Citation Nr: 21061479 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 12-17 585A DATE: October 4, 2021 ORDER Entitlement to service connection for migraine headaches is granted. Entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, his migraine headaches disability is at least as likely as not related to service. 2. The Veteran's PTSD is aggravated beyond its natural progression by his service-connected migraine headaches. CONCLUSIONS OF LAW 1. The criteria for service connection for migraine headaches are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for PTSD as secondary to service-connected migraine headaches are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1972 to July 1975 and August 1975 to November 1976. This matter comes before the Board of Veterans' Appeals (Board) from a July 2009 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared for a hearing before the undersigned Veterans Law Judge in September 2016. A transcript of the proceeding is of record. This claim was most recently remanded by the Board in July 2018 for further development, to include providing addendum VA medical opinions. The Board finds substantial compliance with the remand directives and therefore another remand is not necessary. Stegall v. West, 11 Vet. App. 268 (1998). Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Service Connection 1. Entitlement to service connection for migraine headaches The Veteran contends his migraine headaches began during his second period of service due to the stress from his assigned military occupational specialty (MOS) of military policeman (MP). The Veteran reports that he began experiencing migraines in service, and self-treated with over the counter pain medications and alcohol. The Board concludes that the Veteran has a current disability that is related to his duties as an MP during his second period of service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). August 2008 VA treatment records show the Veteran was diagnosed with migraine headaches in August 2008 and reported a history of headaches at that time. Thus, the Board finds the Veteran has a migraine headache disability. Service treatment records (STRs) do not show any reports, treatment, or medication for migraine headaches. Military personnel records confirm his MOS was military policeman (MP). Military personnel records also confirm that he was enrolled in substance abuse counseling in service. The Veteran's November 1976 separation report of medical history and examination noted no defects. The Veteran was afforded a VA examination in February 2018 wherein the examiner opined against relation to service. However, in the Board's July 2018 decision, the Board found this opinion was inadequate for lack of a complete rationale that considered all relevant evidence of record. Therefore, this examination is entitled to no probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008); Prejean v. West, 13 Vet. App. 444, 448-9 (2000); see also Dalton v. Nicholson, 21 Vet. App. 23 (2007). At the November 2019 psychiatric VA examination, the Veteran reported that he began experiencing headaches in service due to the stress from being an MP. He reported that he did not disclose his headaches during service for fear of being pulled from general duty, so he self-medicated with aspirin and alcohol. Consequently, while on active duty, the Veteran was advised to seek medical treatment and went to see a mental health provider. The examiner opined that it is at least as likely as not that the Veteran's headache condition is due to the stress from his in-service experiences as an MP. The rationale was that the Veteran had no headache condition prior to service and did not experience headaches until after his time as an MP. The examiner explained that the stress from his MOS was the impetus for the condition. The Board finds the November 2019 VA examination and medical opinion to be probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. The examiner who conducted the examination reviewed the record, interviewed the Veteran, and examined the Veteran. The examiner's opinions were based on the specific facts of this case as presented in the record and by the Veteran at an in-person examination. The examiner reviewed the record and provided appropriate rationales that are factually accurate, fully articulated, and soundly reasoned. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Prejean, 13 Vet. App. at 448-9. Accordingly, the Board accepts the VA examiner's opinion as the most probative evidence as whether it is at least as likely as not that the Veteran's migraine headache disability is related to service. The Board acknowledges the November 2019 headache VA medical opinion and July 2021 addendum medical opinion concluding that the Veteran's migraine headaches did not begin in service, within one year of separation from service, or were otherwise related to service. However, upon review of the record, including the positive November 2019 psychiatric VA opinion, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current migraine headache disability is related to service. Accordingly, after resolving all doubt in favor of the Veteran, service connection for migraine headaches is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) The Veteran contends that his acquired psychiatric disorder, to include depression and PTSD, are related to the stresses encountered during his second period of service as an MP. Service connection for PTSD will be granted on a direct basis when there is medical evidence establishing a clear diagnosis of PTSD under 38 C.F.R. § 4.125(a); credible supporting evidence that the claimed in-service stressor actually occurred; and a link, established by medical evidence, between current symptoms and a claimed in-service stressor. 38 C.F.R. § 3.304(f). 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. STRs do not show any reports, treatment, or medication for any mood disorder, though military personnel records do show the Veteran was engaged with substance abuse counseling. Military personnel records also show the Veteran was given several Article 15 violations for not being at his proper place of duty in August and October 1976. The Veteran was detained by civil authorities for several days in November 1976 for unknown reasons. A mental status examination in November 1976 conducted in consideration of discharge was normal. While the Veteran earned an honorable discharge, he was discharged for personal drug use, rehabilitative failure and related poor job performance. The Veteran's November 1976 separation report of medical history and examination noted no defects. VA treatment records indicate the Veteran was first seen for mental health treatment in February 2009 where he endorsed chronic untreated depression for about 20 years. See April 2009 VA treatment records. In June 2011 VA treatment records the Veteran reported depression since 1976. The Veteran has been diagnosed with depression, alcohol dependence (in remission), and opiod dependence (in remission) by VA treating providers. See, e.g., September 2013 VA treatment records; see also February 2018 VA examination. The Veteran was also diagnosed with posttraumatic stress disorder (PTSD) by the November 2019 VA examination. The Veteran was afforded a VA examination in February 2018. The examiner opined that the Veteran's substance abuse predates his military service and is not aggravated by a service-connected psychiatric disorder. The examiner also opined that his diagnosed depression was less likely than not due to service as there is no treatment in service and no evidence that his current symptoms are related to his service. However, in the Board's July 2018 decision, the Board found this opinion was inadequate because it did not consider the Veteran's reported nightmares and headaches in service. Moreover, the Board notes that the Veteran's entrance and separation examinations for both periods of service do not note that he had a substance or alcohol dependence disorder prior to service; thus, there is no competent evidence that his substance abuse predates his military service. Accordingly, the February 2018 opinion is entitled to no probative weight. Nieves-Rodriguez, 22 Vet. App. at 302-04; Prejean, 13 Vet. App. at 448-9. At the November 2019 VA examination, the examiner diagnosed the Veteran with PTSD. The examiner did not diagnose any other psychiatric condition. At the examination the Veteran reported that he began having headaches and nightmares in service due his duties as an MP, as detailed above, and that these symptoms continue to date. The examiner found that the Veteran had no mental health issues prior to service but that he now has clear symptoms of PTSD and headaches which are both related to his in-service experiences as an MP. The examiner opined that his PTSD was at least as likely as not aggravated by his headaches. The rationale was that the evidence shows that Veteran did not have headaches until he began to experience PTSD symptomatology, and that the headaches in turn aggravated his PTSD symptoms. The Board finds the November 2019 VA opinion to be entitled to great probative weight because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez, 22 Vet. App. at 304; Prejean, 13 Vet. App.at 448-9. Here, the Board observes that the Veteran reported at the November 2019 headache VA examination that once he was started on mental health medications, which helped decrease his stress, his headaches improved. Further, VA treatment records also show improvement in his migraines with psychiatric medications and decreased stress. See, e.g., September 2013 and January 2014 VA treatment records. Additionally, the July 2021 addendum opinion indicated that, while still being studied, imbalances in brain chemicals including serotonin, which helps regulate pain in the nervous system also may be involved in the development of migraines. Accordingly, the Board accepts the VA examiner's opinion as the most probative evidence as whether it is at least as likely as not that the Veteran's PTSD was aggravated by his migraine headache disability. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current PTSD was aggravated beyond its natural progression by his service-connected migraine headaches. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for PTSD is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.L. Blevins, 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.