Citation Nr: 20039969 Decision Date: 06/11/20 Archive Date: 06/11/20 DOCKET NO. 16-06 724 DATE: June 11, 2020 ORDER Entitlement to service connection for headaches as secondary to service-connected posttraumatic stress disorder (PTSD) and tinnitus is granted. FINDING OF FACT The Veteran’s headaches are proximately due to his service-connected PTSD and tinnitus. CONCLUSION OF LAW The criteria for entitlement to service connection for headaches as secondary to service-connected PTSD and tinnitus have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the Army from January 1974 to January 1977 and from August 1977 to August 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran’s claim was remanded by the Board in an October 2018 decision. The RO was directed to schedule the Veteran for a VA examination. A VA examination was scheduled and completed in September 2019. Thus, the Board finds that the RO has substantially complied with the October 2018 Board remand directive. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for headaches as secondary to service-connected PTSD and tinnitus The Veteran contends that his headaches are related to his service-connected PTSD and tinnitus. Generally, service connection may be established if the evidence demonstrates that a current disability resulted from a disease or injury incurred in or aggravated by active duty service. 38 C.F.R. § 3.303. To that end, service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to the period of service, establishes the disease was incurred during active duty service. 38 C.F.R. § 3.303 (d). In order to prove service connection, there must be competent and credible evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus or link between the current disability and the in- service disease or injury. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Board notes that the Veteran specifically contends that he is diagnosed with headaches secondary to his service-connected PTSD and tinnitus. Consequently, the Board will not address whether the Veteran’s condition is directly related to his service and will restrict its findings to whether the Veteran’s headaches are proximately due to or aggravated by his service-connected PTSD and tinnitus. As an initial matter, the Board notes that the Veteran is service connected for both PTSD effective November 19, 2010 and tinnitus effective January 17, 2007. The next question before the Board is whether the Veteran has a diagnosis of headaches or has had a diagnosis at any time during the pendency of the appeal. The Board notes that the requirement for a current disability is met “when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim,” even if the disability resolves prior to adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran’s VA treatment records include complaints of and treatment for headaches beginning in March 2009. During a March 2009 audiology consultation, the Veteran stated that he feels off balance when has headaches and his tinnitus gets very loud. He also stated that his tinnitus is louder when he is having headaches. In January 2010, during a primary care appointment, the Veteran stated that he has had very bad headaches lasting three to four days and constant ringing in his ears for many years. He was diagnosed with migraine headaches and prescribed sumatriptan. From January 2010 to March 2016, the Veteran’s treatment records reveal consistent and continued complaints regarding migraines. During a March 2016 neuropsychological evaluation, the Veteran reported experiencing headaches a couple of times a month that “put him down and cause nausea.” However, from December 2016 to December 2019, headaches are neither noted as an active condition during primary care appointments nor did the Veteran complain of headaches during his appointments. The Veteran’s private treatment records include a March 2010 ear, nose, and throat consultation. The Veteran stated that he gets headaches about twice a month lasting up to a couple of days. He was diagnosed with migraine headaches. In July 2017, a disability and benefits questionnaire (DBQ) was completed by. Dr. H.S. The Veteran reported that he continues to have headaches two to three times per month which are brought on by ringing in his ears and stress. He stated that his headaches can last two or more days at a time. Dr. H.S. opined that the Veteran has a current diagnosis of migraine headaches. The Veteran’s Social Security Administration disability records indicate that the Veteran is assessed with noise-induced sensorineural hearing loss with tinnitus and migraine headaches. The Veteran was found to be disabled due to his chronic back pain, hearing loss, migraine, depression, and PTSD from July 18, 2009. During a September 2019 VA examination, the Veteran stated that he could not recall when his headaches began, but he still gets headaches two to three times a month. The examiner opined that there is no objective evidence of headaches in recent years, as the Veteran has repeatedly denied having headaches in visits with his primary care practitioner. After careful consideration of the evidence of record, the Board finds that the preponderance of the evidence supports a finding that the Veteran was diagnosed with migraine headaches at the time his disability compensation claim was filed in April 2014 and during the pendency of his claim. His medical records indicate that the Veteran was first diagnosed with migraine headaches in January 2010 and continued to complain and receive treatment for his headaches until at least July 2017. Although, the September 2019 VA examiner opined that the Veteran is not currently suffering from headaches based on the lack of notations in his VA treatment records, it does not negate the fact that the Veteran had a diagnosis for migraines beginning in January 2010 that continued throughout the pendency of his claim. Accordingly, the Board finds that the Veteran had a current diagnosis of migraine headaches during the pendency of the appeal. Id. The next question before the Board is whether the Veteran’s diagnosed headaches are proximately due to or aggravated by his service-connected PTSD and/or tinnitus. In the July 2017 DBQ completed by Dr. H.S., he opined that based on a review of the Veteran’s claims file, an interview with the Veteran, and medical literature, the Veteran’s service-connected PTSD and tinnitus more likely than not cause and permanently aggravate the Veteran’s headaches. The rationale provided was that the Veteran stated that when his tinnitus flares up, it brings on headaches. Dr. H.S. noted that it is well-established in medical literature that damage to the auditory system resulting in tinnitus can also cause headaches. Dr. H.S. stated that another contributing factor to the Veteran’s migraines is his service-connected PTSD as medical research shows patients with mental health problems like PSTD, depression, and anxiety are more likely to develop headaches because pain and mood are regulated by the same part of the brain. In support of his opinion, Dr. H.S. attached articles titled Psychological and Audiological Correlates of Perceived Tinnitus Severity and Depression in Headaches: Chronification.” The Board finds Dr. H.S.’s opinion to be adequate and highly probative as it is based on an accurate medical history and provides an explanation that contains clear conclusions with supporting data. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board notes that the Veteran was afforded a VA examination in September 2019 where the examiner opined that the Veteran’s headaches were less likely than not incurred in or caused by his service, including a 1976 complaint for headaches associated with tonsillitis. However, as the examiner neglected to opine as to whether the Veteran’s headaches are proximately due to or aggravated by his service-connected disabilities, the Board finds that the opinion is inadequate. Upon review of the record, the Board finds that the preponderance of the evidence supports a finding that the Veteran had a diagnosis of migraine headaches during the pendency of the claim, and his headaches are more likely than not caused by the Veteran’s service-connected PTSD and tinnitus. The Board finds that the Veteran’s medical records indicate that the Veteran was diagnosed with migraine headaches in January 2010 and continued to experience headaches until at least July 2017. Although the Veteran’s recent VA treatment records are silent as to treatment for headaches, he had a current diagnosis during the pendency of his claim. The Board also finds that the July 2017 opinion offered by Dr. H.S. finding that the Veteran’s headaches are caused by his service-connected tinnitus is adequate and highly probative. While the Veteran was offered a VA examination in September 2019, the examiner neither considered whether the Veteran’s headaches were related to his service-connected disabilities nor refuted the opinion offered by Dr. H.S. Accordingly, entitlement to service connection for headaches as   secondary to service-connected PTSD and tinnitus is granted. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Hartford, 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.