Citation Nr: 21005957 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 15-31 169A DATE: February 3, 2021 ORDER Entitlement to service connection for migraines is granted. FINDING OF FACT Resolving all reasonable doubt in his favor, the Veteran’s migraines are causally or etiologically due to service. CONCLUSION OF LAW The criteria for service connection for migraines are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1972 to August 1975. This matter comes before the Board of Veterans’ Appeals (BVA or Board) from a May 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing before the Board. The requested hearing was conducted in April 2019 by the undersigned Veterans Law Judge. A transcript is associated with the claims file. In October 2019 and November 2020, the Board remanded this claim for additional development. Entitlement to service connection for migraines. The Veteran seeks entitlement to service connection for migraines. In general, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. Service connection generally requires credible and competent evidence showing: (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. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed.Cir.1996) (table); 38 C.F.R. § 3.303. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To do so, the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the Veteran. See Masors v. Derwinski, 2 Vet. App. 181 (1992). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant). First, the Veteran has a diagnosis of migraines. See August 2020 VA examination. As such, Shedden element (1) is met. Next, the Veteran asserts his headaches had an onset during service, after an in-service assault. The Board notes the Veteran’s in-service personal assault has been previously conceded and the Veteran is currently service connected for PTSD, rated as 100 percent disabling, as due to his in-service assault. The Veteran testified in April 2019 that his headaches started shortly after the in-service assault during service and that he was experiencing increased stress at the time, but that he did not seek treatment. He testified that he did not go to sick bay while in the military for an issue like headaches. The Board notes that the Veteran is competent to report pain and other symptoms, and that headaches are capable of lay observation. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994). As such, resolving all reasonable doubt in his favor, the Board finds that Shedden element (2) is also met. As for Shedden element (3), nexus, the Board notes a November 2007 VA treatment note wherein the physician opined that the Veteran’s headaches were likely part stress-induced with migrainous features. Then, in July 2010, a VA treatment note indicated the Veteran had a long-standing history of migraines since release from military service in 1975. A January 2017 VA treatment note states the Veteran has had chronic headaches for 40 years. In November 2017, a VA treatment note states the Veteran’s headaches may be related to his military sexual trauma. Similarly, in May 2018, a VA treatment note indicates the Veteran’s headaches were usually related to increased stress. A December 2018 VA treatment note again indicated the Veteran’s headaches may be related to his military sexual trauma. A VA medical opinion was obtained in August 2020. The examiner opined that there was no documented evidence of migraines during active duty and no credible evidence to support a causal link. Continuing, the examiner explained that migraines are caused by a primary neural dysfunction that includes both a genetic component and a hormonal component. The August 2020 VA examiner did not note or discuss the Veteran’s in-service assault and how it may or may not have affected his migraine headaches. As a result, the Board requested an addendum opinion in the November 2020 remand. An addendum was obtained in December 2020. The examiner stated that the causes of migraines are not fully understood, however, genetics and environmental factors appear to play a role. The examiner stated there are a number of migraine triggers including stress and sleep changes. The examiner stated, incorrectly, that there was no evidence of a headache condition per the Veteran’s own words, until 2007. The examiner opined that although the Veteran reported a history of assault during service, no chronic headache condition was noted during service and any headache related to trauma would have been readily evident. Continuing, the examiner noted that although anxiety, stress, fatigue, alcohol, drug use and other factors may serve as triggers, they do not cause the primary mechanism of headaches. The Board notes the December 2020 VA examiner indicated that stress, fatigue, and sleep changes are triggers for migraines. The Veteran testified that he experienced increased stress during service after his assault. Additionally, as noted, several VA treatment notes indicate the Veteran’s migraines are possibly due to stress or his in-service assault. Viewing the medical evidence as a whole, and resolving all reasonable doubt in his favor, the Board finds the evidence indicates the Veteran’s migraines are causally or etiologically due to his time in service. This appeal has been previously remanded two times to obtain an adequate VA medical opinion. The Board declines to remand this case yet again and further delay disposition of this appeal. The Court of Appeals for Veterans Claims reiterated in Wise that “[b]y requiring only an ‘approximate balance of positive and negative evidence’ to prove any issue material to a claim for Veterans benefits, 38 U.S.C. § 5107 (b), the nation, ‘in recognition of our debt to our Veterans,’ has ‘taken upon itself the risk of error’ in awarding such benefits.” Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) (citing Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990)). The Board finds that reasonable doubt should be resolved in favor of the Veteran. Accordingly, the Board finds that service connection for migraines is granted. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Andersen, 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.