Citation Nr: 21010738 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 13-05 903A DATE: February 25, 2021 ORDER Entitlement to service connection for headaches is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s headache condition began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for headaches are not 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 served on active duty from August 1976 until August 1979. He died in January 2014, during the pendency of the appeal. His surviving spouse was substituted as appellant in May 2020. The Appellant testified at a hearing before the undersigned Veterans Law Judge in August 2020. A transcript of that hearing is of record. This appeal was previously before the Board in November 2020 when it was remanded for an addendum medical opinion. The Board finds there has been substantial compliance with the Board’s prior remand directive and will proceed to adjudication. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for headaches During his lifetime, the Veteran contended that his headaches were related to service. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Alternatively, service connection may be established under 38 C.F.R. § 3.303 (b) by evidence of (i) the existence of a chronic disease, such as arthritis, in service during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or evidence of continuity of symptomatology. If the disability claimed is not considered to be a chronic disease under 38 C.F.R. § 3.309, credible lay evidence of continuous symptoms may establish service connection. The question for the Board is whether the Veteran’s claimed headache condition is etiologically related to his active service. A review of the Veteran’s service treatment records show complaints of headaches on several occasions while in service including in October 1976, January 1978, November 1978, and January 1979. In November 1978, the Veteran reported a headache every day for the past week and described pain so intense that it produced nausea. In January 1979, the Veteran’s headache complaints were accompanied by complaints of nausea and vomiting for three days. Both the Veteran’s entrance and separation medical examinations show no defects of the head. The Veteran’s VA treatment records from April 2012 until November 2013 are of record and have been reviewed. Although they mostly relate to treatment for the Veteran’s eyes, they do note a history of headaches for 20 years. Private treatment records from Texas E.N.T. Specialists, Houston Northwest Primary Care, Houston Northwest Medical Center, Houston Neurology and Sleep Diagnostic Center, Greater Houston Physicians, and Dr. A.C., Ph.D. were also reviewed. In April 2007, Dr. J.L. noted the Veteran has a history of bad headaches/migraines for several years and that an MRI performed that month shows no acute intracranial abnormality or abnormal enhancement, mild changes of microangiopathy present, right sphenoid sinusitis, and possible bilateral mastoiditis. A November 2009 private treatment note from Dr. A.C. records the Veteran complaining of a headache that began 2 weeks prior and that the Veteran’s recent headaches as compared to his usual headaches are “very different.” Dr. A.C. also notes a history of headaches spanning 34 years. The Veteran was diagnosed with supratentorial cancer of the brain in February 2011 and underwent surgery the same month to excise a left insular brain tumor. The Board also reviewed several statements submitted by family members and friends of the Veteran including from his spouse, W.T., C.J., M.S., and B.C. The statements detailed the Veteran’s complaints of headaches during service, his ongoing complaints for headaches after discharge, and his decline in health and struggles at the end of his life. The Appellant also described the same in her testimony before the Board. The Veteran submitted his claim for compensation in August 2011. Evidence of record, including treatment reports and statements in support of the claim, show a February 2011 diagnosis of a brain tumor and claim a connection between the headaches in service and the brain tumor diagnosed after service. In a September 2012 notice of disagreement, the Veteran stated that his headaches began while in military service, specifically after leaving the gas chamber. The Board remanded the claim to obtain an adequate medical opinion. An addendum opinion was obtained in November 2020. The opinion provider concluded that it is less likely than not that the Veteran’s headache condition is related to an in-service event, injury, or disease. In support of their conclusion, the opinion provider stated, “[g]iven the change in the character and nature of the headaches, as well as the new onset of a brain mass necessitating surgical excision in 2011, the current headaches should be considered a separate and discrete disease process from the prior headaches during service and the cluster headaches in 1982.” The November 2020 opinion is afforded significant probative weight by the Board, because it reaches a clear conclusion supported by a complete rationale based upon a review of the entire record and consideration of the Veteran’s symptoms. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The lay evidence of record also does not support a finding of continuity of symptomatology for a headache disability other than headaches related to the brain tumor and a VA examiner opined that the headaches associated with the brain tumor were different in nature than cluster headaches diagnosed in 1982. The Board is sympathetic to the Appellant’s belief that the Veteran’s headaches experienced at the time of the claim began during and were due to his active military service. Although lay persons are competent to provide opinions on some medical issues, the issue in this case is outside the realm of the common knowledge of a layperson, because it involves a complex medical issue that goes beyond a simple and immediately observable cause-and-effect relationship. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The November 2020 VA medical opinion is the most probative evidence of record, and it is not favorable to the claim for service connection. There is no competent lay or medical evidence of record indicating the headaches experienced by the Veteran at the time of the claim until his death were related to service. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection, and, thus, the benefit of the doubt provision is not applicable. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The claim must be and is denied. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. Collins, 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.