Citation Nr: 21071447 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 17-15 027 DATE: November 30, 2021 ORDER Service connection for left-side residuals from a stroke with intracranial aneurysm, to include as secondary to service-connected traumatic brain injury, is denied. Service connection for headaches, to include as secondary to service-connected traumatic brain injury, is denied. Service connection for a seizure disorder, to include as secondary to service-connected traumatic brain injury, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran's left-side residuals from a stroke with intracranial aneurysm manifested in service, is causally or etiologically related to service, or otherwise developed secondary to or been aggravated by a service-connected disability. 2. The preponderance of the evidence is against finding that the Veteran's headaches manifested in service, are causally or etiologically related to service, or otherwise developed secondary to or been aggravated by a service-connected disability. 3. The preponderance of the evidence is against finding that the Veteran's asymptomatic seizure disorder manifested in service, is causally or etiologically related to service, or otherwise developed secondary to or been aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for left-side residuals from a stroke with intracranial aneurysm, to include as secondary to a traumatic brain injury, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for headaches, to include as secondary to service-connected traumatic brain injury, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for a seizure disorder, to include as secondary to service-connected traumatic brain injury, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from March 1966 to November 1968. For his service, he was awarded the Combat Infantryman Badge. The Veteran currently has a combined disability rating of 90 percent, with special monthly compensation. In June 2021, the Veteran withdrew a request to appear for a hearing before the Board. PROCEDURAL HISTORY The Veteran's service records reveal that on June 4, 1967, he was attacked and beaten by several assailants. The Veteran suffered a head injury but did not lose consciousness. A physical examination after the assault revealed a lip laceration, ecchymosis, and edema in both the upper eyelids. A neurological examination was reported as being normal. The Veteran was admitted to the hospital for observation. He was discharged to return to duty on June 7, 1967. As the Veteran was on authorized service leave at the time of the attack, the assault has been determined to have occurred in the line of duty. Early December 1979 medical records reflect the Veteran's having headache complaints of one month's duration (i.e., since approximately November 1979) and his use of over-the-counter medications for relief. On December 2, 1979, the Veteran reported having a severe headache of two days duration. After suffering from an acute onset of a "blinding" headache, the Veteran collapsed and was taken to the hospital via ambulance. A physical examination revealed left hemiparesis and hyperactive reflexes in both lower extremities. A lumbar puncture showed grossly bloody cerebrospinal fluid. No medical history of seizures was reported. The Veteran was ultimately diagnosed as having a subarachnoid hemorrhage/right middle cerebral artery aneurysm. On December 7, 1979, he underwent a right frontotemporal craniotomy and clip repair of right middle cerebral artery aneurysm. Postoperatively, the Veteran was reported as doing well for several days. However, he subsequently developed increasing obtundation and hemiplegia secondary to vasospasm and increasing edema. Although his condition ultimately stabilized, the Veteran was noted as continuing to demonstrate a dense left hemiparesis Records dated December 19, 1979 reflect the Veteran undergoing a rehabilitation evaluation related to deficits caused by his subarachnoid hemorrhage. At that time, the Veteran was noted as having mild left hemiparesis with increased reflexes on the left and decreased sensation. An angiography revealed a left middle cerebral artery aneurysm. Subsequent medical records dated January 11, 1980 reflect the Veteran's condition as status-post subarachnoid hemorrhage and clipping of a middle cerebral aneurysm sustaining a significant degree of left hemiplegia secondary to vasospasm. The Veteran was noted as having made an excellent recovery in all areas, with some residual cognitive areas that were also reported to be improving. Post-service, the Veteran has been diagnosed with a traumatic brain injury (TBI), vascular headaches, epilepsy, and asymptomatic generalized tonic/clonic seizures. See September 2017 VA Disability Benefits Questionnaires (DBQs); post-service medical records. SERVICE CONNECTION 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). Service connection for certain chronic diseases, including brain hemorrhages, will be presumed if the diseases manifest to a compensable degree within one year following active military service. Service connection may also be granted on a secondary basis for a disability that is proximately due to a service-connected condition. 38 C.F.R. § 3.310(a). Service connection is also possible when a service-connected disability has aggravated a claimed condition, but compensation is only payable for the degree of additional disability attributable to the aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). 1. Service Connection for Residuals of a Stroke with Intracranial Aneurysm The Veteran argues that his 1967 in-service assault and head injuries are "the cause of all of the issues that [he has] had over the years," to include his 1979 stroke with intracranial aneurysm. As mentioned previously, the evidence confirms the Veteran suffered injuries resulting from his in-service assault. The evidence also shows, as will be discussed in more detail below, that the Veteran suffers from residuals from his 1979 aneurysm that include headaches and seizures. The remaining element needed to establish service connection is a positive medical nexus opinion linking the Veteran's in-service injuries to his post-service aneurysm. While the Veteran clearly believes that the residuals of his 1979 aneurysm are related to his in-service assault/head injury, as a lay person untrained in the medical field, he is not competent to offer a medical nexus opinion that requires specialized knowledge and training. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). A review of the claims file reveals several medical nexus opinions related to the issues on appeal. Unfortunately, none of the opinions are favorable to the Veteran's claims. In September 2017, the Veteran was afforded VA examinations that included a Central Nervous System Disease and Neuromuscular Diseases (Central Nervous System) Disability Benefits Questionnaire (DBQ), a Residuals of TBI DBQ, a Headaches DBQ and a Seizure Disorders DBQ. The examinations were all conducted by the same medical doctor. In completing the DBQ's, the doctor performed a physical examination of the Veteran, obtained a medical history from him, and reviewed the evidence in the claims file. Thereafter, in the Central Nervous System DBQ, he diagnosed the Veteran with a vascular disease stroke secondary to right cerebral artery aneurysm. The other DBQs reflect diagnoses of a TBI, vascular headaches, and generalized tonic/clonic seizures (asymptomatic). In addressing the issue of whether the Veteran's 1967 in-service assault was related to the Veteran's 1979 stroke, the doctor opined that they were not. Specifically, in terms of the 1967 assault, the doctor diagnosed the Veteran as having had a mild traumatic brain injury that had completely resolved. He based his opinion on the lack of medical records to show ongoing complaints that could be attributed to the head injury. Further, the doctor noted that the Veteran's in-service head trauma occurred 12-years prior to the 1979 aneurysm, weighing against the likelihood of a causal connection. Given the overall evidence, he believed that the Veteran's aneurysm and stroke residuals were unrelated to the 1967 assault and head injuries. In terms of the possible issue of aggravation, the doctor found that the evidence did not reveal any ongoing complaints and/or treatment of any possible residuals of the Veteran's mild in-service traumatic brain injury. He indicated the lack of ongoing evidence of residuals, combined with the mild nature of his injuries with only an alteration of consciousness, made opining on any residuals of the head injury less than likely. Since it appeared that the Veteran completely recovered from his 1967 in-service personal assault, and his belief that the 1979 stroke from the surgery to correct the right cerebral aneurysm was completely independent of the in-service head trauma, it was his opinion that the Veteran's TBI would not cause any aggravation of any of his seizures and/or stroke. Therefore, he opined that the Veteran's stroke was less likely than not aggravated beyond its normal progression by his TBI. The Board finds the September 2017 medical opinions to be credible, persuasive, and uncontroverted. As mentioned previously, the VA medical doctor providing the medical opinions considered the evidence of record in conjunction with the Veteran's statements and medical history. He provided clear rationales for his findings, with citations to the record. While the Veteran's representative has requested a remand of the Veteran's claims for further medical guidance, the Board is uncertain as to what additional guidance is being sought. The September 2017 medical doctor addressed the relevant medical questions in this case, specifically whether the Veteran's current disabilities are directly or indirectly related to service, to include his 1967 in-service assault and/or his 1967 TBI on a secondary basis or based upon a theory of aggravation. Absent a specific argument of error, the Board sees no useful purpose to remand the appeal for additional medical development. Lastly, for the purposes of completion, the Board finds for the record that to the extent that service connection on a direct basis must be addressed, the Veteran has not alleged that he suffered a stroke in service, or that he experienced symptomatology that can be associated with an aneurysm or stroke in service. Further, service treatment records do not reflect a diagnosis of a stroke or symptomatology that can be associated with this disability. Based upon the foregoing, the Board finds that service connection for residuals of a stroke on a direct basis must also be denied. 2. Service Connection for Headaches and a Seizure Disorder Turning to the Veteran's specific claims of service connection for headaches and a seizure disorder, the Board observes that the September 2017 medical opinions regarding these disabilities are also unfavorable to the Veteran's claims. In terms of the Veteran's post-service headaches, the September 2017 medical doctor reported that the Veteran's medical records reflect the onset of headaches directly prior to the right cerebralartery aneurysm. While the Veteran reports having post-concussive headaches, the doctor found his post-service symptoms not to be consistent with posttraumatic headaches. He indicated that the Veteran's subjective complaints were more consistent with vascular headaches, as they were over the right temporal region near his surgical scar. As such, he opined that the headaches were more likely than not related to his 1979 surgery and less likely than not incurred in or caused by the in-service personal assault. In terms of the issue of aggravation, the doctor found no medical evidence of ongoing or recurrent headaches after the personal assault in service in 1967. He indicated that the first post-service medical record noting headaches is from 1979; and that these headaches were of one month's duration that became severe two days prior to the diagnosis of right cerebral artery aneurysm that was surgically repaired. Given the foregoing, it was his opinion that the Veteran's vascular headaches were less likely than not aggravated beyond their normal progression by his preexisting TBI. Turning to the Veteran's seizure disorder, the doctor stated that the evidence clearly showed that the Veteran had a right cerebral aneurysm that was unrelated to his in-service head trauma as reflected by the 12-year difference between the two events and the mild nature of the Veteran's 1967 head injury. He went on to state that while the Veteran has clearly suffered many residuals, to include seizures, these residuals are secondary to his right cerebral artery aneurysm and subsequent surgery and unrelated to his in-service TBI. He found no evidence of seizures/stroke prior to the Veteran's 1967 surgery to correct the right cerebral artery aneurysm; and stated that the Veteran's 1979 stroke was clearly the result of the right cerebral artery aneurysm and/or subsequent surgery. As such, it was his opinion that the Veteran's generalized tonic/clonic seizures (asymptomatic) were less likely than not incurred in or caused by the personal assault in service or his subsequent TBI. As for the issue of aggravation, the doctor found no evidence of ongoing complaints, and/or treatment of any possible residuals of the Veteran's mild in-service TBI. He indicated that the lack of ongoing evidence of residuals, combined with the mild nature of the injuries without loss of consciousness, made opining on any residuals of the head injury less than likely. He further stated that it appeared that the Veteran completely recovered from his in-service assault, and his 1979 aneurysm and subsequent stroke from the surgery were completely independent of the in-service head trauma. As such, he indicated that the Veteran's in-service TBI would not cause any aggravation of any of his seizures and/or stroke; and therefore, the Veteran's generalized tonic/clonic seizures were less likely than not aggravated beyond their normal progression by his in-service TBI. Again, as stated above, the Board finds the September 2017 medical opinions provided by the VA doctor to be both credible and persuasive given the evidence upon which they were based and the supporting rationales. See also medical records dated in December 1979 (the Veteran was noted as not having a history of seizures), August 1981 (the records reflect the Veteran as having a diagnosis of status-post right cerebral aneurysm with a residual seizure disorder), and September 2013 ("Seizure likely sec stroke . . ."). Significantly, the medical opinions are also unrebutted. Given the foregoing, the Board finds that the final element needed to establish service connection in this case (i.e., positive medical nexus opinions) has not been met. Therefore, service connection must be denied. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's service connection claims, that doctrine is not applicable. The appeal for service connection for headaches and a seizure disorder is denied. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Talpins 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.