Citation Nr: 21073544 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 17-52 584 DATE: December 9, 2021 ORDER Entitlement to service connection for headaches is denied. REMANDED Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), depressive disorder, anxiety, intermittent explosive disorder, unspecified impulse control, and panic disorder is remanded. Entitlement to special monthly compensation based on aid and attendance is remanded. FINDING OF FACT A headache disability is not etiologically related to active service, and a headache disability was not present within a year of the Veteran's separation from active service. CONCLUSION OF LAW The criteria for service connection for a headache disability have not been met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active naval service from March 1973 to February 1974. This case comes before the Board of Veterans' Appeals (Board) on appeal from a March 2017 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). A review of the record shows that the Veteran has been diagnosed with a variety of psychiatric disabilities. Therefore, the Board has broadened its consideration in accordance with Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board most recently remanded the case for further development in April 2020. The case has since been returned to the Board for appellate review. Headaches The Veteran has asserted that he has a headache disability that is related to his active service. Service treatment records (STRs) reflect that the Veteran complained of a headache in September 1973, and dizziness, nausea, and headaches in December 1973. A review of the post-service medical evidence of record does not show that the Veteran received treatment for his headaches from a VA Medical Center, or from a private facility. As discussed below, the Veteran was diagnosed with migraine headaches at a January 2020 VA examination. In January 2020, the Veteran was afforded a VA examination. The examiner diagnosed the Veteran with migraine headaches. At that time, the Veteran reported that his headache disability began in 1974 and had progressed since then. The examiner noted that the STRs were silent for any headache condition. Further, that the March 2017 VA decision denied the Veteran's claim of entitlement to service connection for headaches. Thus, the examiner opined that the Veteran's headaches were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In an April 2020 decision, the Board found the January 2020 VA opinion to be inadequate and remanded the appeal for a new VA opinion. VA obtained another opinion in July 2020. The examiner noted that the Veteran complained of headaches in September 1973 and in December 1973. Additionally, the examiner noted the Veteran's previous report that his headaches began in 1974 with an insidious onset, and that the headaches have progressed since then. The examiner opined that the Veteran's condition was less likely than not incurred in or caused by the Veteran's claimed in-service injury, event, or illness. In so finding, the examiner stated that the Veteran's noted in-service headaches were acute only. Further, that there was no evidence of chronicity of care and that the Veteran's symptoms were subjective only. The examiner stated that a nexus had not been established. The Board finds the July 2020 VA medical opinion highly probative as the rationale considers the Veteran's STRs showing treatment for headaches, and the examiner considered the Veteran's lay statements regarding continuity of symptomatology. Additionally, the July 2020 VA medical opinion was based on the Veteran's pertinent medical records and the examiner relied on his own training, knowledge, and expertise in rendering his opinion. Moreover, the Board finds that there is no competent medical opinion of record to the contrary. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In an April 2020 decision, the Board found the January 2020 VA opinion to be inadequate and remanded the appeal for a new VA opinion. VA obtained another opinion in July 2020. The examiner noted that the Veteran complained of headaches in September 1973 and in December 1973. Additionally, the examiner noted the Veteran's previous report that his headaches began in 1974 with an insidious onset, and that the headaches have progressed since then. The examiner opined that the Veteran's condition was less likely than not incurred in or caused by the Veteran's claimed in-service injury, event, or illness. In so finding, the examiner stated that the Veteran's noted in-service headaches were acute only. Further, that there was no evidence of chronicity of care and that the Veteran's symptoms were subjective only. The examiner stated that a nexus had not been established. The Board finds the July 2020 VA medical opinion highly probative as the rationale considers the Veteran's STRs showing treatment for headaches, and the examiner considered the Veteran's lay statements regarding continuity of symptomatology. Additionally, the July 2020 VA medical opinion was based on the Veteran's pertinent medical records and the examiner relied on his own training, knowledge, and expertise in rendering his opinion. Moreover, the Board finds that there is no competent medical opinion of record to the contrary. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). While the Veteran is competent to report observable symptoms of a headache disability, he is not competent to provide an opinion linking diagnosed migraine headaches to his active service, as that requires medical expertise and is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Therefore, the Veteran is not competent to provide an etiology opinion for his headache disability. In sum, although the Veteran had a noted history of headaches during service, they were acute, and there was no in-service diagnosis of a migraine disability. Moreover, there is no competent evidence that a headache disability manifested within one year of separation from service or that the Veteran's current migraines are related to his active service. Further, the July 2020 VA examiner's opinion weighs against the Veteran's claim. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for a headache disability is not warranted. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND Acquired psychiatric condition The Board finds that additional development is warranted before the remaining claims on appeal are decided. The Veteran was first afforded a VA examination for his psychiatric disabilities in January 2020. At that time, the examiner noted that the Veteran did not have nor has he ever been diagnosed with a mental disorder. The examiner then opined that the Veteran's psychiatric condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the examiner stated that there was no evidence suggesting a diagnosis while in service, and that the Veteran had a personality disorder that existed prior to service. The examiner opined that the personality disorder was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event or illness. In so finding, the examiner stated that there was no evidence for aggravation while in service. The examiner did not provide any additional rationale. The Veteran was most recently afforded a VA examination for his psychiatric disabilities in July 2020. At that time, the examiner found that the Veteran had an unspecified personality disorder. Further, the examiner noted that the Veteran did not have more than one diagnosed mental disorder. Ultimately, the examiner opined that it was less likely than not that the Veteran's current diagnosis of unspecified personality disorder was directly caused by or was aggravated beyond its natural course by military service. In so finding, the examiner stated that personality disorders are deeply ingrained and maladaptive patterns of behavior of a specified kind. That these disorders typically manifest by adolescence but are not typically diagnosed until an individual is a young adult. Further, that personality disorders are likely shaped by biological factors, including life experiences, particularly early life experiences. However, the examiners did not address the multiple diagnoses of psychiatric disorders noted in the Veteran's Social Security Administration (SSA) records. In that regard, SSA records reflect diagnoses of PTSD, depressive disorder, anxiety, intermittent explosive disorder, unspecified impulse control, and panic disorder. Additionally, given the January 2020 examiner's assertion that the Veteran's personality disorder predated his service, a clarifying medical opinion is needed which addresses whether the Veteran had a preexisting psychiatric disorder that predated service, and whether there was any superimposed disease or injury in service that would have affected the Veteran's personality disorder. 2. Special monthly compensation based on aid and attendance Finally, because a decision on the above remanded issue could significantly impact a decision on the issue of entitlement to special monthly compensation, the issues are inextricably intertwined and a remand is required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion by an examiner with sufficient expertise to determine the nature and etiology of the Veteran's acquired psychiatric disabilities. The examiner should first identify all psychiatric disabilities present during the pendency of the appeal, or proximate thereto. The examiner should address the psychiatric diagnoses noted in the Veteran's SSA records. Specifically, the SSA records reflect diagnoses of PTSD, depressive disorder, anxiety, intermittent explosive disorder, unspecified impulse control, and panic disorder. For each diagnosed psychiatric disability, the examiner should provide an opinion as to whether such disability clearly and unmistakably existed prior to the Veteran's active service, and if so, whether such disability was clearly and unmistakably NOT aggravated by such service. The examiner must note that the Veteran's lay statements alone are not a sufficient basis to support a finding that a disability clearly and unmistakably existed prior to the Veteran's active service. Further, in forming the opinion, the examiner must address the in-service notations of psychiatric symptoms. For any identified psychiatric disability NOT found to preexist the Veteran's active service, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that such disability had its onset during the Veteran's active service, or is otherwise etiologically related to such service. For any personality disorder identified, is it at least as likely as not that the Veteran developed superimposed pathology as a result of active service. The rationale for all opinions expressed must be provided. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board I. Cannaday, 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.