Citation Nr: 21024135 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 14-44 137A DATE: April 22, 2021 ORDER Entitlement to a rating in excess of 10 percent prior to September 9, 2020 and a rating in excess of 20 percent thereafter for intervertebral disc syndrome (IVDS) is denied. Entitlement to service connection for a right shoulder condition is denied. Entitlement to service connection for migraine headaches is denied. FINDINGS OF FACT 1. For the period prior to September 9, 2020, the Veteran’s intervertebral disc syndrome was manifested by no more than forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees or muscle spasm, guarding or localized tenderness not resulting in abnormal gait or abnormal spinal contour or vertebral body fracture with loss of 50 percent or more of the height. 2. For the period beginning September 9, 2020 and thereafter, the Veteran’s intervertebral disc syndrome was manifested by no more than forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees or the combined range of motion of the thoracolumbar spine not greater than 120 degrees, or muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reverse lordosis, or abdominal kyphosis. 3. The preponderance of the evidence is against finding that the Veteran’s right shoulder disability began during active service or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence is against finding that the Veteran’s migraine headaches began during active service or are otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent prior to September 9, 2020 and a rating in excess of 20 percent thereafter for intervertebral disc syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5243. 2. The criteria for service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for migraine headaches have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from November 1990 to May 1994. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a February 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously remanded in May 2018 and October 2019 Board decisions for further development. A remand by the Board imposes a concomitant duty to ensure compliance with the terms of the remand. Where the remand orders are not complied with, the Board itself errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Upon review, the Board finds that the remand directives have been complied with. The Board notes that the AOJ requested the Veteran submit any relevant private treatment records or submit information with which VA can assist the Veteran in obtaining private treatment records. VA requested records for which the Veteran submitted a proper release. The duty to assist is not a one-way street. If a Veteran desires help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining evidence. Wood v. Derwinski, 1 Vet. App. 190 (1991). Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA’s duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). INCREASED RATING General Rating Principles Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40. Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. 38 C.F.R. § 4.59 (discussing facial expressions such as wincing, muscle spasm, crepitation, etc.). Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Excess fatigability and incoordination should be considered in addition to more movement than normal, less movement than normal, and weakened movement. 38 C.F.R. § 4.45. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The Board will consider not only the criteria of the currently assigned diagnostic code, but also the criteria of other potentially applicable diagnostic codes. Rating Principles: Intervertebral Disc Syndrome The Veteran is service connected for intervertebral disc syndrome with a rating of 10 percent for the period from May 26, 2011 to September 9, 2020 and a rating of 20 percent beginning September 9, 2020 and thereafter. Generally, diseases and injuries of the spine are rated under the general rating formula for diseases and injuries of the spine. Under the general rating formula, a rating of 10 percent is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height. A rating of 20 percent is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or the combined range of motion of the cervical spine not greater than 170 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis or abnormal kyphosis. A rating of 30 percent is warranted for forward flexion of the cervical spine 15 degrees or less; or favorable ankylosis of the entire cervical spine. A rating of 40 percent is warranted for unfavorable ankylosis of the entire cervical spine. A rating of 100 percent is warranted for unfavorable ankylosis of the entire spine. Note (1) instructs that any associated objective neurologic abnormalities including but not limited to bowel or bladder impairment, should be evaluated separately under the appropriate diagnostic code. Note (6) instructs that intervertebral disc syndrome (preoperatively or postoperatively) should be evaluated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under §4.25. Here, as discussed below because the evidence of record does not establish that the Veteran has experienced any incapacitating episodes evaluation of the Veteran’s IVDS under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes is not warranted. Analysis Entitlement to an initial rating in excess of 10 percent prior to September 9, 2020 and a rating in excess of 20 percent thereafter for intervertebral disc syndrome. The Veteran’s intervertebral disc syndrome was initially service connected in a February 2012 rating decision, with a rating of 10 percent, effective May 26, 2011. The Veteran filed a notice of disagreement in January 2013, and following an October 2014 statement of the case, the Veteran perfected his appeal with a December 2014 form 9. The Veteran’s claim was remanded in May 2018 and October 2019 Board decisions. Following the October 2019 Board decision, a January 2021 rating decision increased the Veteran’s rating for intervertebral disc syndrome to 20 percent, effective September 9, 2020. Accordingly, the issue before the Board is entitlement to an initial rating in excess of 10 percent prior to September 9, 2020 and a rating in excess of 20 percent thereafter for intervertebral disc syndrome. The Veteran contends that he is entitled to an increased rating for his intervertebral syndrome. However, the preponderance of the evidence of record does not establish that the Veteran’s intervertebral disc syndrome warrants a rating in excess of 10 percent prior to September 9, 2020 or a rating in excess of 20 percent beginning September 9, 2020 and thereafter. Entitlement to a rating in excess of 10 percent prior to September 9, 2020. September 2011 treatment records note complaints of lower back pain. However, the Veteran’s posture remained within functional limits and a September 2011 MRI of the Veteran’s lumbar spine was normal. The Veteran was afforded a VA examination for his lumbar spine in September 2011. The Veteran reported limitation in walking due to his spine condition; he noted he was able to walk 400 yards in ten minutes. The Veteran denied experiencing any falls but endorsed symptoms of stiffness and spasms. The Veteran denied experiencing fatigue, decreased motion, paresthesia, numbness, bowel problems or bladder problems. However, he endorsed weakness of the leg. The Veteran reported that his pain occurs four times per day, lasting one hour each time. He reported that the pain travels to his right leg and characterized his pain as moderate. The Veteran reported that pain is exacerbated by physical activity, sitting, driving, and sleeping and relieved by rest and medication. The Veteran reported that during flare ups he experiences functional impairment described as pain, slowness, stiffness, and limitation of motion of the joint such as bending. The Veteran reported that he was not receiving any treatment for his back and denied any history of surgeries, hospitalizations, or incapacitating episodes. However, he also reported that his back pain made his performance suffer with respect to construction and janitorial work. On examination, the Veteran demonstrated flexion to 70 degrees with pain at 60 degrees, extension to 30 degrees with pain at 20 degrees, right lateral flexion to 30 degrees with pain at 20 degrees, left lateral flexion to 30 degrees with no pain noted, right rotation to 30 degrees with pain at 30 degrees, and left rotation to 30 degrees with no pain noted. The Veteran was able to perform repetitive use testing with no additional degree of limitation. The examiner noted that joint function of the spine was additionally limited by pain and pain has a major functional impact. Additionally, the examiner noted that the Veteran’s spine was limited by fatigue, weakness, lack of endurance, and incoordination. Inspection of the spine revealed a normal head position with symmetry and appearance. There was symmetry of spinal motion with normal curves of the spine. No lumbosacral motor weakness was noted, however the Veteran had sensory deficit of the right lateral thigh, right front leg, right medial leg, right lateral leg, right back of the thigh, right dorsal foot, and right lateral foot. The examiner noted evidence of lumbar intervertebral disc syndrome. In April 2014 the Veteran reported low back pain after prolonged sitting or standing. In June 2014 the Veteran reported increased back spasms due to his work. Subsequent VA treatment records for the period prior to September 9, 2020, continue to note ongoing complaints of low back pain. Ultimately, the evidence of record does not substantiate entitlement to a rating in excess of 10 percent prior to September 9, 2020. First, the record does not show any evidence of incapacitating episodes requiring bed rest prescribed by a physician. Therefore, the Veteran is not entitled to a rating under the formula for rating IVDS based on incapacitating episodes. With respect to the general rating formula for diseases or injuries of the spine, while the record shows that the Veteran has reported back pain, during his examination the Veteran demonstrated flexion to 70 degrees with pain at 60 degrees, extension to 30 degrees with pain at 20 degrees, right lateral flexion to 30 degrees with pain at 20 degrees, left lateral flexion to 30 degrees with no pain noted, right rotation to 30 degrees with pain at 30 degrees, and left rotation to 30 degrees with no pain noted. The Veteran’s range of motion does not more nearly approximate the criteria for a rating in excess of 10 percent. The Board has also considered whether higher ratings for the Veteran’s IVDS disability is appropriate under 38 C.F.R. §§ 4.40, 4.45, and 4.59, and concluded that such is not warranted. Even considering pain on range of motion, flexion has been limited to no less than 60 degrees and extension has been limited to no more than 20 degrees. The fact that he may have had pain in range of motion testing does not warrant a higher evaluation. See Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011) (discounting the notion that the highest disability ratings are warranted where pain is merely evident as it would lead to potentially absurd results). The evidence shows limitation of motion even with consideration of pain above more closely approximates the current evaluations than the higher evaluations sought by the Veteran for the period prior to September 9, 2020. The Court has also established that flare-ups must be considered. Sharp v. Shulkin, 29 Vet. App. 26 (2017). Guidance on how to evaluate flare-ups has not been particularly clear. However, the Board finds overall wisdom in Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Flare-ups must be quantifiable and must result in limitation of motion or function beyond that contemplated by the already provided evaluation. In addition, because there is a regulation addressing stabilization of ratings, the flare-up must be of such length as to establish that the overall impairment is more severe than currently evaluated, rather than a brief snapshot in time. While VA treatment records note that the Veteran reported having pain in his back exacerbated by standing or sitting for long periods of time, during his VA examination, the Veteran characterized his pain as no more than moderate. Moreover, the Veteran maintained flexion to no less than 60 degrees, extension to no less than 20 degrees and rotation to no less than 30 degrees The evidence does not substantiate that the Veteran has flare-up that result in limitation of motion or function beyond that contemplated by the already provided evaluations.   For the above reasons, A rating in excess of 10 percent for the period prior to September 9, 2020 is not warranted. As the preponderance of the evidence is against any higher or separate rating, the benefit of the doubt doctrine is not otherwise for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Entitlement to a rating in excess of 20 percent beginning September 9, 2020 and thereafter. September 2020 VA treatment records notes complaints of back spasms. The Veteran was afforded a VA examination in September 2020. The Veteran alleged that his back pain has gotten worse over time. He reported symptoms of stiffness, decreased range of motion, mobility, and endurance. The Veteran reported that his current treatment included Tylenol, as needed. Notwithstanding his symptoms the Veteran denied having flare-ups but endorsed functional loss which included difficulties standing, sitting, and driving for long periods of time. Upon examination the Veteran demonstrated forward flexion to 55 degrees, left lateral flexion to 5 degrees, right lateral flexion to 15 degrees, extension to 10 degrees, right lateral rotation to 20 degrees and left lateral rotation to 20 degrees. Pain was noted on examination and caused functional loss with forward flexion, extension, right lateral flexion, left lateral flexion, right lateral rotation and left lateral rotation. There was no evidence of pain with weight bearing and no objective evidence of localized tenderness or pain on palpation. The Veteran remained able to perform repetitive use testing with no additional loss of function or range of motion after three repetitions. The examiner noted that pain, fatigue, weakness, and lack of endurance all limit functional ability with repeated use over time, resulting in forward flexion to 45 degrees, extension to 5 degrees, right lateral flexion to 10 degrees, left lateral flexion to 10 degrees, right lateral rotation to 15 degrees and left lateral rotation to 15 degrees. There was no evidence of guarding or muscle spasms and the Veteran maintained 5/5 muscle strength. With respect to deep tendon reflexes the Veteran demonstrated normal reflexes of the right knee and ankle, but hypoactive reflexes of the left knee and ankle. A sensory exam noted normal sensation of the right thigh, knee, lower leg, ankle, and foot but decreased sensation of the left thigh, knee, lower leg, ankle, and foot. A straight leg raise was negative on the right but positive on the left. The Veteran was noted to have moderate intermittent radicular pain of the left lower extremity, moderate paresthesia of the left lower extremity and mild numbness of the left lower extremity. The examiner characterized the Veteran’s radicular pain as mild. There was no evidence of ankylosis of the spine and no other neurological abnormalities were noted. The Veteran did not require the use of assistive devices and no scars were noted. With respect to the impact of the Veteran’s IVDS on his ability to work, the examiner noted that the Veteran is currently employed as security and lost one to two weeks of work time over the prior 12 months. The examiner noted that the Veteran’s ability to perform sedentary activity of employment due to IVDS with left radiculopathy is moderately impaired due to limitations of sitting, standing, and diving. It was also noted that the Veteran’s ability to perform physical activity of employment is mild to moderately impaired due to limitations of standing, lifting and carrying. Finally, the examiner noted objective evidence of pain with non-weight bearing. Based on the evidence of record for the period beginning September 9, 2020 and thereafter entitlement to a rating in excess of 20 percent is not warranted. During the examination, the Veteran demonstrated no less than forward flexion to 45 degrees, extension to 5 degrees, right lateral flexion to 10 degrees, left lateral flexion to 10 degrees, right lateral rotation to 15 degrees and left lateral rotation to 15 degrees. In accordance with 38 C.F.R. §§ 4.40, 4.45, and 4.59 the Board has considered the Veteran’s symptoms of functional loss, pain, weakness, and fatigue. However, these symptoms do not more nearly approximate entitlement to a rating in excess of 20 percent even with the symptoms indicating functional impairment. The Veteran’s symptoms are adequately contemplated by the 20 percent rating criteria. Further the Board notes that the Veteran has denied experiencing flare-ups for this time period. As the preponderance of the evidence is against any higher or separate rating, the benefit of the doubt doctrine is not otherwise for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Entitlement to a rating in excess of 20 percent for the period beginning September 9, 2020 and thereafter is denied. SERVICE CONNECTION Legal Criteria Generally, to establish a right to compensation for a present disability a veteran must show: (1) a present disability; (2) an 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, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Analysis 2. Entitlement to service connection for right shoulder disability. The Veteran contends that his right shoulder disability began in service. A September 2020 VA examination establishes that the Veteran has a current disability of right rotator cuff tendonitis. With respect to an in-service injury, in his January 2013 notice of disagreement and his February 2014 Form 9, the Veteran contends that he injured his shoulder in service after he pushed a 600-pound cable reel to prevent it from falling on him. Consistent with the Veteran’s contentions, during September 2011 VA treatment, Veteran also reported sustaining a shoulder strain in 1992 in service. The Veteran is competent to report an in-service shoulder injury. Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge); 38 C.F.R. § 3.159. However, the Board does not find the Veteran’s contentions credible as they are not supported by the other evidence of record including the Veteran’s service treatment records. The Veteran’s June 1990 enlistment examination does not note any shoulder abnormalities; in April 1994 the Veteran waived his right to undergo a separation examination. The Veteran’s service treatment records do not note any complaints of or treatment for right shoulder pain or injury in service. While the absence of medical evidence alone does not substantiate that an injury did not occur here, the Board finds that a right shoulder disability which required 15 days of light duty is a disability that would have been noted in the course of evaluation or medical treatment. See Buckzynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (noting that the absence of an entry in a record may be evidence against the existence of a fact if it would ordinarily be recorded). Notably, the Veteran’s service treatment records contain treatment records regarding the Veteran’s persistent complaints of neck, back and knee pain in service in 1990 as well as February 1994 and March 1994. The record also contains notes of the Veteran’s treatment for a facial fracture which required stability with maxilla and mandibular fixation in November 1990. Thus, given that the service treatment records contain evidence of the Veteran’s other reported symptoms and treatment in service, it stands to reason that if the Veteran reported a shoulder injury that required light duty during his period of service this would be noted in the service treatment records. As such, this weighs against a find that the Veteran sustained an in-service injury. Further, post service the record contains no evidence of complaint of or treatment for the right shoulder until February 2011. VA treatment records note a complaint of right shoulder pain, shortly before the Veteran filed his claim for service connection. A February 2011 MRI noted no osseous abnormalities, no displaced fracture, abnormal periarticular soft tissue calcifications or substantial changes of erosive or degenerative arthritis. September 2011 VA treatment records note that the Veteran reported that the pain started in 1992 after a shoulder strain injury. A February 2014 MRI notes right shoulder inflammation of the tendons with two small tears; physical therapy was recommended. April 2014 VA treatment records diagnose the Veteran has having a right shoulder torn glenoid. The record does not establish a nexus between the Veteran’s current disability and his military service. The Veteran was afforded a VA examination for his shoulder in September 2020. Subjectively the Veteran reported that the right shoulder injury began in service while in military training exercises. He reported that his right shoulder got worse over time with increased pain and endorsed currents symptoms of stiffness, decreased range of motion, mobility, and endurance. The examiner indicated that he was unable to render a medical opinion regarding the etiology of the Veteran’s right shoulder. However, in a January 2021 VA addendum opinion an examiner opined that after review of the existing medical records and service treatment records available there is no objective evidence to support a medical nexus for the right shoulder condition incurred in, related to, or aggravated by service. The examiner noted that while the Veteran is deemed competent to report a history of symptomatology, he is not capable of diagnosing those symptoms or establishing an etiological relationship and the medical evidence does not support an etiology that the right shoulder condition was incurred in or caused by service The Board affords probative weight to this opinion as it is based on a review of the evidence of record and provides a thorough rationale. The preponderance of the probative evidence of record does not establish a nexus between the Veteran’s current right shoulder disability and military service. Entitlement to service connection for a right shoulder injury is denied. 3. Entitlement to service connection for migraine headaches. The Veteran contends that he is entitled to service connection for migraine headaches. During his September 2020 VA examination the Veteran reported that his migraines began in 1992, with periodic headaches involving both sides of his head a few times a month, lasting a few hours each time. Evidence of record including the Veteran’s September 2020 VA examination establishes that the Veteran has a current disability of migraine headaches. The Veteran’s enlistment examination does not note any complaints of headaches. As discussed above, the Veteran waived his right to a separation examination. However, service treatment records also contain no complaints of or treatment for headaches in service. Post service, a February 2011 VA treatment record notes the Veteran has a history of migraine headaches since 2004. The record contains no evidence of treatment for headaches prior to 2004. Thus, while the Veteran is competent to report symptoms of headaches, the Board does not find his contentions credible as there is no evidence of treatment for headaches in service and post service treatment records note the Veteran’s migraines began in 2004. The Board finds the service treatment records and post service medical records to be more probative because they were created contemporaneously, whereas the Veteran lay statements regarding the onset of his headaches have been made more than a decade post service. Curry v. Brown, 7 Vet. App. 59, 60 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by the Veteran). Similarly, the record contains no opinion establishing a nexus or causal relationship between the Veteran’s current disability and his military service. Following the Veteran’s September 2020 VA examination, a January 2021 VA addendum opinion indicates that after review of the evidence of record, there is no objective evidence to support a medical nexus for the migraine headaches incurred in, related to, or aggravated by service, to include falling off a truck. The examiner notes that while the Veteran is deemed competent to report a history of symptomatology, he is not capable of diagnosing those symptoms or establishing an etiological relationship. The medical evidence does not support an etiology for the migraine headache condition incurred in or caused by service. The Board affords probative weight to this opinion because, the record shows no complaints or treatment for headaches in service and post service February 2011 VA treatment records note that the Veteran’s migraine headaches began in 2004, more than a decade post service. Based on the evidence of record which does not establish an in-service headaches nor a nexus between the Veteran’s current disability and military service, entitlement to service connection for migraine headaches is denied. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Wimbish, 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.