by his service-connected left eye disability. CONCLUSION OF LAW The criteria for service connection for a headache and/or equilibrium disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service in the United States Marine Corps and from March 1988 to March 1992. In March 2013, the Veteran testified at a hearing before a Veterans Law Judge. The transcript is of record. In March 2020, the Veteran was informed that the Veterans Law Judge who held his hearing was no longer employed by the Board, and offered him an opportunity for a new hearing. He was informed that if he did not respond to the letter within 30 days, the Board would assume that no new hearing was desired. The Veteran did not reply to the March 2020 letter within 30 days. The Board will adjudicate his claim. In January 2018, the Board remanded the case to the Agency of Original Jurisdiction (AOJ) to obtain a supplemental VA nexus opinion. He underwent a VA examination in March 2018, and supplemental opinions were provided in August 2019, and October 2019. These opinions are adequate because they were based upon an in-person examination of the Veteran, a review of the claims file, consideration of his lay statements, and provided rationales for their findings. There was substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection The Veteran contends that his service-connected left eye disability causes headaches and problems with balance and equilibrium, and that a separate rating for these symptoms is warranted. He does not assert that they are directly due to service, including due to the headache documented in his service treatment records in December 1991. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. To establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 C.F.R. § 3.303 (2019); see also Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disability or injury. 38 C.F.R. § 3.310(a) (2019). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(a) (2017); Allen v. Brown, 7 Vet. App. 439, 448 (1995). To establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. Second, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). Third, the Board must weigh the probative value of the evidence in light of the entirety of the record. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102 (2019). When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 4 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran was treated once for a headache in service. In December 1991, he reported feeling pressure in his left eye, along with twitching muscles which were causing him to have a headache. It was noted that he had laser surgery on his left eye the day before. No other mention of headaches was made in his service treatment records. In May 2015, the Veteran underwent a VA eye conditions examination with Dr. D. K. In addition to noting the Veteran’s service-connected left eye disability, he noted that he a central corneal ulcer that was secondary to soft contact lens wear, first diagnosed in 2011. In March 2018, the Veteran received a VA examination for headaches. He reported that his headache disability developed about 10 to 15 years ago and he attributed his disability to his service connected eye disability. He reported having headaches a couple of times a week. He stated that the pain began in the back and came up behind his ears and across the back of his head. The examiner diagnosed tension headaches with onset in the early 2000s. The examiner concluded that the Veteran’s disability was not due to service. First, the examiner noted that the Veterans current treatment records failed to show evidence of a chronic headache condition. Second, there was nothing in the Veteran’s service records to show treatment for a “chronic headache condition.” The Veteran’s description of his headaches matched the definition of tension headaches and that they were “completely unrelated to any injury and/or event that occurred during [his] military service period.” The examiner noted that there were multiple causes of tension headaches including food, activities, and other stressors and cited to medical literature supporting her finding. In an August 2019 VA opinion, the examiner who conducted the March 2018 examination noted that the Veteran had a corneal ulcer beginning in 2012 that was caused by soft contact lens wear. She stated that she had reviewed an eye examination on “/2018” by Dr. K., which showed the 2012 diagnosis of a corneal ulcer. The eye examination conducted by Dr. K. was in May 2015, so the Board assumes that the examiner made a typographical error. The examiner noted that the Veteran did not require ongoing medical treatment for his service-connected central serous retinopathy (CSR) of the left eye “until the unrelated corneal ulcer developed.” She also noted that CSR was also known as central serous chorioretinopathy (CSC). She explained that CSR is an eye disease that causes visual impairment, often temporary, in one eye usually. She stated that when active, CSR causes blurred or distorted vision, and that a blurred or gray spot in the central visual field is common when the retina is detached, She stated that reduced visual acuity may persist after the fluid has disappeared. The examiner stated that the Veteran’s service-connected left eye disability does not result in long-term intermittent tension headaches, and/or balance and equilibrium problems, according to medical literature. She noted that the Veteran was treated for a headache in service, but explained that it “…was an isolated and intermittent headache that resolved w[ith]o[ut] residual and was more likely due to the eye ‘twitching’ that also resolved.” The examiner concluded that the Veteran’s CSR is unrelated to the claimed headaches and/or balance and equilibrium problems. In October 2019, the same examiner concluded the Veteran’s headache and equilibrium condition was not caused by or aggravated by his service connected disability. She stated that the Veteran’s central cerous chorioretinopathy (CSC) “…is not a known or recognized cause of headache and/or balance/equilibrium problems and following a review of the medical literature, in this examiner’s opinion.” She stated that headaches and equilibrium problems were “not known complications of the condition per a review of medical evidence, and the eye condition is typically not in any an [sic] aggravating fac[to]r for any other medical condition, to include headache and/or equilibrium problem[s].” She explained that visual recovery usually occurred within a few weeks to months without treatment. She also concluded that the Veteran’s headaches did not increase in severity beyond their natural progression due to his CSC. At his March 2013 hearing, the Veteran testified that he had headaches a couple of times a week and that he felt stress in his eyes, and that when his eyes were tired he had headaches that lasted about a half an hour to an hour. The Veteran is competent to report that he has headaches and to describe their frequency and observable symptoms. His statements are also credible. However, determining the etiology of his headaches would require knowledge of internal physical processes that are not observable to a lay person. The record does not show that the Veteran has the requisite training, knowledge, and experience to provide a competent etiological opinion for his headaches. The VA opinions are based on a review of the evidence and medical literature, and those opinions are afforded high probative weight. The examiners considered the Veteran’s in-service treatment for a headache once in December 1991 but found that treatment was an isolated incident that resolved. They considered the Veteran’s lay description of the onset, frequency, and symptoms associated with his headaches and the examiner provided thorough and persuasive rationales regarding direct service connection and both the causation and aggravation prongs of secondary service connection. The VA opinions are highly probative evidence against both direct and secondary service connection. Thus, as the preponderance of the evidence is against the claim, the Board finds that service connection is not warranted. See Alemany v. Brown, 9 Vet. App. 518 (1996). D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Brunot, 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.