Citation Nr: 21069400 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 19-10 221 DATE: November 18, 2021 ORDER Entitlement to service connection for migraine headaches is granted. FINDING OF FACT The Veteran has experienced migraine headaches since her separation from service. CONCLUSION OF LAW The criteria for entitlement to service connection for migraine headaches are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1986 to July 1988. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a May 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Veteran testified at a hearing conducted by the undersigned Veterans Law Judge. 1. Entitlement to service connection for migraine headaches is granted. Direct service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. 38 C.F.R. § 3.303. For certain chronic diseases, including migraines, another way to prove the second and third service-connection elements is continuity of symptomatology. See 38 C.F.R. § 3.309(a) (listing "[o]ther organic diseases of the nervous system" as a chronic disease). Continuity of symptoms is established if the Veteran establishes (1) that a condition was "noted" during service, (2) post-service continuity of symptoms, and (3) medical or, in certain circumstances, lay evidence of a link between the present disability and the continuity of symptoms. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013). Starting with the first element (current disability), this requirement is met when the Veteran has a disability at or approximate to the time a claim is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In December 2003, the Veteran underwent a private neurological evaluation. There, she reported suffering from headaches two to three times a week with throbbing or pulsating head pain lasting 8-10 hours. She also complained of nausea, sensitivity to light and sound, and vision changes. Her private neurologist's impression was migraine headaches. More recent medical records show migraine headaches still among her "active problems." Accordingly, the Board finds the Veteran currently disabled. Moving from the Veteran's current medical problems to her problems during service, the Veteran complained of headaches for the past five days in April 1988. At the time, the medical officer assessed headaches, "probable sinus but tension maybe a factor." At exit, the Veteran again reported frequent or severe headaches on her medical history report. In the physician's summary, the medical officer noted that her headache problem "lasted two weeks due to sinusitis problem," and she fully recovered with "NCNS [no complications, no sequelae]." Her exit neurological evaluation was clinically normal. Because the Veteran was assessed with headaches during service, the Board finds the Veteran suffered an in-service injury or disease. With the first two legal requirements met, the Veteran's appeal comes down to the last elementwhether her current migraine headaches are related to the ones she experienced during service. To address the issue, the Veteran underwent a headache examination in January 2019. There, the medical examiner diagnosed the Veteran with migraine headaches but found them unrelated to her service. In the opinion, the examiner relies on two things to support her unfavorable opinion. First, she points out that there was only "a single . . . notation of a headache" during service, and it was "secondary to an acute and transitory sinusitis" problem. And second, she cites the "lack of evidence of . . . diagnosis or treatment of headaches post separation until" December 2003. There are no medical opinions in the record challenging the examiner's conclusion. The Board begins with the basic principle that the Veteran is competent to report what she has "heard, felt, seen, smelled, or tasted." Layno v. Brown, 6 Vet. App. 465, 469 (1994). After all, the Veteran does not need to be a doctor to know her head hurts. As noted, she complained of headaches during service and at exit. After separation, she testified that her headaches continued to the present day. The earliest medical record in the claims file supports the Veteran's testimony. In December 2003 (and well before the current claim), the Veteran reported "a long history of migraines" to her neurologist. White v. Illinois, 502 U.S. 346, 356 (1992) ("[A] statement made in the course of procuring medical services, where the declarant knows that a false statement may cause misdiagnosis or mistreatment, carries special guarantees of credibility."). What's more, the Veteran submitted a statement from her former bunkmate and roommate corroborating her testimony. Because of their living circumstances, the two were frequently around each other. She witnessed the Veteran suffering from migraine attacks during service going so far as to escort her to the hospital for treatment. The two kept in touch, and the Veteran told her that she continued to suffer from migraine attacks after separation. On this record, the Board finds the Veteran's testimony competent and credible. Weighing the probative value of the evidence, the Board finds it at least in equipoise. The examiner's no-chronicity conclusion relies heavily on the 15-plus year evidentiary gap between July 1988 (the Veteran's discharge date) and December 2003 (the first post-service documented diagnosis). But confirmatory clinical records are not required. Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). And for good reason. Sometimes, the veteran won't realize they are sick until well after the first symptoms appear. Other times, they won't be able to afford medical care. Or, as here, the medical records may be unavailable. At her hearing, the Veteran testified she saw an internist in the mid-1990s who treated her migraines. She attempted to obtain those records, but her healthcare provider had retired in the interim. Oddly, the examiner expressly mentions in the opinion that the Veteran reported "a long history of migraines" to her neurologist in December 2003. This medical history necessarily implies that her headache problem began before that visit, potentially well before then. Despite this, the medical examiner does not offer a medical reason to doubt that implication, explain why the Veteran's statements or recollection are inconsistent with the evidence, medical principles relating to the onset and progress of the disease, the specific findings in the record, or her professional judgment. On the other hand, the Veteran competently testified that her headache problems began during service and continued after she left. Her testimony is corroborated by the available medical and lay evidence. Given the deficiencies in the examiner's medical opinion, the Board assigns more probative value to the Veteran's testimony. (Continued on the next page) Although there is no medical opinion connecting the Veteran's current disability to her service, the Board finds the Veteran's competent, credible, and probative evidence of continuous symptoms provides that link. Accordingly, the Board finds the criteria for service connection met. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Canedy, 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.