Citation Nr: 21011344 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 15-00 492A DATE: March 1, 2021 ORDER Service connection for headaches as secondary to service connected intervertebral disc syndrome with spinal stenosis is denied. FINDING OF FACT The Veteran’s headaches are not caused or aggravated by his service-connected intervertebral disc syndrome with spinal stenosis, spondylitis, facet arthropathy and lower extremity radiculopathy. CONCLUSION OF LAW The criteria for service connection for headaches as secondary to service connected intervertebral disc syndrome with spinal stenosis are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from July 1992 to April 1996. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an August 2009 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in September 2018, March 2019 and April 2020. In April 2020, the Board remanded the instant claim due to the Veteran not appearing for his scheduled October 2019 VA examination pursuant to the Board’s March 2019 remand. The Board instructed that an addendum opinion addressing the nature and etiology of the Veteran’s headaches in light of a September 2006 private treatment record indicating there is a connection between the Veteran’s headaches and spinal disabilities was to be obtained. Such an opinion was obtained in May 2020. The Board determines that there has been substantial compliance with its previous remand. Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand by the Board confers the right to compliance with remand orders). The claim now returns to the Board for further appellate review. Service Connection Generally, service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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). A disability which is proximately due to or the result of a service-connected disease shall be service connected. 38 C.F.R. § 3.310(a). A claimant is also entitled to service connection on a secondary basis when it is shown that a service-connected disability has aggravated a nonservice-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). 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; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Service connection for headaches as secondary to service connected intervertebral disc syndrome with spinal stenosis is denied. The Veteran generally contends that his migraine headaches are a result of his service-connected spinal disabilities. Direct service connection has not been alleged. The Veteran’s service treatment records are silent to any headache related complaints, treatments or diagnosis. He was diagnosed with migraines and occipital neuralgia in the May 2020 VA examination. Post-service treatment records include a September 2006 private medical report, which noted that the Veteran had cervical injury after a fall from work and his symptoms included headaches. See January 2009 Medical Treatment Records. An October 2006 private treatment note indicated that the Veteran was being treated for cervical facet blockade and the risk included spinal headaches. See May 2010 Medical Treatment Records. In a November 2018 VA examination, the examiner opined that the Veteran’s headaches were less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service connected intervertebral disc syndrome with spinal stenosis, spondylitis, facet arthropathy and lower extremity radiculopathy (previously rated as spondylitis lumbar back, with L5 laminectomy). The examiner opined that no medical literature was found to support a correlation between intervertebral disc syndrome with spinal stenosis, spondylitis, facet arthropathy, lower extremity radiculopathy and headaches. Based on a review of the medical record, history of present illness, and the examination, the examiner reasoned that a nexus was not established. However, this opinion did not consider the September 2006 private treatment note suggesting a possible relationship between headaches and a spinal disability. As a result, the Board’s March 2019 remand determined that an additional opinion addressing this treatment note was necessary. In a May 2020 VA examination, the examiner opined that the Veteran’s migraine headaches and occipital neuralgia are less likely than not proximately due to or the result of the service-connected intervertebral disc syndrome with spinal stenosis, spondylolisthesis, facet arthropathy, and lower extremity radiculopathy. The examiner also reasoned that there is insufficient clinical evidence to support a positive link between the claimed migraine headache and the service-connected spine conditions. Based on common medical knowledge, migraine headaches are classified as primary headaches. This indicates that they are not caused by an underlying disease. In addition, the medical literature does not support a pathophysiological link between migraine headaches and spine disabilities including intervertebral disc syndrome with spinal stenosis, spondylolisthesis, facet arthropathy, and lower extremity radiculopathy. However, for the occipital neuralgia diagnosis, the examiner opined that the currently diagnosed occipital neuralgia is at least as likely as not proximately due to or the result of service-connected cervical spine conditions. She reasoned that there is sufficient clinical evidence to support a positive link between the currently diagnosed occipital neuralgia and the service-connected cervical spine conditions. Based on general medical knowledge, occipital neuralgia are secondary headaches that are caused by an underlying condition, such as neck injuries. A review of the medical record revealed a history of service-connected neck injuries (1992-1996), diagnoses of cervical facet arthropathy, secondary myofascial pain, cervical spondylosis mild and diagnosis of occipital neuralgia in 2006. In the August 2020 addendum opinion, the examiner clarified her opinions by stating that after reviewing the May 2020 VA examination and the available medical records, the Veteran was diagnosed with migraine headache and occipital neuralgia. These two conditions are considered separate, although they share overlapping symptoms. For this reason, it is not feasible to delineate symptoms between the two conditions without resorting to mere speculation. Occipital neuralgia is the only diagnosis that has a direct link to the cervical spine disability. According to general medical knowledge, occipital neuralgia are secondary headaches that are caused by an underlying condition, such as neck injuries, whereas migraine headaches are classified as primary headaches. The examiner considered all evidence of record after thorough review of the claims file, including lay statements properly weighed and reported clear conclusions with supported data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2009); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). There is no contrary opinion of record. The Board acknowledges the statements of the Veteran as to the existence and etiology of his claimed headaches and acknowledges that the Veteran is competent to give evidence about what he experienced. For example, he is competent to discuss the fact that he experiences symptoms of pain. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994). However, while the Veteran is competent to report his current symptoms, as a lay person he does not have the education, training, or experience to diagnose or opine as to the etiology of the condition. See Jandreau v. Nicholson, 492 F.3d 1372, 1377-78 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428 (2011). Therefore, the Veteran’s statements are of low probative value. Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability considering the criteria to be more persuasive than the Veteran’s reports regarding the etiology of his condition. Here, the medical examiners have concluded that the Veteran’s headaches are etiologically related to his cervical injuries and not his lumbar injuries. However, the Veteran is not service-connected to any cervical injuries, and therefore cannot be service-connected to headaches as secondary to a cervical injury. His service-connected lumbar back disability stem from lower back injuries he incurred while in service; however, it is not found to be etiologically related to his headaches. Furthermore, the Veteran has not provided evidence of a direct causation for his headaches nor has he provided evidence that it was chronic in nature. (Continued on the next page)   Therefore, the Board concludes that the preponderance of the evidence is against finding that the Veteran meets the criteria for service connection for headaches as secondary to service connected intervertebral disc syndrome with spinal stenosis. In reaching the conclusion above, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Adeyemi, 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.