Citation Nr: 21015144 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 17-33 848 DATE: March 16, 2021 ORDER Entitlement to service connection for tension headaches, secondary to service connected disease bilateral pes cavus, bilateral lower extremity neuropathy, and knee patellofemoral pain syndrome, on a causation basis, is granted. (The issues of entitlement to a disability rating in excess of 30 percent for service-connected bilateral pes cavus, entitlement to a higher disability rating for left knee patellofemoral pain with degenerative arthritis, and entitlement to a total disability rating based on individual unemployability due to service-connected disability prior to January 1, 2008 are the subject of a separate panel decision) FINDING OF FACT The Veteran’s tension headaches are caused by his service-connected bilateral pes cavus with metatarsalgia, peripheral neuropathy of the left and right foot, patellofemoral pain syndrome of the left and right knee, and left lower extremity femoral radiculopathy. CONCLUSION OF LAW The criteria for service connection for tension headaches, secondary to service-connected diseases, on a causation basis, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1972 to July 1972 and September 1983 to January 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2020, the Veteran testified at a virtual Board hearing held before the undersigned Veterans Law Judge (VLJ). A copy of the transcript of that hearing is associated with the claims file. The issues of entitlement to a disability rating in excess of 30 percent for service-connected bilateral pes cavus, entitlement to a higher disability rating for left knee patellofemoral pain with degenerative arthritis, and entitlement to a total disability rating based on individual unemployability due to service-connected disability prior to January 1, 2008 are presently on appeal and were the subject of testimony at December 2014 and September 2020 Board hearings. Those issues will be the subject of a separate decision to be signed by a panel of three VLJs, to include the two VLJs who held hearings on those matters. Entitlement to service connection for tension headaches is granted. 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. Service connection may also be granted for a disability that is proximately due to, or the result of, service-connected disease or injury. 38 C.F.R. § 3.310(a). The Veteran asserts that he suffers from headaches which are related to sleep impairment caused by pain from his service-connected disabilities. The Veteran is in receipt of service connection for bilateral pes cavus with metatarsalgia, peripheral neuropathy of the left and right foot, patellofemoral pain syndrome of the left and right knee, and left lower extremity femoral radiculopathy, as well as other orthopedic disabilities. At the September 2020 Board hearing, the Veteran testified that his headaches are worse when he is unable to sleep, and that one of his doctors told him that he thought lack of sleep was causing his headaches. Throughout the relevant appeal period, the Veteran has reported to his VA health care providers and VA examiners that pain from his service-connected bilateral foot, bilateral lower extremity neuropathy, and knee disabilities interferes with his ability to sleep and decreases the quality. The record contains an August 2013 VA neurology record, which recorded the Veteran’s reports of worsening headaches following poor sleep due to pain and pins and needle sensation in the lower extremities and feet. The neurologist assessed the Veteran with headache- tension type, worse due to sleep deprivation due to pain. The Veteran was provided with a VA examination pertaining to his claimed headaches in January 2016. The examiner noted that the Veteran reported daily tension headaches which began in 2012, with more severe headaches three or four times per week, which he attributed to poor sleep. The examiner concluded that the Veteran’s headaches were less likely than not caused by his service-connected conditions, reasoning that the ankle and left elbow conditions had been present for many years before the headaches began and that these old injuries had no anatomical connection to headaches. Upon review of the record, the Board finds the conclusion of the August 2013 neurologist to represent the most probative evidence concerning the relationship between the Veteran’s tension headache disability and his service-connected disabilities. The Veteran is also competent to report his subjectively experienced headache symptoms, and their relative severity following poor sleep due to pain. The rationale of the January 2016 VA examiner is flawed because, for a veteran to be service connected on a secondary basis under a causation theory, the primary disability need not be service connected, or even diagnosed, at the time the secondary condition is incurred: “[t]here is no such temporal requirement inherent in § 3.310(a).” Frost v. Shulkin, 29 Vet. App. 131, 133 (2017). To the extent there is ambiguity as to whether service connection is warranted on a causation or aggravation basis, the Board resolves this interpretive doubt in favor of the Veteran to find service connection warranted on a causation basis. See Brown v. Gardner, 513 U.S. 115, 118 (1994) (in construing veterans’ law, “interpretive doubt is to be resolved in the veteran’s favor”). Moreover, service connection cannot be granted on an aggravation unless the baseline level of severity of the nonservice connected disease is established by medical evidence and that is not apparent in this case. 38 C.F.R. § 3.310(b). For the foregoing reasons, entitlement to service connection for tension headaches, secondary to service connected disease, is warranted. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Solomon, 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.