Citation Nr: 21068061 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 19-04 765 DATE: November 9, 2021 ORDER Entitlement to service connection for headaches is granted. FINDING OF FACT Affording the Veteran the benefit of doubt, her headaches began in service and have continued to the present time. CONCLUSION OF LAW The criteria for service connection for headaches have been met. 38 U.S.C. §§ 1131, 5107, 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from June 1982 to September 1986. The Board notes that the Veteran's claim above was adjudicated in a June 2020 Board decision but has since been returned to the Board following an August 2021 Joint Motion for Partial Remand (JMPR) and corresponding Order from the Court of Appeal for Veteran's Claims (Court). Of note, while the Veteran appealed all the issues in the June 2020 Board decision to the Court, she only presented arguments for the claim of service connection for migraines. The Court thus deemed the other claims adjudicated in the June 2020 Board decision, (i.e.1) service connection for a gynecological condition, other than fourth degree tear with rectovaginal fistula and female sexual arousal disorder); (2) service connection for a hysterectomy; (3) service connection for a neck condition; and (4) service connection for an eye condition, to include glaucoma) abandoned. As such, the Board's June 2020 as to these issues is final. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish entitlement to service-connected compensation benefits, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence"). Service connection must be considered on the basis of the places, types, and circumstances of his service as shown by his service records, the official history of each organization in which she served, his medical records, and all pertinent medical and lay evidence. See 38 C.F.R. § 3.303(a); see also Jandreau v. Nicholson, supra; and Buchanan v. Nicholson, supra. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). Entitlement to service connection for headaches, to include migraine headaches. The Veteran contends that her migraine headaches are related to her active service. Upon review of the claims file, the Board finds that evidence as to whether the Veteran has migraine headaches and whether she had migraine headaches in service is in equipoise, and as such, the Veteran should be provided with the benefit of the doubt. 38 C.F.R. § 3.102. Turning to the element of service connection for a current disability, the Veteran was diagnosed with migraine headaches in January 2019 VA treatment note and a July 2017 VA examiner noted that her headaches described after a fall in 2010 were "suggestive of migraine type headaches." However, the Veteran at various points in the claims file denied that she had headaches, (e.g. December 2006 VA treatment note and a May 2015 VA treatment note) or limited their occurrence to specific external factors (i.e. stress at work) as reported in a June 2012 VA treatment note. In weighing this evidence, the Board notes that when the Veteran denied symptoms of headaches it was usually in the context of an unrelated medical appointment (e.g in the May 2015 VA treatment note the Veteran was being seen for a foot issue). That being said, the evidence which indicates that the Veteran has migraine headaches is inconclusive. The January 2019 VA treatment note contains only a passing mention of the Veteran's migraine noting that the Veteran has a history of migraine headaches and tension headaches and was previously on timolol, a medication for migraine, but this was stopped in August 2018. The July 2017 examiner was likewise unclear noting that the Veteran headaches were "suggestive of migraine type headaches" but ultimately, not providing a diagnosis. The Board finds that the evidence for and against the claim is equally balanced and thus placed in equipoise. As such, the statute 38 U.S.C. § 5107(b). controls and the Veteran is provided the benefits of the doubt. Thus, a diagnosis of migraines, or headaches, during the appeal period has been established. Turning to in-service incurrence, the Board notes that the Veteran reported headaches twice. Once in July 1986 wherein the Veteran reported right-sided headaches lasting all day and becoming worse in the afternoon and reported having previous similar attacks. The second, in August 1986, wherein the Veteran as treated for "severe" headache and the clinician provided a tentative diagnosis of migraines. Importantly, the Veteran was separated from service about two weeks after this clinician tentative diagnosis. Considering the timing, the Board is left with a tentative diagnosis from a clinician who ultimately was unable to resolve one way are another due to the timing of the Veteran's separation. Thus, an in service incurrence has been established. The Board recognizes that the Veteran has stated that her headaches began in service and have continued to the present day. The Board must base its determination of service connection on consideration of all the pertinent medical and lay evidence of record. 38 C.F.R. § 3.303(a). Here the Veteran has provided credible statements that she suffered from headaches, beginning in service where she was diagnosed with migraine headaches, which continued up until the present, the medical evidence shows diagnoses of headaches in service and currently. In light ot the evidence, the Board finds that all elements of service connection for headaches have been met and service connection for headaches is warranted. GAYLE E. STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Acosta, 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.