Citation Nr: 21030959 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 14-41 563 DATE: May 20, 2021 ORDER Entitlement to service connection for headaches, to include as secondary to service-connected tinnitus, is denied. FINDING OF FACT The Veteran's headaches are not secondary to service-connected tinnitus and are not otherwise related to an in-service injury, disease, or event. CONCLUSION OF LAW The criteria for service connection for headaches due to service or service-connected tinnitus are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from April 1970 to January 1972. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in August 2018 and August 2020, at which time the appeal was remanded for additional development. The case has now been returned to the Board for further appellate action. 1. Entitlement to service connection for headaches, to include as secondary to service-connected tinnitus. Service connection may be granted for a disability resulting from disease or injury incurred or aggravated during active service. 38 U.S.C. § 1110. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Without evidence of disease or injury during service, service connection may still be granted if all of the evidence, including that pertinent to service, establishes that the disability was incurred in service. See 38 C.F.R. § 3.303(d). Additionally, a disability which is proximately due to or the result of a service-connected disease or injury shall be service connected (except as provided in § 3.300(c)) and any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. 38 C.F.R. § 3.310. The Veteran asserts that he has experienced headaches since service and that he has headaches at least 14 to 20 times per month because of his service-connected tinnitus. As evidence in support of this claim, he has submitted printouts of websites stating, inter alia, that headaches and tinnitus often occur simultaneously, but that headaches accompanied by tinnitus can have many contributory causes or at least be associated with several other conditions, including physical injury, sinus infection/lesions, other infections, hypertension, brain tumors, strokes, certain drugs/medications, and anxiety about tinnitus, among other conditions. The Board notes at the outset, however, that while the Veteran is competent to report symptoms that he has observed, he is not competent to opine on the etiology of his headaches. The issue of the etiology of headaches is medically complex, and a competent opinion as to etiology of headaches requires medical training and credentials. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds that the Veteran's statements that he's had headaches since service not credible. His service treatment records (STRs) do not evidence any complaints, treatment, or diagnosis of chronic headaches or a related condition, despite showing that he received treatment for other acute conditions, namely, a right ankle sprain. The report of his separation examination reflects a normal head, ears, and neurologic clinical evaluation. The initial postservice documentation of complaints, treatment, or diagnosis of headaches was not until June 2008 (more than 35 years after his separation from service), when private treatment records from Dr. M.E. note the history of present illness/chief complaint as "Follow up having 3 weeks headaches and BP around 170/100." Notably, the Veteran had been treated for multiple other medical conditions prior to that, including high blood pressure, coronary artery disease (with a stent being put in 2005), chronic renal impairment, and gout. Although the Veteran asserts that he has experienced headaches that increased in severity since service, he says that he never reported them to his primary physician for over 40 years because he "feared going to a doctor because of the numerous tests they put you through and still can't diagnose the problem." However, according to his statements, he eventually did go to a doctor to have testing completed, and according to him, the results of a "cat" scan of his head, carotid doppler test, and urinalysis were normal. The Veteran also stated that one of his physicians told him that his headaches were not caused by his blood pressure. The results of the aforementioned tests are in the claims file, and they do not evidence any nexus between the Veteran's headaches and any service-connected condition or the Veteran's active service. Further, there are no medical treatment records or other competent medical evidence in the claims file that evidence any such nexus (including the incurrence of headaches during the Veteran's active service). It is reasonable to believe that if the Veteran had been experiencing chronic headaches prior to June 2008, he would have reported such to his treating physician in the course of receiving cardiac treatment at that time. Notations of headaches appear more regularly in his treatment records in 2013, around the time that the Veteran filed his claim for service connection for headaches. Significantly, notations in the treatment records up to that point do not associate or link his reports of headaches to tinnitus. Moreover, the October 2012 VA audiological examination report does not note complaints of headaches in relation to his tinnitus, only difficulty understanding people when they are talking. It is reasonable to expect that the Veteran would have also reported a history of headaches during that examination if he had a history of chronic headaches that he related to his tinnitus. In weighing credibility, VA may consider inconsistent statements, self-interest, consistency with other evidence of record, and desire for monetary gain. Caluza v. Brown, 7 Vet. App. 498. As the Veteran's more recent statements indicating that his headaches began in service and have persisted since are inconsistent with the other evidence of record, including his service and private treatment records and the VA audiological examination report, the Board finds his more recent statements not credible. Therefore, it is not shown that his headaches manifested in service, and service connection for headaches on the basis that they became manifest in service and persisted is not warranted. The competent and credible evidence that addresses the matter of a nexus between the Veteran's headaches and his service or his service-connected tinnitus is in the December 2020 VA examiner's opinion. After examination of the Veteran and review of the claims file, the examiner opined that the Veteran's headaches are less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected tinnitus. The examiner's opinion also reflects that the Veteran's headaches are less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner's rationale was essentially that the Veteran did not complain of headaches prior to or during his active service; that his complaint of headache in 2008 is likely related to high blood pressure; that review of medical article submitted by the Veteran mentions multiple causes of headaches (including hypertension, any rupture or pressure on carotid or vertebral arteries, and anxiety about tinnitus), but the Veteran's claims file does not support any of the causes mentioned, as he had a negative CT and carotid ultrasound demonstrated grade 1 stenosis; and that a review of medical literature does not support tinnitus as a cause of headache. Considering the evidence in the claims file, including but not limited to that discussed above, the Board finds the December 2020 VA examiner's opinion is the most probative evidence of record on the issue of the etiology of the Veteran's headaches. The Board is entitled to assume the competence of a VA examiner, and here, it has determined that it is appropriate to do so. See, generally, Cox v. Nicholson, 20 Vet. App. 563, 569 (2007). Considering the opinion of the presumably competent examiner that provided that opinion, and the Board's findings regarding the Veteran's credibility, as discussed above, the Board finds that the preponderance of the evidence weighs against this claim. The VA examiner was not only competent, but they also supported their opinions with a well-reasoned rationale citing the Veteran's medical records and the test results contained therein. Thus, here, there is competent and credible evidence weighing against this claim, in the form of the VA examiner's opinion, an absence of any competent medical evidence showing causation of headaches by tinnitus or in-service incurrence and persistence since, and only the Veteran's inconsistent and incredible reports, decades later, of tinnitus beginning during service. The Board finds that the evidence weighing against this claim, namely, the December 2020 VA examiner's opinion, is more probative than the evidence weighing in favor of this claim. Accordingly, entitlement to service connection for headaches, to include as secondary to service-connected tinnitus, is denied. (Continued on the next page) In denying this claim, the Board finds that the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. T. V. CASEY Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Banks, 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.