Citation Nr: 21005145 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 16-49 624 DATE: January 29, 2021 ORDER Service connection for a chronic headache disability is granted. Service connection for an acquired psychiatric disorder characterized as a major depressive disorder (MDD) and an obsessive-compulsive disorder (OCD) is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, the evidence supports a finding that her chronic headaches onset during her active service. 2. The preponderance of the evidence supports a finding that the Veteran has experienced MDD and OCD since her active service. 3. At no time during the current appeal period has the Veteran been diagnosed with posttraumatic stress disorder (PTSD). CONCLUSIONS OF LAW 1. The criteria for service connection for a chronic headache disability have been met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 2. The criteria for service connection for an acquired psychiatric disorder characterized as an MDD and an OCD have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.125. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1999 to September 2002. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2007 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). A November 2018 Board remand recharacterized the issues to combine the claims for service connection for mental health disorders to include any psychiatric disorder. 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; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection requires competent evidence of (1) a current disability; (2) the incurrence or aggravation of a disease or injury during service; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Additionally, service connection can also be established through application of a statutory presumption for chronic diseases, such as organic diseases of the nervous system (including migraine headaches) and a psychosis, when manifested to a compensable degree within a year of separation from service. 38 C.F.R. §§ 3.307, 3.309. If a chronic disease is not manifested to a compensable degree within a year of separation of service, then, generally, a showing of “continuity of symptoms” after service is required for service connection. 38 C.F.R. § 3.303(b). Chronic headache disability Upon entrance to service, the Veteran reported frequent or severe headaches that preexisted service. However, the entrance examination provider did not note a prior diagnosis of migraine headaches on the entrance examination. As such, the Board finds that the Veteran was sound as to this condition upon her entry into active service. Rather, the Veteran believes that she has a chronic headache disability that onset during her active duty and continued thereafter. Medical evidence establishes a current diagnosis of chronic migraine headaches. Therefore, the issue is whether her current chronic headache disability is indeed related to her active service. Specifically, she asserts that she first exhibited migraines during basic combat training. STRs show complaints and symptoms of headaches. Further, a pertinent VA examination conducted in May 2003 (within one year after the Veteran’s separation from active service) diagnosed the Veteran with migraine headaches. During the current appeal, the Veteran underwent two VA examinations (in August 2019 and August 2020) to determine the nature and etiology of her chronic headache disability. The Board acknowledges that both examiners opined against service connection for the Veteran’s chronic headaches. Specifically, the August 2019 examiner concluded that there was no objective evidence of a chronic headaches incurred in, caused by, or permanently aggravated by active service. Further, the August 2020 examiner concluded that the Veteran’s migraines are not secondary to her service-connected lumbar spine disability or claimed depression, as it is widely accepted medical knowledge. While the Board cannot ignore or disregard the VA examiner’s medical conclusions [Willis v. Derwinski, 1 Vet. App. 66 (1991)], the Board is free to assess medical evidence and is not compelled to accept a medical opinion. Wilson v. Derwinski, 2 Vet. App. 614 (1992). The Board finds both medical opinions problematic as they do not address the Veteran’s competent lay statements regarding the in-service onset of her migraines and her continued symptoms thereafter. For these reasons, the negative nexus opinions are not probative, as they are based upon unreliable medical evidence and did not consider the Veteran’s probative factual assertions. Resolving all reasonable doubt in favor of the Veteran, the evidence supports a finding that her chronic headache disability onset during her active service. She is competent to report what she has experienced through her senses, and the Board has no reason to question the credibility of her reports as to the timeline of the onset of her symptoms. Thus, service connection is warranted for migraine headaches. Acquired psychiatric disorder The Veteran contends that her psychiatric disorders are related to her active service. Specifically, she asserts that the stress from military service and being away from home caused her to have anxiety. An August 2019 VA examiner diagnosed a depressive disorder with mixed features. Therefore, the issue is whether this diagnosed disability is related to the Veteran’s active service. In this regard, the Board notes that the Veteran’s STRs are negative for complaints of, or treatments for, a psychiatric disorder. According to post service medical records, an October 2003 VA nursing note shows that the Veteran reported complaints of depression and OCD. A January 2004 a psychology note indicates that the Veteran was seen for symptoms related to her depression. A May 2004 medical assessment plan showed that the Veteran’s depression was being medicinally treated. Subsequent records show continuous complaints and treatments for various psychiatric disorders, ultimately leading to a diagnosis of OCD and depression, as indicated in a November 2007 VA examination. The Veteran reports, and the treatment records confirm, that she has experienced psychiatric symptoms since service. While there is some absence of annotations of psychiatric symptoms in early post-service medical records, the Board finds that the Veteran is competent to report that she experienced symptoms of a psychiatric disorder during this period (since service). Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board, thus, accords probative weight to the Veteran’s competent and credible statements. Importantly, the record contains credible evidence of a continuity of psychiatric symptoms beginning in service, as reported by the Veteran, and continuing thereafter. The Board has no reason to doubt the Veteran’s veracity regarding the onset of acquired psychiatric disorders and the continuity of pertinent symptoms. Thus, the Board finds the Veteran’s statements to be probative. Based upon the Veteran’s reports of psychiatric symptoms in service and her competent and credible reports of continuous psychiatric symptoms since service, the Board finds that her psychiatric disorders are a result of her military service. With resolution of reasonable doubt in the Veteran’s favor, service connection for an acquired psychiatric disorder characterized as MDD and OCD is warranted. In reaching this decision, the Board acknowledges that an August 2020 VA examination resulted in a favorable opinion for secondary service connection, establishing a nexus between the Veteran’s service-connected lumbar spine disability and her current depression. Specifically, the examiner stated that “adverse mental health functioning in include mood regulation…is commonly associated with persistent chronic and debilitating pain such as lumbosacral strain.” However, as previously noted herein, the Board finds that direct service connection for an acquired psychiatric disorder characterized as MDD and OCD is warranted. As direct service connection is the greater benefit over secondary service connection, the Board need not address the matter of secondary service connection further in this decision. In addition, the Board recognizes that the Veteran also claimed service connection for PTSD. In this regard, the Board notes that the Veteran showed both positive and negative PTSD indications at VA screenings for PTSD. However, the claims folder is absent of a confirmed diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a) under the DSM. The threshold consideration for any service connection claim is the existence of a current disability. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Consequently, the Board finds that the criteria for service connection for PTSD are not met. Accordingly, the Board finds the evidence supports that the Veteran’s current psychiatric disability, characterized as MDD and OCD, is the result of her active military service. As such, service connection for an acquired psychiatric disability, characterized as MDD and OCD, is warranted. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. R. Bobb, 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.