Citation Nr: 21002762 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 16-51 882 DATE: January 14, 2021 ORDER Entitlement to service connection for a bilateral shoulder disability, to include as secondary to service-connected migraine headaches, is denied. Entitlement to service connection for a neck and upper back disability, to include as secondary to service-connected migraine headaches, is denied. FINDINGS OF FACT 1. The Veteran’s bilateral shoulder disability was not caused or chronically worsened by her service-connected migraine headaches, nor otherwise etiologically related to her active service. 2. The Veteran’s neck and upper back disability was not caused or chronically worsened by her service-connected migraine headaches, nor otherwise etiologically related to her active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a bilateral shoulder disability, to include as secondary to service-connected migraine headaches, have not been met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2019). 2. The criteria for entitlement to service connection for a neck and upper back disability, to include as secondary to service-connected migraine headaches, is denied. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active air service from November 1992 to November 1996. This case comes before the Board of Veterans’ Appeals (Board) on appeal of a May 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is associated with the claims file. This case was previously before the Board in November 2019, at which time the issues on appeal were remanded for additional development. The case has been returned to the Board for further appellate action. Service Connection – Bilateral Shoulder, Neck, and Upper Back Disabilities The Veteran asserts that her shoulder, neck, and upper back disabilities, which include pain and limited mobility, are associated with her service-connected migraine headaches. In an October 2015 statement, the Veteran’s chiropractor, Dr. J.C., reported that she had pain in the neck, upper back, and bilateral shoulders which led to migraine headaches. Dr. J.C. assessed that an underlying origin of the Veteran’s migraines, in addition to environmental triggers, was within her neck, upper back, and both shoulders. Additionally, Dr. J.C. noted that keeping those areas free from nerve pressure, and her upper cervical spine from impinging on her brainstem, only provided temporary relief for the Veteran’s migraines. In a November 2015 statement, the Veteran stated that she believed that the root cause of her migraines was neck, shoulder, and upper back issues. The Veteran stated that she received Botox injections in the neck, shoulders, upper back, head, and forehead every three months. The Veteran also stated that she had over four migraines a week, that were not resolved with treatment. In a July 2017 treatment note, it was revealed that the Veteran had about a year of lateral and posterolateral shoulder pain, especially with elevation but also while lying on it. At that time, the Veteran was noted as being a very active individual who works with weights and participates in cross fit often. The Veteran also reported that she had been consistent with exercises given to her, had been going to the chiropractor, and that the massage therapist modified her gym routine, but that she continued to have pain in her lateral shoulder. In October 2017, the Veteran was afforded a VA examination for headaches. At that time, the Veteran reported that her migraines provoked tension and pain in her neck and shoulder, and that muscle spasms and tension also provoked her migraines. In an October 2017 treatment note, the Veteran was assessed as presenting with symptoms consistent with rotator cuff tendonitis and subsequent upper trapezius pain. At that time, it was also noted that the Veteran had been consistent with her exercises, but that she did not respond well to an exercise program and magnetic resonance imaging (MRI) was recommended for her left shoulder. In a February 2018 treatment note, the Veteran was noted as having a full active range of motion in both shoulders with pain upon movement. In December 2018, the Veteran was noted as having constant left shoulder pain, but no significant injury to her shoulder in the past. At that time, the Veteran reported that she worked out regularly and had been able to lift, and stated that she attributed her left shoulder pain to overuse. In January 2019, the Veteran reported improvement in her neck muscle weakness due to omitting the trapezius pars descendens the previous two clinic visits. At the June 2019 Board hearing, the Veteran testified that her upper back, neck, and shoulders were affected with the pain from her migraines, and that her neck and shoulder pain could last even after the migraines were gone. The Veteran also testified that her pain prevented her from performing routine activities (e.g. overhead lifting, picking up, cooking, and driving), and that the medication she took for her migraines did not relieve her neck and shoulder pain. In an August 2019 treatment note, the Veteran was noted as having a prior diagnosis of rotator cuff tendinopathy from August 2016, and a left shoulder x-ray that revealed mild osteoarthritis. In another August 2019 treatment note, the Veteran was noted as having arthralgia of the shoulder. In January 2020, the Veteran was afforded a VA examination for shoulder conditions. At that time, the Veteran reported that her intermittent shoulder pain was both due to, and worsened by, her migraine headaches. The VA examiner reported that the Veteran’s diagnosis was bilateral shoulder strain and that during her flare-ups there was pain in both shoulders that caused a limited range of motion (ROM). However, the VA examiner opined that the Veteran’s bilateral shoulder disabilities were neither caused by her service, nor aggravated by her service-connected migraine headaches. The VA examiner reasoned that the Veteran had no complaints of shoulder pain or indication of chronic shoulder conditions during her active service. Additionally, the VA examiner found that a review of both the definition of a migraine, from the American Headache society, and pertinent medical literature, revealed no physiologic link between the neurovascular nature of the migraine headache and the manifestation of musculoskeletal pain. In January 2020, the Veteran was also afforded a VA examination for neck conditions. At that time, the Veteran reported that her intermittent neck pain was worsened with her migraines. The VA examiner reported that the Veteran’s diagnosis was a cervical strain and that there was pain noted on the examination that caused functional loss on forward flexion, extension, bilateral lateral flexion, and bilateral lateral rotation. However, the VA examiner opined that the Veteran’s neck and back disability were neither caused by her service, nor aggravated by her service-connected migraine headaches. The VA examiner reasoned that the Veteran’s service treatment records (STRs) were negative for complaints of neck or thoracic pain, and there was no causative link between her migraine headaches and cervical and thoracic condition. At the outset, the Board notes that the October 2015 opinion from Dr. J.C. is afforded low probative value. In that regard, Dr. J.C.’s opinion reveals that the Veteran’s neck, shoulder, and upper back pain are part of the underlying origin of her migraine headaches. In this case, the Veteran asserts the opposite, that her migraine headaches cause, or worsen, her neck, shoulder, and upper back pain. Therefore, the Board finds that Dr. J.C.’s opinion is insufficient as it does not speak to the issue of whether the Veteran’s migraine headaches caused or aggravated her neck, shoulder, and upper back disabilities. In contrast, the Board notes that the January 2020 VA examinations are the most probative evidence of record. In that regard, the VA examiner thoroughly reviewed the claims file and discussed the relevant evidence, considered the contentions of the Veteran, reviewed the pertinent medical literature, and provided supporting rationales for the conclusions reached. Further, there is no evidence to the contrary of the VA examiner’s opinions. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, the Board acknowledges that the Veteran is competent to report the observable symptoms of her neck, shoulder, and upper back pain. However, the Veteran is not competent to render an etiological opinion linking her neck, shoulder, and upper back pain to her service-connected migraines. An etiological opinion of this nature, especially in light of the additional diagnoses affecting those areas, requires medical expertise and is outside the realm of knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board also finds that the Veteran’s statements are not credible as they are inconsistent with the other evidence of record. In that regard, during the June 2019 Board hearing, the Veteran testified that her pain prevented her from performing routine activities, however, during her routine course of treatment it was noted that the Veteran routinely engaged in exercise that included lifting weights and cross fit. The Veteran also failed to report that her migraines were the cause of her neck, shoulder, and back pain during her routine course of treatment, as indicated by her December 2018 treatment note reporting overuse as the cause of her shoulder pain. Based on the foregoing, in this case, the Board finds that the most probative evidence weighs against the claims. Accordingly, the Board finds that the preponderance of the evidence is against the claims and entitlement to service connection for neck, shoulder, and upper back disabilities, to include as due to service-connected migraine headaches, is not warranted. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Byrd, 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.