Citation Nr: 21024985 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 17-06 576 DATE: April 27, 2021 ORDER Entitlement to service connection for acute intermittent episodic tension headaches (claimed as headaches, migraines), to include as due to an undiagnosed illness is denied. FINDINGS OF FACT The Veteran has a current diagnosis of acute intermittent episodic tension headaches. The preponderance of the evidence is against finding that the Veteran’s headaches began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for headaches are not met. 38 U.S.C. §§ 1110, 1117, 1118, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from March 1985 to October 1985 and from February 2004 to November 2004. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision by a Department of Veteran’s Affairs (VA) Regional Office (RO). The Veteran requested a hearing which was held in June 2017; the transcript has been associated with the file. In January 2019, the Board remanded the issues of headaches and an inner ear disability. While on remand the RO granted service connection for the Veteran’s inner ear disability. As a result, the only matter currently before the Board is entitlement to service connection for headaches. The Veteran appeared at a hearing before a Veterans Law Judge (VLJ) of the Board of Veterans’ Appeals (Board) in June 2017. A transcript of the hearing is of record. As this VLJ is no longer employed at the Board, the Veteran was offered the opportunity to testify at another hearing by a December 2020 letter. The Veteran responded in January 2021 that he did not wish to have another hearing. As such, the Board will proceed based on the evidence of record. Service Connection Establishing service connection generally requires (1) evidence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). For Persian Gulf Veterans, service connection is warranted pursuant to 38 U.S.C. § 1117 and 38 C.F.R. § 3.317 if a Veteran presents evidence (1) that he or she is a Persian Gulf Veteran; (2) who exhibits objective indications of chronic disability resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as those listed in paragraph (b) of 38 C.F.R. § 3.317; (3) which became manifest either during active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent during the presumptive period prescribed by the Secretary; and, (4) that such symptomatology by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 C.F.R. § 3.317(a). 1. Entitlement to service connection for acute intermittent episodic tensions headaches (claimed as headaches, migraines) The Veteran asserts that his headaches began during his active duty service in 2004 while deployed in Iraq and have continued to the present. See June 2017 hearing transcript (received 6/20/2017, pp. 14). Additionally, during the June 2017 hearing the Veteran asserted that his headaches were due to an undiagnosed illness. As an initial matter, the Veteran was diagnosed with “acute intermittent episodic tension headaches” during an August 2020 VA examination. There are no other medical documents of record that suggest the Veteran’s headaches are due to an undiagnosed illness. As the Veteran’s headache condition is related to a known clinical diagnosis, 38 C.F.R. § 3.317 is not for application. However, the Veteran may still seek service connection on a direct basis. Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). As stated above, the Veteran was diagnosed with “acute intermittent episodic tension headaches” during his August 2020 VA examination. As a result, the first element of service connection has been met. The next element of service connection requires an in-service onset or aggravation of the condition. The Veteran’s service treatment records are negative for complaints, treatment, or symptoms related to headaches. At enlistment to active duty in February 2004, the Veteran stated he did not experience “frequent or severe headaches.” He further stated he did not then, nor had he ever had frequent or severe headaches. In October 2004 the Veteran was asked if he currently had or if he developed headaches during his deployment to which the Veteran stated, “no.” The Veteran further stated his health during the 2004 deployment “stayed the same or got better.” In the Veteran’s October 2014 notice of disagreement, he asserted that for his headaches, he is “on three different blood pressure pills and the headaches come and hurt whenever. Day or night I take my meds for them two times daily.” However, the record does not support the medication in question was specifically prescribed for his headaches but rather to manage his blood pressure. Additionally, during the June 2017 hearing the Veteran testified that he only takes over the counter medication for his headaches on an as needed basis. The Veteran’s VA outpatient records from November 2004 through May 2019 do not show complaints of nor treatment for headaches. The Veteran reported one instance of headache pain in December 2004 in relation to a sinus issue he was currently having and dehydration. Furthermore, the Veteran denies having headache on multiple occasions during his VA outpatient appointments to include in April 2014, April 2015, January 2016, January 2017, and January 2018. The first assertion of headaches in the Veteran’s file was his initial claim to service connection in February 2013. During the June 2017 hearing the Veteran stated he would get headaches while in service that would be treated with over the counter medication and reduced sun exposure when possible. He further stated that he had headaches prior to service but that they were worse after his return from deployment. This is despite asserting their onset began during in 2005, one year after service during his August 2020 VA examination. Additionally, as stated above both at entry to active service in February 2004 and at separation in October 2004, the Veteran denied experiencing headaches. The Veteran then stated that he still had headaches “occasionally.” He asserted that he sought treatment for his headaches at the St. Louis VA medical center and that blood tests had been conducted but no diagnosis could be given. However, those records are associated with the file and do not show any complaints of headaches nor testing ordered to determine a diagnosis for headaches. The Veteran also clarified that his blood pressure medication helps relieve his headaches which he asserts are due to an “undiagnosed illness.” The Veteran underwent a number of VA examinations in August 2020 and September 2020. Initially, in August 2020 the Veteran underwent a VA examination in which the examiner diagnosed his headaches as tension headaches with a known etiology. Tension headaches are the most common form of head pain amongst adults and can be triggered by day to day stressors. The examiner opined that the Veteran’s headaches were “less likely than not” related to a “specific exposure event experienced by the Veteran during service in Southwest Asia.” The examiner concluded that headaches and migraines have a known etiology and did not result from any exposure. The Veteran also underwent an August 2020 Gulf War examination in which the examiner stated that the Veteran’s headaches had a known etiology. The examiner further stated that the Veteran did not have additional signs or symptoms of any other ailments. Veteran’s physical examination was noted to be normal. In the September 2020 VA examination the examiner again stated that the Veteran was diagnosed with tension headaches. The examiner also stated again that it was less likely than not that the Veteran’s headaches are a result of his active duty service. This is because the Veteran’s headaches are “intermittent” and can be treated with over the counter medications which relieve his pain. The examiner further stated the Veteran’s headaches were not chronic as the Veteran’s symptoms were subjective only. This includes a pain in the back of his head and some sensitivity to light. In contrast, symptoms of a migraine are more standard in that most people experience vomiting, nausea, and extreme sensitivity to light or sound. However, the Veteran is reporting sporadic headaches brought on by noise, “primarily while driving” as he is a truck driver, that can be treated with over the counter medication and sometimes rest. This is a common occurrence amongst many adult individuals. The examiner concluded by stating that the Veteran’s file was “negative for any documentation of diagnosis or treatment for headaches” but his reports favor a diagnosis of tension headaches. In summary, the August 2020 and September 2020 examiners all concluded that the Veteran had a current diagnosis of tension headaches. The Veteran’s headaches are not a result of his service in Southwest Asia nor are they a result of his active duty service. The examiners concluded that he is experiencing tension headaches as many adult individuals do when under stressful circumstances. The examiners stated that the Veteran’s symptoms are subjective and do not mirror the symptoms of migraines. The Board finds these opinions probative, as they provided a clear conclusion with supporting data, and reasoned medical explanations connecting the two. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran asserts that his headaches began in service and have continued since then to the present. While the Veteran is more than competent to report on the observable symptoms of his headaches, the record does not support his assertions. At entry to active service in February 2004 the Veteran denied having headaches despite testifying in June 2017 that he had headaches prior to service. Additionally, in the Veteran’s October 2004 separation examination he also denied headaches despite additional June 2017 testimony that he was experiencing headaches in service. Furthermore, the Veteran states his headache severity increased after his return from service, but the record reflects there has been little to no treatment for this condition. The Veteran has sought treatment for a number of different ailments through the VA since November 2004 with no mention of a headache condition until his claim to service connection in February 2013, 9 years after his separation from active duty service. Additionally, the Veteran was offered VA examinations for other disabilities in which he was seeking service connection with no mention of headaches during those examination as well. Given the Veteran’s many opportunities to report headache symptoms or complaints at VA examinations and when seeking treatment for other disabilities over the years, and the fact that he did seek treatment and examination for other disabilities, there is a foundation laid to infer that the absence of complaint in the medical records is negative evidence the Board may weigh against the claim. In this case, the Veteran’s recent statement reporting a long history of headache symptoms is contradicted by past records in which he appears to have reported all of his existing medical conditions without mentioning any problems related to headaches or head pain. See AZ v. Shinseki, 731 F.3d 1303 (Fed. Cir. 2013). Additionally, the Veteran’s statements regarding onset are inconsistent throughout the record. The Veteran’s asserts he sought treatment for his headaches after his separation but there is no medical documentation of record to support that. Furthermore, the Veteran asserted he was taking blood pressure medication to control his headaches but that is not the case. There is also no documentation while the Veteran was in service to support his claims that he was experiencing headaches while deployed. This includes the Veteran’s self-reported medical history in February 2004 and October 2004. When determining the credibility of lay evidence such as this, the Board may properly consider internal consistency, facial plausibility, and consistency with other evidence of records. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). While lay evidence cannot be found not credible solely due to the lack of contemporaneous medical records, contemporaneous evidence has a greater probative value than history reported by the Veteran. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Curry v. Brown, 7 Vet. App. 59, 68 (1994). As a result, and due to the inconsistent nature of the Veteran’s assertions regarding his headaches, his lay statements regarding onset are not found to be credible and afforded no probative weight. The applicable medical and lay evidence does not establish that the Veteran has experienced headaches since service that have continued to the present nor that his headaches are a result of his active duty service. Evidence of record shows the Veteran did not begin reporting symptoms of headaches until his claim to service connection in February 2013 and has since denied having headaches in his VA outpatient records as stated above. Additionally, the August 2020 and September 2020 VA examiners concluded that the Veteran did not have a chronic condition nor was there a medical basis to link the Veteran’s current headache condition to his active duty service. (Continued on the next page)   The claim is therefore denied. The preponderance of the evidence is against the claim for service connection for headaches and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 4.3. Robert N. Scarduzio Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Associate Counsel, S. Conti 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.