Citation Nr: 21027496 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 14-17 310 DATE: May 5, 2021 ORDER Entitlement to service for bilateral hearing loss is denied. Entitlement to service connection for an acquired psychiatric disability is denied. Entitlement to service connection for a headache disability is denied. FINDINGS OF FACT 1. The preponderance of the evidence shows that the Veteran's pre-existing bilateral hearing loss was not aggravated by service. 2. The preponderance of the evidence is against finding that the Veteran's acquired psychiatric disability began during active service; was otherwise related to an in service injury or event; or was proximately caused by or aggravated by his service-connected pes planus. 3. The preponderance of the evidence is against finding that the Veteran's headache disability began during active service or was otherwise related to an in service injury, event, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1111, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.385 (2020). 2. The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. § 3.303, 3.310 (2020). 3. The criteria for service connection for headache disability have not been met. 38 U.S.C. §§ 1110, 1111, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army Reserves from August 1986 to November 1986 with additional service in the Kansas Army National Guard. In August 2017, the Veteran testified before the undersigned Veterans Law Judge (VLJ) and a transcript is of record. In February 2018, the Board remanded the case to the Agency of Original Jurisdiction (AOJ) to obtain outstanding VA records and receive VA examinations for his feet disability, headaches, sleep apnea, and psychiatric disabilities. The AOJ was unable to obtain the Veteran's records from Fort Sill, Oklahoma. The Board notes attempts were made to obtain these records, but the AOJ was informed these records do not exist. The Veteran received new VA examinations in August and September 2019. However, the Board found that new VA opinions were necessary for his bilateral hearing loss, psychiatric condition, and headache service connection claims. Accordingly, in February 2020, the Board remanded the Veteran's claims. The Board remanded the Veteran's bilateral hearing loss claim for an additional addendum opinion that addressed the Veteran's disability as a possible congenital defect. The Board remanded the Veteran's psychiatric and headache service connection claims for direct and secondary service connection nexus opinions. The Veteran received new VA examinations in February 2020 with addendum opinions in August 2020, September 2020, and February 2021. The Board finds that the new examinations and opinions were based on a complete review of the claims file and provided adequate rationales for each opinion. The new opinions for the Veteran's bilateral hearing loss, psychiatric, and headache claims are adequate and substantially complied with the remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. To establish service connection for the claimed disorder, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 C.F.R. § 3.303 (2020); see also Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. Second, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). Third, the Board must weigh the probative value of the evidence in light of the entirety of the record. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102 (2020). When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 4 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Bilateral Hearing Loss For veterans who served 90 days or more after December 31, 1946, the chronic diseases listed in 38 U.S.C. § 1101(3) and 38 C.F.R. § 3.309(a), including sensorineural hearing loss, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101(3), 1112(a)(1) (2018); 38 C.F.R. §§ 3.307(a), 3.309(a) (2020). Specific to claims for service connection for hearing loss, impaired hearing is considered a "disability" for VA purposes only when the auditory threshold in any of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; when the thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC test are less than 94 percent. 38 C.F.R. § 3.385 (2020). The Veteran's hearing loss meets the criteria for VA hearing loss. The Veteran's service treatment records note that he was routinely exposed to hazardous noise. The first and second elements of a service connection are met and the remaining question before the Board is whether there is a nexus between the Veteran's current hearing loss and his periods of service. The Board notes that the Veteran's May 1986 enlistment examination into the Army Reserves shows some evidence of hearing loss. However, the degree of hearing loss noted on his entrance medical examination did not meet the criteria for VA hearing loss; thus, the presumption of soundness applies. McKinney v. McDonald, 28 Vet. App. 15 (2018). The Board acknowledges that the presumption of soundness does not apply to a Veteran whose claim is based on a period of ACDUTRA who has not previously established veteran status; however, here the Veteran's status has been established because he was previously granted service connection for disabilities during his time in the Reserves and ACDUTRA. Smith v. Shinseki, 24 Vet. App. 40 (2010). A veteran is presumed to have been in sound condition when examined, accepted, and enrolled for service except as to defects, infirmities, or disorders noted at the time of examination, acceptance, enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111 (2018); 38 C.F.R. § 3.304 (2020). To rebut the presumption of soundness the burden is on VA to satisfy a two-prong test by showing by clear and unmistakable evidence that the Veteran's disability both existed prior to service and was not aggravated during service. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991). Even when there is clear and unmistakable evidence of preexistence, the claimant need not produce any evidence of aggravation in order to prevail under the aggravation prong of the presumption of soundness. Rather, the burden is on VA to establish by clear and unmistakable evidence that it did not or that any increase was due to the natural progress of the disease. Horn v. Shinseki, 25 Vet. App. 231, 235 (2012). The Board also notes that some of the medical evidence suggested that the Veteran's bilateral hearing loss was a congenital defect. For VA purposes, a "defect" is defined as a structural or inherent abnormality or condition which is more or less stationary in nature and is generally incapable of improvement or deterioration. See O'Bryan v. McDonald, 771 F.3d 1376, 1380 (Fed. Cir. 2014). Congenital or developmental defects are generally not considered a disease or injury for the purpose of service connection. 38 C.F.R. § 3.303 (c), 4.9 (2020). The presumption of soundness applies to a congenital disease but not to a congenital defect. Quirin v. Shinseki, 22 Vet. App. 390, 397 (2009); Winn v. Brown, 8 Vet. App. 510, 516 (1996). This is because defects by nature pre-exist service. Service connection may be granted for a congenital disorder based on in-service aggravation. See VAOPGCPREC 82-90. A disease considered by medical authorities to be of congenital, familial (or hereditary) origin by its very nature preexists Veteran's military service, but that service connection for such diseases could be granted if manifestations of the disease in service constituted aggravation of the condition. See Carpenter v. Brown, 8 Vet. App. 240, 245 (1995); Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993). Additionally, service connection may still be granted for any superimposed disease or injury. Evidence The Veteran's service records show evidence of hearing loss. A May 1989 audiogram showed bilateral hearing loss, and the Veteran was put on profile. The audiogram noted that the Veteran was routinely exposed to hazardous noise. Additionally, audiograms from July 1988 and March 1989 showed bilateral hearing loss. His June 1990 examination noted evidence of pronounced bilateral hearing loss and noted his need for hearing aids. A March 1995 memorandum noted that the Veteran had moderately severe bilateral hearing loss which placed him in the #3 permanent profile range for hearing, and a hearing aid was necessary to meet fitness standards. He was also found not fit for assignments requiring acute hearing. In May 1991, the Veteran received an audiological examination, but no etiological opinion for his hearing loss was provided. However, the examiner noted that further examination was needed rule out the possibility of a tumor or other right ear abnormality. In a December 1992 examination, the Veteran's bilateral hearing loss was attributed to his loud noise exposure while in bootcamp. In a June 1994 private record, the Veteran reported that his hearing began to diminish in 1987 and worsened over time. A May 1995 private treatment record also considered his bilateral hearing loss. The examiner noted that Veteran reported progressive hearing loss that had worsened recently. The examiner noted that the etiology of his hearing deficit was undetermined but noted that it was unlikely that there was an acoustic tumor present. In September 1995, the Veteran received a VA examination. The examiner noted the Veteran's report of being exposed to machinery and airplanes in service. The examiner noted that the Veteran had considerable difficulty hearing during the examination. While the examiner did not provide an etiological opinion, he stated that there was no evidence of perforation or scarring from past perforations. The examiner also noted that there was no evidence of any disease of the mastoids. The Veteran submitted a private record from January 1999. The examiner gave the Veteran an audiogram which showed bilateral hearing loss but did not provide an etiological opinion. In a March 2003 private opinion, the examiner noted that because of the Veteran's in-service noise exposure it was "reasonable to assume that exposure to field artillery in the armed services has resulted in sensorineural hearing loss." The Veteran submitted several lay statements describing his in-service noise exposure and subsequent hearing loss. In an October 1998 statement he reported first noticing his hearing loss in 1987, but it was not severe. He reports that his hearing loss progressed and did not realize the impact of his in-service noise exposure until told by doctors. He was exposed to loud noises in service from 1986 to 1993 when he was around the tanks and artillery. He reiterated his claims in an October 2002 statement. In November 2004, the Veteran received another VA examination. The examiner opined that the Veteran's case did not present as typical of noise induced hearing loss. The Veteran's hearing loss onset was some time after exposure and there was no evidence showing hearing loss immediately after noise exposure. The examiner acknowledged there was some medical literature to suggest delayed onset hearing loss, but also noted the considerable evidence against delayed hearing loss. The examiner noted that "a review of the pure tone thresholds failed to show the typical sloping or dip configurations usually associated with noise exposure and acoustic trauma." Consequently, the examiner concluded that hearing loss due to noise exposure is an injury that does not worsen once noise exposure has ceased; here, the Veteran's hearing loss has worsened despite no longer being exposed to acoustic trauma. The examiner noted that there is "no support in the literature for noise exposure or acoustic trauma as an etiological factor in hearing losses with this type of presentation and progression." The examiner found the evidence was against the positive, private opinion of the March 2003 private examiner. The examiner concluded it was less likely than not that the Veteran's hearing loss was due to noise exposure or acoustic trauma in service. The November 2004 examiner noted that if the Veteran had a congenital malformation of the cochlear, there could be a causal relationship between his hearing loss and acoustic trauma. An experienced radiologist or neuro-otologist would need to acquire high quality images of his cochlear to rule out that possibility. Consequently, in March 2005, an audiologist noted there was no relationship between congenital malformation and acoustic trauma. The addendum noted VA did not have a neuro-otologist and it was outside the scope of an audiologist to suggest malformation of cochlea. In a June 2006 private opinion, the examiner noted that the etiology of the Veteran's hearing loss as unclear. The examiner noted there was no evidence of a structural compression of the nerve since his disability is bilateral and it is unusual for a structural problem to cause bilateral compression. The examiner noted it was possible that his hearing loss was caused by trauma during military training, and there was no evidence that his symptoms were congenital. However, the examiner also provided other possible explanations for his hearing loss such as vasculitis, lupus, Lyme disease, or sarcoidosis. The Veteran's next VA examination was in February 2007. The examiner noted the lack of acoustic complaints during active duty service. The examiner opined that due to the limited amount of time the Veteran was exposed to excessive noise and no evidence of acoustic damage until 4 years after service, the Veteran's current disability is not likely related to service. The examiner also noted that he was not qualified to opine on a congenital malformation of the cochlea. The Veteran's next VA examination was in October 2011. The examiner noted that the Veteran reported hearing difficulties in service after exposure to loud noises in boot camp, but his problems did not become significant until 1992. The examiner noted the evidence of record documenting his hearing loss while in the Reserves. However, the examiner concluded that an etiological opinion could not be provided because any opinion would be based on speculation due to the lack of evidence at discharge. The Veteran received another VA examination in March 2013. The examiner noted that his May 1986 enlistment examination showed hearing loss at 25 decibels and further audiograms showed a rapid progression in hearing loss for both ears. His hearing continued to decline at a rapid rate after discharge. Nevertheless, the examiner opined is was less likely than not that his hearing loss was not due to service. The Veteran's bilateral hearing loss was severely atypical for noise induced hearing loss. The Veteran's hearing loss is a low-frequency hearing loss with good high frequency thresholds. A hearing loss induced by noise exposure would be a high frequency hearing loss with preservation of low frequency hearing threshold. Thus, the examiner found that the severity was extremely atypical for Veteran's reported exposure and configuration and shape of his hearing loss is extremely atypical. The examiner opined is was more likely that the Veteran's hearing loss is due to genetic/familial autoimmune in origin. This opinion was based on the fact there was hearing loss noted on his enlistment examination and the progression of hearing loss after active duty service. The examiner noted specifically "one would not expect a hearing loss to further progress when the veteran was no being exposed to damaging noise." In a December 2014 private record, the examiner noted that the Veteran developed progressive hearing loss while in the Reserves. However, the examiner agreed that the Veteran's audiograms were atypical for noise exposure with the lack of hearing loss at higher frequencies. In additional lay statements, the Veteran attributed his hearing loss to his in service noise exposure. He consistently reiterated that his hearing issues began in service. Similarly, at his August 2017 Board hearing, his spouse testified that the Veteran has had hearing issues since she has known him. The Veteran and his spouse have been together for 23 years. The Veteran's most recent VA examination was in February 2020. The examiner determined that while the Veteran's bilateral hearing loss clearly and unmistakably existed prior to service, his hearing loss was clearly and unmistakably not aggravated beyond its natural progression due to his in-service noise exposure. The Veteran entered service with evidence of bilateral hearing loss which progressed once he was no longer exposed to military noise. Accordingly, it was less likely that the Veteran's in-service noise exposure caused his hearing loss. The examiner opined that the Veteran had underlying genetic hearing loss since the Veteran's hearing loss progressed so rapidly even without noise exposure. The examiner noted, however, that while there may be a genetic component to his hearing loss, the Veteran does not have a congenital defect. His imaging failed to show evidence of a congenital defect. Thus, his military service did not superimpose on a congenital defect. The examiner noted it was likely the Veteran had an inherited form of hearing loss given that he has 2 relatives with early onset hearing loss. Additionally, if his military service had worsened his condition beyond what expected, when he was no longer exposed to acoustic trauma, he should have experienced an arrest in his hearing loss. Thus, since there was no acceleration in his hearing loss and it continued after discharge, it is less likely than not that his hearing loss was aggravated by service. This opinion supports a finding that the presumption of soundness is not rebutted with respect to the Veteran's hearing loss. The examiner also provided an addendum in August 2020. The examiner noted again that the Veteran did not have a congenital defect because a defect would have been visible on an MRI. Thus, since there was no structural abnormalities noted and that the Veteran had 2 relatives with early onset hearing loss, an inherited form of hearing loss is the most likely etiology. Here, the specific genetic mutation that caused hearing loss is unknown, but given the Veteran's rapid hearing loss, including after removal from excessive noise, indicates an underlying condition. The examiner notes that if the Veteran's hearing loss was from acoustic trauma when the noise was removed his hearing loss would have stabilized. The examiner notes, however, that "given his genetic predisposition for hearing loss and the noise he was exposed to, it is at least as likely as not that his condition worsened beyond its natural progression to some extent as a result of military service." The examiner also specifically noted the conflicting opinions of the March 2013 VA examination and December 2014 examination and agreed with the March 2013 opinion that the Veteran's hearing loss was likely attributed to genetics. The examiner provided another addendum in September 2020 to clarify his conflicting February 2020 and August 2020 opinions. The examiner noted that the Veteran's inherited hearing loss developed at an early age. He then had 3 months of active duty service with conceded excessive noise exposure. The Veteran's bilateral hearing loss continued to progress in the absence of any military noise. The examiner noted that the "likelihood he was able to develop this severe of hearing loss over 3 months in the service during training is essentially impossible." Consequently, the examiner concluded that the fact the Veteran's hearing loss progressed without further exposure to excessive noise indicates that his hearing loss was caused by his genetic predisposition and his military service. Analysis The evidence fails does not show that the Veteran has a congenital defect. The Board acknowledges that evidence shows that the Veteran's bilateral hearing loss has a genetic component. However, the February 2020 examiner stated and further clarified in an August 2020 addendum opinion, that the Veteran's bilateral hearing loss was not a congenital defect because there was no evidence of structural abnormality. The Board finds that the presumption of soundness is not rebutted with respect to the Veteran's hearing loss. There was clear and unmistakable evidence that the Veteran's hearing loss existed prior to service. While the Veteran's entrance examination showed some evidence of hearing loss, he did not meet the criteria for VA hearing loss. However, the February 2020 VA examiner opined that the Veteran's bilateral hearing loss clearly and unmistakably existed prior to service. The examiner noted the entrance examination as well as noting the Veteran's likely genetic etiology of his hearing loss based on his relatives that also had early onset hearing loss. Nevertheless, in the February 2020 and subsequent addendum opinions, the examiner concluded that the Veteran's bilateral hearing loss was not aggravated by his in-service noise exposure. The examiner consistently noted that because the Veteran's bilateral hearing loss worsened even after he was no longer exposed to excessive noise. Furthermore, the examiner opined that the severity of hearing loss experienced by the Veteran over his time in service was unlikely caused by his in-service exposure. Accordingly, the examiner opined that the increase in the Veteran's disability was caused by his genetic predisposition to bilateral hearing loss. VA opinions from March 2013, February 2020, and August attributed his bilateral hearing loss to a genetic predisposition and they persuasively support their statements by citing to the rapidity of the worsening of hearing loss even after removal from noise exposure. The opinions also noted that if his hearing loss had been due to noise exposure, it would have stabilized after the noise was removed. The Board affords the VA opinions high probative value and concludes that the preponderance of the evidence provides competent evidence that the Veteran's hearing loss was not due to service. The Board also acknowledges the multiple opinions of record concerning direct service connection. As noted above, the Veteran's in-service noise exposure was conceded. The preponderance of probative evidence is against the Veteran's claim that his in-service noise exposure caused his bilateral hearing loss. Multiple opinions in the record attribute his hearing loss to a genetic cause, unrelated to service. While the Veteran's lay statements were considered, the probative evidence of record was against his lay statements. Thus, the Board finds that direct service connection is also not warranted. Lastly, presumptive service connection for hearing loss as a chronic disease under the provisions of 38 C.F.R. § 3.309(a) is not warranted because the hearing loss did not manifest to a compensable degree within one year of separation from service. 2. Psychiatric Disorder Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disability or injury. 38 C.F.R. § 3.310(a) (2020). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(a) (2020); Allen v. Brown, 7 Vet. App. 439, 448 (1995). To establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Facts In a June 1990 examination, the Veteran reported frequent trouble sleeping and depression. In a lay statement the Veteran stated that his hearing loss caused his depression. Additionally, at his Board hearing he testified to attacks on his military base shortly after basic training and he began to experience hallucinations. He also testified that his depression may be due to his nonservice-connected sleep apnea and hearing loss. The Veteran's spouse also testified that he has struggled with psychiatric issues since she has known him. The Veteran received a VA examination in August 2019 and was diagnosed with adjustment disorder with mixed anxiety and depression. The examiner found the Veteran to be a marginally reliable historian and that he was vague or inconsistent with his expected symptoms. The examiner concluded that his symptoms failed to meet the criteria for posttraumatic stress disorder (PTSD). The data does not support the Veteran's contention that he had a psychiatric disorder at the time of service and his symptoms appeared related to his current life stressors. Accordingly, the examiner concluded his psychiatric issues were not related to service. In its most recent remand, the Board found that this opinion was inadequate because its rationale was insufficient. For this reason, an addendum opinion was required. In a February 2020 VA opinion, the examiner determined that the Veteran's psychiatric disability was not caused or aggravated by his service-connected pes planus. The examiner explained that there were not any medical records to show that pes planus with degenerative arthritis caused or aggravated his anxiety. The examiner explained that the Veteran's assertion was that his psychiatric disorder was due to things that happened to him in service. In an August 2020 addendum, the examiner considered all his lay statements in forming her nexus opinion. She noted that the Veteran's reported stressors were vague, and that the evidence did not show that he was diagnosed with any mental health condition due to the stressors. The examiner noted that the Veteran's psychiatric disability was caused by situational life stressors, specifically his divorce, and was not due to his service-connected pes planus. Regarding aggravation, she noted that there were circumstances of life stressors which caused a mood reaction, and these were identified by the medical record and occurred after service. In support of her conclusion that the Veteran's psychiatric disability was not aggravated, she stated that the record showed periods of time where the Veteran had not been diagnosed with any mood problems. Thus, his disability was not proximately due to or aggravated by his pes planus. The examiner noted that the Veteran's medical records failed to provide evidence "from a medical professional to equate any symptoms of depression and anxiety to his flat feet disability." In a February 2021 addendum, the examiner reiterated her agreement with the August 2019 examiner's conclusion that the Veteran's psychiatric disability was not due to service. The examiner noted the Veteran's service record provided no evidence of any psychiatric issues and there were no "extensive circumstances that occurred during service that resulted in mood issues." The preponderance of the evidence is against find that the Veteran's acquired psychiatric disability was caused by any in-service event or secondary to his other service-connected disabilities. The Board notes the Veteran's lay statements concerning his various in-service incidents were considered by the VA examiners. However, multiple VA examiners noted that the Veteran attributed his psychiatric issues to situational life stressors and not any in service incidents. The examiners also noted the lack of in service treatment for any psychiatric conditions or treatment. Accordingly, the Board finds the preponderance of the probative evidence is against of finding of direct service connection for the Veteran's psychiatric disability. Furthermore, in a February 2020 VA opinion and subsequent addendum opinions, the examiner concluded that his psychiatric disability was not caused by or aggravated by his service-connected pes planus. The examiner also consistently noted that the Veteran's psychiatric conditions were linked to his situational life stressors. The Veteran's lay statements were considered, but the preponderance of the evidence failed to show that his psychiatric disability was secondary to his service-connected disability. Consequently, secondary service connection for the Veteran's psychiatric disability is not warranted. The Board notes the opinions of record linking the Veteran's psychiatric condition to his sleep apnea and headaches; however, these disabilities were found to not be related to his service. 3. Headaches In a June 1990 examination the Veteran reported suffering a head injury but noted "don't know" for frequent or severe headaches. In lay statements the Veteran relates his headaches to his service-connected tinnitus and his nonservice-connected sleep apnea. At his Board hearing, the Veteran testified that he started experiencing headaches right after basic training. He attributes his headaches to his depression, stress, anxiety, and hearing loss. His wife also testified that when they met in 1994, he complained about headaches. The Veteran received a VA examination in September 2019. The examiner noted there was nothing in his service records documenting treatment or complaints for headaches. The examiner noted the Veteran's response of "don't know" as to having frequent or severe headaches on his July 1990 examination. Accordingly, the examiner concluded that the Veteran's headaches were less likely caused by service. In a September 2020 opinion, the examiner stated that based on a review of the record there was no relationship between the Veteran's headaches and service. The examiner opined that there was no evidence to support any evaluation, diagnoses, or treatment to link his headaches to service. (Continued on the next page) The Board finds that the preponderance of the evidence is against of finding of service connection for the Veteran's headache disability. The Board finds the September 2020 VA examiner provided competent, credible evidence against the Veteran's claim. The examiner based their review on the entire record, including the Veteran's lay statements concerning his headaches in service and shortly after service. While the lay statements are considered, the VA opinion is afforded higher probative value, as the Veteran has not been shown to have the requisite knowledge to provide an etiological opinion. Therefore, the Board finds that service connection for a headache disability is not warranted. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Brunot, 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.