Citation Nr: 21012724 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 11-25 707 DATE: March 5, 2021 ORDER Entitlement to service connection for headaches is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran’s tension headaches are related to service, or were caused or aggravated by his service-connected shoulder disability. CONCLUSION OF LAW The criteria for entitlement to service connection for headaches have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served active duty in the United States Army from September 1978 to September 1982. This matter comes to the Board of Veterans’ Appeals (Board) on appeal of a July 2009 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). In July 2014, October 2017, April 2019, and August 2020, the Board remanded the issue on appeal for additional development, and the case has since been returned for further appellate review. A remand by the Board confers on the claimant a legal right to substantial compliance with the remand order. Stegall v. West, 11 Vet. App. 268 (1998). The Board remanded the claim in July 2014 in order to provide the Veteran with a VA examination and address whether his in-service injury had a relationship to his headaches. The Board again remanded the claim in October 2017 to obtain an opinion on secondary service connection pertaining to the issue of aggravation. The Board remanded the claim in April 2019 because the VA examiner based their conclusions on factual inaccuracies and again requested a secondary service connection opinion. The Board’s August 2020 remand directed the RO to provide the Veteran with an in-person examination to determine the nature and etiology of his headache condition, which must address aggravation. An exam and opinion was provided in December 2020, and as such, substantial compliance has been achieved and the merits of the claim are discussed below. Id. at 271. Service Connection 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 established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists, and (2) that the current disability was either (a) caused by, or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310 (a); Allen v. Brown, 7 Vet. App. 439 (1995). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 1. Entitlement to service connection for headaches is denied. The Veteran contends he is entitled to service connection for headaches as they are related to a shoulder injury sustained during active duty service. Throughout the claims period, the Veteran has consistently asserted his headaches began after his shoulder dislocation and surgery and the symptoms have persisted since. Alternatively, he asserts his headaches are due to the resulting neck pain from his service-connected shoulder disability. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of tension headaches, and evidence shows that he experienced an in-service left shoulder injury, the preponderance of the evidence weighs against finding that the Veteran’s headache condition is related to service or a service-connected disability. The December 2020 examiner opined that the Veteran’s condition was less likely than not due to, or aggravated by, his service-connected left shoulder. He diagnosed the Veteran’s condition as tension headaches and opined there is no anatomic or pathophysiological basis for aggravation of the tension headache proximately due to or the result of osteoarthritis left shoulder and acromioclavicular joint. The examiner also opined the Veteran’s headaches are less likely than not directly related to service. He notes the Veteran was diagnosed with a soft tissue contusion while on active duty but service treatment records lacked evidence of a significant head injury, loss of consciousness, or chronic headaches. The December 2020 examiner concluded the Veteran’s tension headaches are more likely due to his neck pain. He notes, “Tension headaches are one of the most common headaches in the general population. Pain in the posterior neck muscles with muscle spasm and muscle tension of the neck are often a precipitating factor for tension headaches due to the anatomic relationship of the neck and head. However, there is no anatomic or pathophysiological basis for tension headache proximately due to or the result of osteoarthritis left shoulder and acromioclavicular joint.” He further notes, “the Veteran has a documented history of a chronic neck condition with chronic neck pain, which is consistent with the medical research on the etiology of tension headaches. The Veteran’s chronic neck condition with chronic pain is more likely than not the cause of any aggravation of the Veteran’s tension headaches.” However, as the Veteran is not service-connected for his neck pain, a secondary theory of entitlement is barred as a matter of law. See 38 C.F.R. § 3.310 ; DeLisio v. Shinseki, 25 Vet. App. 45, 59 (2011). The Board finds the examiner’s opinion highly probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data, with respect to all theories of entitlement. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Further, the November 2019 examiner also indicated the Veteran’s diagnosis as tension headaches and notes his symptom onset began following service. C&P 11/11/2019, pg. 4/10. The December 2018 examiner diagnosed his condition as common headaches and indicates they occur a couple times a year. C&P, 12/3/2018 pg. 2/5. The February 2017 examiner notes his diagnosis as tension headaches with an onset of 2008. C&P, 2/1/2017, pg. 1/3. Although the Veteran’s service treatment record indicates he sustained a contusion when he was involved in an altercation in September 1981, he was discharged in good condition and the rest of the Veteran’s record is devoid of headache complaints, and no reports of symptoms are listed by the Veteran during periodic treatment. See STR, 5/22/2015, pg. 19,22/92. Although the Veteran believes his headaches are related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/anatomical relationships pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examinations. As the preponderance of the evidence weighs against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for service connection is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T.N. Chapman, 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.