Citation Nr: 21061589 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 17-48 289A DATE: October 4, 2021 ORDER Entitlement to service connection for a headache condition is granted. FINDING OF FACT The evidence is at least in equipoise as to whether the currently diagnosed headache condition was incurred in or is otherwise attributable to service, to include as secondary to a service-connected disability or combination of service-connected disabilities. CONCLUSION OF LAW The criteria for entitlement to service connection for a headache condition have been met. 38 U.S.C. §§ 1110, 1111, 1131; 38 C.F.R. § 3.303, 3.310; Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1990 to January 1994. Entitlement to Service Connection for a Headache Condition The Veteran seeks service connection for a headache condition, which he contends manifested in service and has continued to the present day. In the alternative, he asserts that even if the condition did not begin until after his discharge from service, it nevertheless is secondary to his service-connected post-traumatic stress disorder (PTSD) and tinnitus. Entitlement to service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Secondary service connection is permitted based on aggravation, such that compensation is payable for the degree of aggravation of a nonservice-connected disability caused by a service-connected disability. 38 C.F.R. § 3.310 (b); Allen v. Brown, 7 Vet. App. 439 (1995). Consequently, there exist two potential theories of entitlement to secondary service connection namely, causation under § 3.310(a) and aggravation under § 3.310(b). At the outset, the Board notes that VA has not engaged in any significant development in support of the Veteran's headache claim. A review of available VA medical records does show that he reported a history of experiencing headaches during an initial evaluation in May 2011. However, no subsequent records document any further treatment for headaches. The Veteran has not undergone a VA examination to evaluate the nature and likely etiology of the claimed headache condition. That being stated, the Board does find that sufficient evidence has been submitted by the Veteran himself to substantiate his claim of entitlement to service connection for a headache condition. Specifically, the Board highlights the findings of a Dr. H.S., who evaluated the Veteran and presented his findings in an October 2017 Disability Benefits Questionnaire (DBQ) as well as a written evaluation also dated in October 2017. In the DBQ, Dr. H.S. noted that the Veteran reported that he began experiencing headaches in service while stationed in Somalia and that they continued ever since then, gradually worsening in severity over time. After an in-person evaluation and review of the claims file, Dr. H.S. diagnosed the Veteran with tension-type headaches. Moreover, in the corresponding October 2017 written evaluation, Dr. H.S. opined that it was as likely as not that the Veteran's headaches both began in service and were permanently aggravated by service-connected PTSD and tinnitus. In support thereof, the examiner noted that the Veteran was consistent in that he associated his tinnitus with his headaches, and he simultaneously reported that his tinnitus symptomatology also began in 1993 while he was stationed in Somalia. Furthermore, Dr. H.S. referred to medical literature and research tending to show a correlation between the incidence of tinnitus and psychological symptomatology and the development and severity of headaches. Dr. H.S. additionally highlighted the Veteran's own reporting that his symptoms of tinnitus and anxiety also regularly preceded the onset of his chronic headaches. In light of Dr. H.S.'s indication that he reviewed the claims file prior to issuing his positive nexus opinion, and his reference to multiple research articles in support of his determination, the Board finds that Dr. H.S.'s opinion is highly probative as to the ultimate issue of whether the headache condition is secondary to the Veteran's service-connected disabilities. Sklar v. Brown, 5 Vet. App. 140 (1993). After further review of the claims file, the Board does not find that there is any evidence tending to discount Dr. H.S.'s determination that the Veteran has a headache condition that is secondary to his service-connected disabilities. As stated, the Veteran has not been afforded a VA examination to evaluate the nature and etiology of his claimed headache condition. The only relevant objective evidence of record is Dr. H.S.'s positive and probative etiology opinion. Overall, the Board concludes that the evidence is at least in equipoise as to the question of whether the headache condition is secondary to the Veteran's service-connected disabilities. Consequently, service connection is warranted. Allen, supra. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher M. Collins, 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.