Citation Nr: 21011016 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 12-31 351 DATE: February 26, 2021 ORDER Entitlement to service connection for chronic headaches, to include as secondary to service-connected tinnitus, is denied. FINDING OF FACT The probative evidence of record reveals that the Veteran had headaches in service that were determined to be the result of poor vision. The most competent and probative evidence of record reveals that the Veteran’s post-service chronic headaches are not related to service. They were not caused by the Veteran’s service-connected tinnitus and a baseline cannot be established to determine whether, and to what extent, they were aggravated by his tinnitus. CONCLUSION OF LAW The criteria for entitlement to service connection for chronic headaches, to include as secondary to service-connected tinnitus, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.3.09. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from May 1969 to February 1971. He testified before the undersigned Veterans Law Judge (VLJ) at a Travel Board hearing in November 2017. A transcript of the hearing is of record. As previously noted, in March 2018, the Board denied the Veteran’s claim for service connection for chronic headaches. He appealed that decision to the Court of Appeals for Veterans Claims (the Court). In February 2019, the Court issued a Joint Motion for Partial Remand (JMPR), finding that the September 2012 VA examination report relied upon by the Board in denying the Veteran’s claim did not adequately address whether the Veteran’s chronic headaches were aggravated by his tinnitus. The JMPR did not state that there were any concerns regarding the analysis provided by the Board as to whether the Veteran’s chronic headaches were directly related to service. In July 2019 and November 2020, the Board remanded the Veteran’s claim for additional VA medical opinions. Entitlement to service connection for chronic headaches to include as secondary to service-connected tinnitus. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be granted on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Aggravation of a non-service-connected disease or injury by a service-connected disability may also be service-connected. 38 C.F.R. § 3.310(b). However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established. 38 C.F.R. § 3.310(b). The Veteran’s post-service medical records confirm a diagnosis of chronic headaches. See September 2012 VA Examination Report. Therefore, the first element of service connection has been met. The Veteran’s service medical records show that on his entrance Report of Medical History dated in October 1968, he endorsed frequent and severe headaches. The headaches were found to be related to eye strain. On his discharge Medical Board - PEB examination report dated in January 1971, the Veteran was noted to have bilateral refractive error with severe myopic astigmatism. He was found to be unqualified for retention for military service. During his BVA hearing, he testified that he experienced headaches throughout service He has also contended that his chronic headaches are due to his bilateral eye condition (which he is not service-connected for), and in the alternative, his service-connected tinnitus. See March 1971 Rating Decision (denying service connection for an eye disorder); July 2008 Statement in Support of Claim; BVA Hearing Testimony. Therefore, the second element of service connection has also been met. To the extent the Veteran contends that his post-service chronic headaches have developed secondary to his bilateral eye condition, the claim must be denied because he is not currently service-connected for any eye disorder. The question before the Board therefore becomes whether there is a so-called “nexus” between the Veteran’s current post-service chronic headache disorder and service or if it is secondary to his service-connected tinnitus. The Veteran was afforded a VA examination for his headaches in September 2012. After reviewing the claims file and obtaining a medical history of the Veteran, the VA examiner opined that his post-service headaches were less likely than not proximately due to or the result of his tinnitus. As rationale, the examiner explained that patients could have both tinnitus and headaches. However, it is more likely that the headaches would be acute rather than chronic. He stated that medical knowledge dictates that a search must be conducted in an effort to determine the cause of headaches experienced simultaneously with tinnitus, because tinnitus by itself does not cause headaches. Rather, further medical treatment should be undertaken in this type of situation because these headaches may be due to a brain tumor, an aneurysm, arthritis of the temporal mandibular joint, or stress which leads to increased sensitivities to hearing and to pain. In support of his assertions, the examiner cited to a medical journal describing tinnitus and its causes. In terms of whether the Veteran’s post-services headaches were linked to the headaches he experienced during service, the examiner opined that it was less likely than not that they were related. In support of his opinion, the examiner explained that the Veteran’s service medical records revealed that he entered service with vision difficulties and eye strain. The military physician at the time noted that the Veteran’s headaches were probably due to eye strain. The Veteran’s eyesight was subsequently corrected (to the extent it could be), after which his in-service headaches ceased. During Medical Board proceedings, the military determine the Veteran was not fit for duty because of his vision problems and he was discharged. According to the Veteran’s medical history, it was not until approximately 2009 that he began experiencing headaches again, over three decades after he separated from service. The Veteran’s medical history noted that his earlier headaches were of a dull ache that were on top of the head and lasted for a few years before going away. In describing his post-service headaches, the Veteran indicated that he experienced sharp and throbbing pain towards the back and sides of his head that lasted for only a few minutes. Thus, the headache symptomology reported by the Veteran in-service and subsequent to service are of a different nature. Given the foregoing, the examiner stated that the Veteran’s post-service headaches had nothing to do with the reference to headaches in service, as the in-service headaches were probably due to poor eyesight and resolved after proper eye wear. To address whether the Veteran’s headaches were aggravated by his service-connected tinnitus, the Board sought additional VA medical opinion. Such opinions were obtained in December 2019 and December 2020. In December 2019, the VA examiner opined that the Veteran’s headaches were less likely than not proximately due to or the result of his service-connected tinnitus. The examiner explained that there is no medical literature or records to support the Veteran’s headaches were due to his tinnitus. He determined that the medical evidence was not sufficient to support a determination of a baseline level of severity for the Veteran’s headaches and there was no link between tinnitus and his headaches. Instead, the examiner stated “his tinnitus is consistent with noise exposure in service. One of the most common symptoms associated with chronic headaches and the onset of migraines is eye strain. Some activities that demand intense use of your eyes for long periods is normally the underlying cause, but eye strain could also be linked to general vision problems.” The examiner attributed the Veteran’s chronic headaches to general eye strain. As noted above, the Veteran is not currently service-connected for any eye disorder, to include eye strain. In November 2020, the Board again remanded the Veteran’s claim to obtain additional VA medical opinion. Specifically, the Board requested an opinion regarding whether the Veteran’s chronic headaches were aggravated by his tinnitus. In December 2020, the VA examiner explained that tinnitus increases the risk of triggering migraines and headaches. However, in this instance, the medical evidence is not sufficient to support a determination of a baseline level of severity. As noted by the previous examiner, the Veteran has several comorbidities, including a significant history for alcohol abuse, such that it would not be possible to determine the extent that his tinnitus, as opposed to any other impairment, aggravated his chronic headaches. As noted above, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established. In this instance, the medical evidence does not support a causal relationship between the Veteran’s currently diagnosed chronic headaches and his military service. The medical evidence of record also does not establish a sufficient relationship between the Veteran’s tinnitus and his headaches. The VA examiners found that the Veteran’s tinnitus did not cause his headaches and although it is possible that his tinnitus could have aggravated his headaches, it is not possible to determine with any certainty (i.e. baseline) to the extent that occurred. There are no medical opinions of record in support of the Veteran’s claim. It is worth noting that on VA examination in September 2012, the Veteran himself indicated that he did not believe his post-service headaches were related to his tinnitus. He testified at his Board hearing that he was not sure if his tinnitus aggravated his headaches or made his headaches occur and instead attributed his headaches to his eye disorder. See BVA Hearing Transcript, pgs. 21-22. To the extent the Veteran has attempted to provide an opinion as to the etiology of his headaches, the Board finds he is not competent to so opine. As noted above, the Veteran has not contended that he has experienced the same type of headaches since service. Instead, the record evidence establishes that his in-service headaches resolved after his eyesight was corrected (to the extent possible). Then, several years post-service, he began to experience headaches occurring in a different part of his head. Although he is competent to state he has headaches, as that is capable of lay observation, he has not shown that he has the necessary medical expertise to provide an opinion regarding the etiology of his current headaches. Further, to the extent he contends that his headaches are related to his tinnitus, the Board affords more probative weight to the VA medical opinions of record. As noted, the Veteran has several comorbidities that could cause or aggravate his headaches. Further, he does not have the necessary medical training to establish a baseline for his headaches. Therefore, his opinions regarding aggravation lack probative weight. Based upon the current evidence of record-both lay and medical-the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for chronic headaches either directly related to service or secondary to his service-connected tinnitus. Thus, the claim must be denied. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Martha R. Luboch, 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.