Citation Nr: 21007714 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 15-22 122 DATE: February 10, 2021 ORDER Entitlement to service connection for traumatic brain injury (TBI), to include dizziness, memory loss, and seizures, is denied. Entitlement to service connection for post-traumatic headaches is denied. FINDINGS OF FACT 1. The Veteran had a TBI during service, but he also had several post-service head injuries; the preponderance of the evidence is against finding that the Veteran manifested any current disability, such as dizziness, memory loss, or seizures, that can be causally linked to the in-service TBI or any other incident of service. 2. The Veteran’s current headache disability was not shown as chronic in service nor manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease including the in-service TBI. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for TBI, to include dizziness, memory loss, and seizures, have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for post-traumatic headaches have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1972 to October 1976. These matters return to the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision issued by the Department of Veterans’ Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. By way of background, the Board previously remanded these claims in September 2018 and July 2020 for additional development including obtainment of federal records from SSA, which have been associated with the claims file. As such, the Board finds substantial compliance with the July 2020 remand directives has been met. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding when a remand is issued, the Veteran is entitled, as a matter of law, the right to compliance with the remanded order). The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service Connection Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty, or for the aggravation of a pre-existing injury or disease in the line of duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). The elements of direct service connection are: “(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,” also known as the nexus element. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases, including epilepsies and headaches as an organic disease of the nervous system, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013) (holding that only conditions listed as chronic diseases in § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b)). When service connection cannot be established on a presumptive basis, the Court has held that the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis. See Combee v. Brown, 34 F.3d 1039 (1994). 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. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., varicose veins, tinnitus (ringing in the ears), etc.), (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. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Turning to the relevant evidence of record, upon entrance to service, the Veteran was clinically evaluated as normal while denying experiencing frequent or severe headaches, dizziness, fainting spells, or head injury. See March 1972 entrance examination. During service in July 1973, the Veteran reported being hit in the face and eyes, including getting “maced”. See July 1973 service treatment records (STRs). In December 1973, the Veteran reported experiencing dizziness on and off for three days with pain in the head and eyes. See December 1973 STRs. In September 1975, the Veteran complained of dizziness and headaches for which he was directed to be evaluated for glasses. See September 1975 STRs. In December 1975, the Veteran stated that he had a “bad headache” across the frontal lobe due to being hit with a nightstick. See December 1975 STRs. The Veteran said that he lost consciousness for no more than five minutes. Id. In February 1976, the Veteran sought medical care following a cold for multiple days with a headache. See February 1976 STRs. At separation, the Veteran was clinically evaluated as normal. See October 1976 separation examination. He denied experiencing dizziness and fainting spells as well as frequent or severe headaches. Id. The Veteran checked “don’t know” in response to head injury. Id. Immediately after service, there are no treatment records or anything in the record showing complaints, treatment, or diagnoses related to headaches, head injuries, dizziness, fainting spells, or any other “residual” of a head injury. In April 1997, three decades after service, the Veteran filed a claim indicating that in 1973 during active duty he suffered a broken nose, which causes problems with breathing through the left nostril. He also noted a post-service 1992 eye injury, which required his left eye lens to be removed, as well as a post-service 1995 back injury, resulting in problems lifting his left arm over his head. At that time, he submitted private eye clinic records dated February 1997 indicating a “history of being beaten with a lead pipe, sustaining severe facial trauma.” This history is expanded upon in VA ophthalmology records from 1997. An October 1997 record indicates a history of the Veteran being hit by a pipe by a robber in 1991, causing aphakia. An October 1997 VA examination also notes history of a 1994 automobile accident where the Veteran hurt his low back and left shoulder. The examiner, at that time, also noted an in-service fight in 1972 in Okinawa where the Veteran had a fractured nose. Records from May 1997 indicate the Veteran was struck by a vehicle as a pedestrian. See May 1997 non-government treatment records. May 1997 records show emergency services personnel indicated that he may have lost consciousness following the initial impact, but upon arrival he was responsive, awake, and breathing. Id. Upon examination, he was actively moving his extremities and verbalizing, although incoherently. Id. CT imaging was completed revealing no acute intracranial abnormality including no hemorrhage, acute infarction, hydrocephalus, mass, or significant intracranial injury. Id. Relevant impressions indicated a closed head injury. Id. There are minimal treatment records from 1997 to 2010, but the VA outpatient treatment records from this time confirm the Veteran’s history of post-service injuries, and a loss of vision since the 1995 incident where he was hit in the face. The Veteran was afforded a VA examination in October 2009 pertaining to his nose where his medical history was noted to include a 1973 in-service fight where his nose was fractured, a post-service fight in 1995 where his left eye was hit, and a post-service automobile accident in 1997 where he suffered facial bones injury. In November 2011, the Veteran filed a claim for the first time alleging an in-service TBI with residuals, to include, headaches, memory loss, dizziness, headaches and seizures. Treatment records do not show such complaints until November 2011. In particular, the Veteran was seen in November 2011 reporting complaints of a headache that was moderate to severe lasting for a week. See November 2011 VA treatment records. In contrast, a November 2012 treatment record specifically shows the Veteran denied experiencing headaches, dizziness and a history of TBI. See December 2012 VA treatment records. The Veteran similarly denied experiencing headaches, blackouts, and seizures in January 2013. See January 2013 VA treatment records. In 2015, the Veteran reported experiencing previous head trauma in the 1990s due to a car accident including reports of “headaches at times”. See February, April, and June 2015 VA treatment records. In March 2016, neurology clinic notes reference CT imaging of the head revealing effects of previous trauma referencing that the Veteran had an accident in 1997 or 1998. See March 2016 VA treatment records. The neurologist noted that Veteran was referred for a consult due to decreased balance and dragging legs with walking. Id. Imaging revealed cervical spine stenosis which is symptomatic. Id. The Veteran was afforded multiple VA examinations to determine the nature and etiology of any TBI and post-traumatic headache disability. In March 2012, the examiner found that the Veteran had a diagnosis of concussion and head trauma. See March 2012 VA examination. The Veteran stated that he had a traumatic brain injury in 1973 when he was in a fight and fractured his nose. Id. He said he did not lose consciousness but was “dazed” for an unknown duration. Id. The Veteran did not report any memory, attention, or concentration problems. Id. He did report difficulty making decisions and has mildly impaired judgment. Id. The examiner found the Veteran has symptoms of dizziness, headaches, and bilateral tinnitus that have been present for “many years.” Id. The Veteran reported experiencing a seizure disorder for the past five to six years. Id. A 1997 head CT was completed following the Veteran’s pedestrian/vehicle accident revealing no intracranial abnormalities. Id. The examiner opined that it was at least as likely as not that the Veteran suffered a TBI while on active duty. Id. The examiner stated that the Veteran’s urinary frequency, cranial nerve dysfunction, and erectile dysfunction would not be secondary to his TBI. Id. Regarding the 1973 incident involving a fractured nose, the examiner found that the records surrounding the incident did not include comments regarding a TBI or any alternations or loss of consciousness. Id. Then in 1975 when the Veteran was seen due to being hit with a night stick during service, he stated that he was unconscious for no more than five minutes. Id. Upon assessment, he had a normal neurological examination. Id. The examiner opined, based on the alteration of consciousness during the 1975 event, it was at least as likely as not that the Veteran suffered a TBI during service. Id. Regarding the seizure disorder indicated by the Veteran, the examiner concluded that in light of the lack of diagnosis and the reported onset of five to six years ago, it is less likely than not that this is secondary to his TBI during service. Id. The examiner reasoned that Veteran has not been diagnosed with a seizure disorder nor has he seen anyone for the suggested condition. Id. It was not listed in the Veteran’s “problem list.” Id. He is taking a medication but notes it is used for sleeping problems. Id. The Veteran stated that he last had a seizure in the July prior to the examination but states he did not use any medication for it. Id. Diagnosis of a seizure disorder has not been confirmed. Id. According to his girlfriend, the Veteran’s whole body shook for at least five minutes. Id. A seizure workup has not been completed including an EEG. Id. The Veteran’s CT shows no scars. Id. The Veteran’s treatment records lack any reference to treatment for seizures or any history related thereto. Id. The patient states that he drinks 40 ounces of beer per day and has a history of cocaine abuse, the last time being a month prior to the examination. Id. Ultimately, the examiner concluded that in light of the lack of diagnosis and the statement that these began five to six years ago, it is less likely than not that this is secondary to his TBI during service. Id. Regarding headaches, the examiner opined that it is less likely than not that the Veteran’s current headaches are a continuation of the headaches he reported during service. Id. The examiner noted that the Veteran reported experiencing headaches for varying duration during the past 10-15 years when he is in the sun or heat. Id. The examiner reasoned that while he reported a headache during service, upon separation, he denied experiencing frequent or severe headaches. Id. The Veteran reported his current headaches began 10-15 years ago; therefore, it is less likely than not they are a continuation of his headaches noted during service. Id. The Veteran denied experiencing any memory loss during the examination. Id. Therefore, the examiner opined it is less likely as not that the Veteran’s current memory loss is secondary to his injury during service. Id. The Veteran did report experiencing dizziness for the past 10-15 years which occurs when he is in the heat or moving too fast. Id. He does have a history of bilateral tinnitus. Id. During service in 1975, the Veteran reported headaches and dizziness when he was seen for an eye clinic consult. Id. At separation, he denied a history of dizziness or fainting spells. Id. He stated that his current dizziness began 10-15 years ago. Id. Given onset and a lack of complaint at separation, the examiner opined it is less likely as not that the Veteran’s current dizziness is a continuation of the dizziness noted during service. Id. An addendum opinion was issued in September 2012 wherein the examiner sought to clarify whether the Veteran suffered a TBI during the in-service night stick incident in 1975 and/or the 1997 pedestrian/vehicle accident. See September 2012 VA addendum. When addressing the night stick incident in 1975, the examiner opined that he cannot resolve without resort to mere speculation if the Veteran suffered a TBI. Id. He explained that the Veteran self-reported losing consciousness for no more than five minutes, but there are no other notes indicating loss or alteration of consciousness from the physician. Id. The impression indicated multiple bruises. Id. The examiner stated regarding the pedestrian/vehicle accident in 1997 that there is a note indicating the Veteran had been drinking earlier in the evening and there was evidence of cocaine use. Id. According to paramedics, the Veteran was initially unconscious, but this may have been from the drinking or cocaine use and/or from the accident. Id. Upon examination, the provider noted a “questionable loss of consciousness.” Id. Given the Veteran’s substance abuse along with the note stating there was a questionable loss of consciousness with a different note indicating unconsciousness initially, the examiner opined that he cannot resolve whether the Veteran suffered from a TBI in 1997 without resort to mere speculation. Id. The Veteran was afforded another VA examination in June 2019 during which the Veteran reported that his nose was broken in 1973 while active duty. See June 2019 VA examination. The Veteran emphasized during the examination that he was not sure why he was there as he did not recall submitting an appeal regarding service connection. Id. He stated that he is an alcoholic and wanted help. Id. The examiner noted that the Veteran smelled of alcohol and reported drinking whiskey in the morning before the examination. Id. When asked about his broken nose in 1973, he said that he was “knocked out” and did not recall what happened until he was in his bunk the next day. Id. He says that he went to medical and was put on light duty. Id. The examiner found that the Veteran’s STRs confirm he had a broken nose but there were no comments made as to whether the Veteran suffered a concussion or lost consciousness. Id. Then, the Veteran stated that he was hit in the head with a night stick in 1975. Id. STRs indicate bruising and loss of consciousness for an undetermined period of time with a headache. Id. Light duty was noted. Id. The Veteran’s STRs lack any other entries regarding head injury or loss of consciousness. Id. The examiner noted there are entries regarding dizziness and headaches attributed to eyeglasses prescription. Id. In 1992, the Veteran was hit in the face with a lead pipe and suffered significant trauma including ruptured and subluxed lens. Id. In 1997, he was a pedestrian struck by a car. Id. He suffered facial trauma and a sinus fracture. Id. Loss of consciousness was reported by the paramedics, but the Veteran had also been using cocaine and alcohol at the time and the loss of consciousness was not discussed again. Id. The examiner noted that the Veteran has been followed at the VA outpatient clinic with no reports of headaches, seizures, or memory problems. Id. He did report imbalance around 2015 which was attributed to a diagnosis of cervical spine stenosis. Id. During the examination, the Veteran stated he thinks his memory is “pretty good right now.” Id. He knew the day of the week and the date. He recalled the examiner’s name after an interval. Id. Judgment was noted to be normal with routinely appropriate social interaction. Id. Headaches were reported. Id. The examiner found the Veteran has headaches, including migraines, attributable to a TBI. Id. The examiner indicated that the Veteran underwent neuropsychological testing in 2012 that had an unreliable score due to validity. Id. The examiner also referenced the Veteran’s 2015 CT of his head showing old trauma including to the sinuses and facial bones with mild cerebral volume loss noted. Id. Ultimately, the examiner found that the Veteran did not have memory problems after service. See July 2019 VA addendum. The examiner opined that while the Veteran did have a documented loss of consciousness during service which indicates a mild TBI, he does not have any residuals which can be attributed to the TBI suffered during service. Id. He did not report further headaches in service after the TBI. Id. He does not think he has a problem with memory. Id. In fact, the examiner reasoned that the Veteran completed computer training after the service indicating he was able to learn and remember after separation. Id. Regarding headaches, the Veteran stated that he has had headaches for a long time. He does not know if the headaches started when he was in service. The examiner stated that his STRs did note he had headaches associated with the wrong eye glass prescription. He also had a headache reported in 1975 after being hit in the head as well as in association with a viral syndrome. During the examination, the Veteran stated that he gets daily headaches but has not reported them to his primary care physician or neurologist. The examiner opined in a July 2019 addendum that the Veteran’s headaches are less likely than not related to service including the TBI. See July 2019 VA addendum. He reasoned that the Veteran did suffer a documented TBI while active duty, but his current headaches did not occur for many years after service. Id. Regarding seizures, the examiner determined that the Veteran does not have a diagnosed seizure disorder. Id. He did have some sort of “blacking out spells” which started in the past 15 years or so but the gap in time indicates that the spells are not due to the head trauma incurred during service. Id. The Veteran stated that he starts “shaking and falls out.” Id. He said that it could have been due to alcohol consumption and noted that his girlfriend thought he had a seizure a couple of months ago. Id. He is not sure if he has had any other spells. Id. The examiner mentioned that the Veteran previously told an examiner that he has had blackouts since 2007, stating that he feels dizzy and has to sit down. Id. During the Veteran’s 2015 neurology consult for imbalance, a seizure issue was never mentioned. Id. The examiner opined that these episodes, which the Veteran calls seizures, are less likely than not related to his time during service because they started 15 years after separation. See July 2019 VA addendum. As to dizziness, the examiner stated that the Veteran’s dizziness has been attributed to imbalance due to spinal stenosis. Id. Thus, it is less likely than not that the Veteran’s dizziness is related to TBI in-service or to service. See July 2019 VA addendum. The examiner reasoned that it did not occur for many years after separation. Id. The examiner further reasoned that the Veteran has suffered many physical traumas to the head both in and after service. Id. He has also affected his brain through alcohol and cocaine abuse. Id. Thus, it is impossible to know which brain insult caused which problem. Id. It is clear, however, that his memory was “okay” after service and he did not have headaches or dizziness for many years after service. Id. The Board finds the June 2019 VA examination and July 2019 VA addendum include consideration of the Veteran’s medical history and set forth all pertinent findings, such that the Board is able to make a fully informed decision. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). When considered together and with the entire evidence of record, the Board finds the examination reports adequate for adjudication of the Veteran’s service connection claims because they are based upon an accurate medical history and provide explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (once VA undertakes to provide a medical examination or opinion, it must ensure that the examination or opinion is adequate). While the March 2012 VA examination and opinion as well as the September 2012 addendum have been previously deemed inadequate regarding whether the Veteran had a TBI during service, the reports of symptoms and notations therein may still carry probative value as well as the other opinions regarding dizziness, seizures, memory loss, and headaches. See Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (holding “Furthermore, even if a medical opinion is inadequate to decide a claim, it does not necessarily follow that the opinion is entitled to absolutely no probative weight.”). 1. Entitlement to service connection for TBI, to include dizziness, memory loss, and seizures, is denied. The Veteran contends he is entitled to service connection for a TBI that occurred during service and residuals related thereto. As outlined above, the facts of this case are complicated because while an in-service TBI is confirmed in the Veteran’s STRs, it is also well documented that the Veteran suffered several serious post-service altercations, to include being hit in the face with a lead pipe during a robbery sometimes in the early 1990s, followed by at least one (if not two) different automobile accidents also in the 1990s. The Veteran’s record does not show any treatment after service prior to the 1990s injuries and, therefore, the issue here is whether the Veteran’s complaints of dizziness, memory loss, and seizures, can be associated specifically with the in-service TBI versus post-service trauma. For reasons outlined below, the Board finds service connection is not warranted. Dizziness The Veteran has competently and credibly reported experiencing dizziness. This is corroborated by the medical evidence of record as well as the VA examinations and addendums. The Board finds the June 2019 opinion and July 2019 addendum to be highly probative regarding the Veteran’s in-service TBI. It is undisputed that the Veteran was struck with a night stick in 1975 after which the Veteran stated that he lost consciousness for no more than five minutes. The June 2019 VA examiner stated that the documented loss of consciousness during service indicates he had a TBI during service noted to be mild. While the loss of consciousness in 1975 was reported only by the Veteran, the Board has no reason to doubt his credibility or competency to convey this symptom. As such, the remaining question for the Board is whether the Veteran’s current dizziness is causally related to the in-service TBI. The Board finds highly probative the VA opinions of record regarding a lack of nexus to service. The 2012 VA examiner noted that the Veteran experiences dizziness while having a history of bilateral tinnitus. Most significant is the 2012 examiner’s lack of nexus opinion based on the reasoning that the Veteran’s complaints of dizziness began in the last 10-15 years, decades after service, with no complaints reported at separation. Similarly, the 2019 VA examiner offered a negative nexus opinion based on the significant time lapse between service and symptom onset as well as a finding that the Veteran’s dizziness is attributable to his imbalance from spinal stenosis. The decades between service and reports of dizziness is corroborated by the medical evidence of record. While the Veteran reported dizziness during service, the first report occurred prior to the in-service TBI and the second was in connection with an eye clinic consult. Both of which appear to have resolved in light of a lack of complaints throughout the remainder of service despite being treated for other health issues. Indeed, upon separation, the Veteran declined experiencing dizziness. It is undisputed that it was not until decades after separation that the Veteran reported a complaint of dizziness. Treatment records lack any mention of dizziness until the Veteran filed a claim for benefits during which he acknowledged that dizziness did not begin until 10-15 years before the 2012 VA examination. Although a lack of contemporaneous medical evidence does not automatically constitute substantive negative evidence, the Board may weigh the absence of contemporaneous records when assessing the credibility of lay evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006); Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011). He has consistently conveyed the same onset of dizziness during his VA examinations. The Veteran’s representative contends the Veteran’s in-service TBI was the onset of dizziness symptoms. The Board relies upon the competent and credible medical evidence of record regarding symptom onset over this contention because the medical evidence of record consistently indicates that the Veteran’s dizziness onset was actually 10-15 years before the 2012 VA examination as reported by the Veteran. In light of the medical evidence of record, as well as the Veteran’s own reports of symptom onset, the Board finds the 2012 and 2019 VA examiners opinions to be highly probative. While the Veteran contends that his in-service TBI caused his dizziness, he is not competent to render a nexus opinion as it is a complex medical question requiring specialized medical knowledge and training. Jandreau, 492 F.3d at 1377. Consequently, the Board gives more probative weight to the competent medical evidence of record. In conclusion, the Board finds the preponderance of the evidence is against an award of service connection for dizziness related to the Veteran’s in-service TBI. Thus, the benefit-of-the-doubt doctrine is not for application and the claim must be denied. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Memory Loss The Board concludes the Veteran does not have a current diagnosis of memory loss and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). While the Veteran claimed memory loss in association with his service connection claim, during his first VA examination in 2012, the Veteran denied any memory loss. In fact, he had no complaints of memory, attention, or concentration problems during his first VA examination. During the second VA examination in 2019, the Veteran stated that he was not sure why he was at the examination and did not recall submitting an appeal to his service connection claim. While this may have been a sign of memory loss, the Veteran also stated that he had consumed alcohol before the examination and the examiner indicated he smelled of alcohol. When prompted to describe his complaint of memory loss, the Veteran said that his memory is “pretty good right now.” The examiner indicated he knew the day of the week, the date, and recalled the examiner’s name after an interval. Neither VA examiner found that the Veteran experiences any form of memory loss. In fact, the 2019 VA examiner reasoned that the Veteran’s completion of a computer training course after service demonstrated his ability to learn and remember following service. Additionally, the Veteran has not complained of memory loss throughout his extensive medical records except for a claim in connection for benefits. Although a lack of contemporaneous medical evidence does not automatically constitute substantive negative evidence, the Board may weigh the absence of contemporaneous records when assessing the credibility of lay evidence. Buchanan, 451 F.3d at 336-37; Buczynski, 24 Vet. App. at 224. The Veteran’s representative contends that the Veteran’s medical records reflect diagnosis of memory loss. Upon review, however, there is no indication the Veteran has a memory loss condition. The Board finds the competent and credible medical evidence of record is more probative on this matter than the Veteran’s statements made in connection with a claim for benefits. Thus, the Board decides the preponderance of evidence is against finding that the Veteran has memory loss. The Board has also considered whether service connection could be granted based on functional impairment of earning capacity due to memory loss. Service connection is not precluded solely when there is no diagnosis, if there is nevertheless functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (2018). The Board finds, however, the evidence indicates the Veteran has not experienced any functional impairment due to memory loss, much less the kind of functional impairment that would affect earning capacity. In fact, the 2012 VA examiner considered seizures, memory loss, dizziness, and headaches when assessing whether the Veteran experiences subjective symptoms that might interfere with work. The examiner opined that the Veteran’s dizziness, headaches, bilateral tinnitus, and insomnia might mildly interfere with work. Memory loss, however, was not referenced or found at all. Given the Veteran’s lack of symptoms associated with memory loss and complaints related thereto, the Board concludes the preponderance of the evidence is against finding functional impairment of earning capacity due to memory loss. Consequently, service connection for memory loss is denied as the evidence preponderates against the claim. Therefore, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107. Seizures The Board concludes that the Veteran does not have a current diagnosis of seizures or a seizure disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321. The June 2019 VA examiner evaluated the Veteran and determined that, while he may have experienced subjective symptoms of “blacking out spells,” he did not have a diagnosis of seizures or a seizure disability. Rather, the Veteran stated that his girlfriend thought he had a seizure, but the Board notes the Veteran’s girlfriend is not competent to render such a diagnosis. See Jandreau, 492 F.3d at 1377. The Veteran reported experiencing “black outs” beginning around 2006 or 2007 but did not report experiencing these incidents to a provider. The Veteran stated the “black outs” could be related to his alcohol consumption. Of note, the Veteran’s CT scan of his brain did not include any scars indicating previous seizures. The Veteran’s representative contends that the Veteran’s medical records reflect diagnosis of seizures. Upon review, however, there is no indication the Veteran has a seizure disorder. Indeed, despite receiving medical treatment consistently from 1997, the Veteran’s treatment records do not contain a diagnosis of seizures or a seizure disability. In fact, the Veteran’s treatment records lack any reference to complaints, treatment, or diagnosis of seizures. Although a lack of contemporaneous medical evidence does not automatically constitute substantive negative evidence, the Board may weigh the absence of contemporaneous records when assessing the credibility of lay evidence. Buchanan, 451 F.3d at 1336-37; Buczynski, 24 Vet. App. at 224. The Veteran’s statements made regarding seizures are solely in conjunction with his claim for benefits. In light of the lack of medical records referencing any such condition, the Board assigns more probative value to the VA examiner’s opinion that the Veteran does not have a seizure disorder than the Veteran’s statements made in relation to his claim for disability benefits. Even considering the Veteran’s reports of “black outs”, the Board finds highly probative the March 2012 VA examiner’s opinion as well as the June 2019 VA examiner’s opinion that it is less likely than not the Veteran has a seizure disorder that was caused by or incurred during service including as a result of the in-service TBI. Both examiners stated that the temporal distance between the in-service TBI and the Veteran’s first report of “black outs” or contended seizures occurred many decades after service. While the Veteran believes he has a seizure disorder that is causally related to service, the Board finds he is not competent to render such a diagnosis or nexus opinion. These questions require specialized medical knowledge and training. Jandreau, 492 F.3d at 1377. Consequently, the Board gives more probative weight to the competent medical evidence of record. The Board also finds given the Veteran’s lack of seizure diagnosis as well as an absence of complaints related to seizures during the year following separation, the chronic condition presumption for epilepsies is not applicable. The Board concludes the lack of complaints of symptomatology or any functional impairments of earning capacity related to seizures cuts against a finding of any current disability for VA purposes. See Saunders, 886 F.3d at 1367-68. Based on the aforementioned, the Board finds the preponderance of the evidence is against an award of service connection for seizures related to the Veteran’s in-service TBI including on a presumptive basis as a chronic epileptic condition. As such, the benefit-of-the-doubt doctrine is not for application and the claim must be denied. 38 U.S.C. § 5107; see also Gilbert, 1 Vet. App. at 57. 2. Entitlement to service connection for post-traumatic headaches is denied. The Veteran contends he suffers from post-traumatic headaches that began during service and have continued since separation, or, in the alternative, are causally related to his in-service TBI. The Board finds service connection is not warranted. Regarding chronicity, the Veteran’s STRs indicate multiple complaints of a headache, however, each complaint resolved as evidenced by the Veteran’s normal separation examination wherein he declined experiencing frequent or severe headaches. The headache reported in 1972 was attributed to his eye glass prescription, which was confirmed by the June 2019 VA examiner. A headache was reported prior to and then in association with the 1975-night stick incident, but records in the months following lack complaint of continued headaches. In fact, there is mention of a headache in February 1976, but it was in relation to a cold for which the Veteran was treated. Otherwise, STRs are silent for complaints of headaches. Of note, upon separation, as previously mentioned, the Veteran declined frequent or severe headaches. In the year following separation, the record lacks any complaints of, treatment for, or diagnosis related to a headache. In fact, the first notation of a headache following separation from service was in 1997, decades after separation, in association with the pedestrian/motor vehicle accident. While the Veteran has stated in connection with his claim for benefits that he has experienced headaches since the in-service TBI, the Board finds the medical evidence of record lacking mention of headaches until 1997 and then not until 2011 to be more probative regarding chronicity. Thus, the presumptions related to chronic conditions are not applicable for the Veteran’s headache condition. Service connection may still be granted on a direct basis. Based on the competent and credible medical evidence of record, the Board finds the Veteran has a current disability of headaches, including migraines. While the June 2019 VA examiner indicated in the Veteran’s headache disability benefits questionnaire (DBQ) that he does not have a headache disability, the same examiner indicated that the Veteran experiences TBI residuals of headaches, with migraines. Further, the March 2012 VA examiner found that the Veteran experiences symptoms of headaches which are also corroborated by the Veteran’s lay statements regarding his headache symptoms. Resolving all doubt in favor of the Veteran, a headache disability has been established. 38 C.F.R. § 3.102. As previously mentioned, the Board finds a TBI occurred during service. Thus, the remaining question for the Board is whether the Veteran’s current headaches are causally related to the in-service TBI. Of great importance in this case is the Veteran’s multiple head traumas during service and following separation. During service, the Veteran was hit in the face in 1973 and then struck with a night stick in 1975. Following separation, the Veteran was hit in the face with a lead pipe in 1992 causing injuries to the eye. Then in 1997, the Veteran was struck as a pedestrian by a vehicle. As previously mentioned, the Veteran’s in-service incident in 1975 has been deemed to be a TBI. Between separation from service and the 1997 pedestrian/vehicle accident, the Veteran’s treatment records lack any mention of complaints, treatment, or diagnosis regarding headaches. The Veteran, however, has contended he has experienced headaches since the in-service TBI. Although a lack of contemporaneous medical evidence does not automatically constitute substantive negative evidence, the Board may weigh the absence of contemporaneous records when assessing the credibility of lay evidence. Buchanan, 451 F.3d at 1336-37; Buczynski, 24 Vet. App. at 224. Here, for decades following service, the Veteran did not report experiencing headaches. After the 1997 pedestrian/vehicle accident, the Veteran’s treatment records remain silent for any complaints, treatment, or diagnoses related to headaches until 2011. In fact, in 2011, the Veteran reported experiencing a weeklong headache on the day after he filed a claim for service connection for residuals of a TBI including headaches. Thus, the Board finds more probative the Veteran’s treatment records following separation over the Veteran’s statements made in connection with a claim for benefits. Further, and of greater significance is the highly probative June 2019 VA examiner’s nexus opinion. The June 2019 VA examiner offered a negative nexus opinion based on the reasoning that the Veteran’s first complaints of headaches following service did not occur for many years thereafter. Rather, as previously mentioned, they began in 1997 following another head trauma. As the examiner stated, in addition to the many physical traumas to the head, the Veteran has also abused alcohol and cocaine. Thus, the examiner opined that it is impossible to know which brain “insult” caused which problem. Despite this impossible task, the VA examiner was able to determine, however, that the Veteran’s headaches did not occur for many years after service and were less likely than not caused by the in-service TBI. The Board finds this opinion to be highly probative. While the Veteran contends that he has experienced headaches because of his in-service TBI, he is not competent to offer a nexus opinion on this issue especially considering the intervening pedestrian/vehicle accident in 1997 involving a closed head injury which coincided with the Veteran’s first documented report of a headache since service. The nexus opinion in this case is a complex medical question requiring specialized medical knowledge and training. See Jandreau, 492 F.3d at 1377. As such, the Board will rely upon the competent and credible medical nexus opinion of record which is highly probative. Considering the June 2019 VA examination and July 2019 addendum opinion, as well as the remaining evidence of record including the Veteran’s lay statements regarding symptoms, the Board finds the preponderance of the evidence is against the Veteran’s claim. Consequently, service connection for post-traumatic headaches is not warranted and the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; see also Gilbert, 1 Vet. App. at 57. Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.C. Allen, 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.