Citation Nr: 21031511 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 14-10 911A DATE: May 24, 2021 ORDER Entitlement to service connection for migraine headaches, as a residual of an in-service head injury, is granted. Entitlement to service connection for residuals of an in-service head injury other than migraine headaches, to include a stroke, residuals of a stroke, or other head and facial injuries, is denied. FINDINGS OF FACT 1. The evidence is in relative equipoise as to whether the Veteran's migraine headaches are a result of an in-service injury. 2. The preponderance of the evidence is against finding that the Veteran has residuals of a head injury other than migraine headaches, to include stroke, residuals of a stroke, or any head or facial injuries or contusions. CONCLUSIONS OF LAW 1. Resolving doubt in the Veteran's favor, the criteria for service connection for migraine headaches are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for residuals of an in-service head injury other than migraine headaches, to include a stroke, residuals of a stroke, or any head or facial injuries or contusions, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 1963 to July 1965. These matters come before the Board of Veterans' Appeals (Board) on appeal from September 2011 rating decision issued by the Department of Veterans Affairs regional office (RO) in Montgomery, Alabama. The Veteran testified before the Board at an April 2017 hearing. A transcript of the hearing has been associated with the claims file. The Board notes that the Veteran's representative, Military Order of the Purple Heart withdrew its representation in September 2019 due to the closure of its offices. The Veteran has neither requested nor secured new representation since that time, and therefore the Board finds that it may proceed with adjudication. Service Connection Initially, the Board notes that this appeal has been adjudicated as two separate service-connection claimsone for head and facial injuries, and one for a stroke to include as secondary to head and facial injuries. Both claims stem from the same reported incident in service, and all the symptoms noted through the appeal period stem, in the Veteran's view, from that incident. In an August 2017 Remand, the Board requested that the Veteran undergo a traumatic brain injury (TBI) examination to determine all current diagnoses relating to the Veteran's reported in-service injury. Based on the VA TBI examination, the Veteran was then afforded VA scars and headaches examinations. At all examinations, he has reported similar symptomatology that he believes is connected to having landed wrong after a parachute jump in service. The scope of a claim includes any disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Accordingly, and for clarity, the Board has recharacterized the claim, as reflected on the title page, as one for any residuals of an in-service head injury. As discussed below, the Board is able to award service connection for migraine headaches as due to this in-service head injury. However, the evidence does not show the presence of other related residuals. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) 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); see also Caluza v. Brown, 7 Vet. App. 498 (1995). As noted, the Veteran asserts that he suffers several residuals from the same in-service injury. Specifically, he has testified that while in jump school in service, he got tied up with another jumper which caused his chute to totally collapse. The two men fell quickly to the ground. In August 2010, the Veteran stated that after his accident, his sliced nose healed in two months, but he had a headache that lingered for several days and reoccurred for 18 years following the accident. He states that after the accident in service, he experienced difficulty with reading, writing, and sustaining conversations, as well as short-term memory loss. The Veteran's primary contention is that as a result of his parachute jump accident in service, his brain hit the inside of his skull, causing contusions which later developed into minor strokes that caused minor damage to the brain each time and gradually the symptoms grew worse (i.e., causing severe headaches, confusion, sleepiness, impaired memory, slurred speech, and irritability) and eventually caused a major stroke in August 1982, and a subsequent stroke in 2015. In connection with his claim for service connection, he submitted a statement describing his injury, and his brother submitted a statement indicating that he noticed differences in the Veteran's mental condition upon his return from service. See August 2010 statements. A statement from a fellow serviceman was submitted in March 2011; therein, W.H. wrote that he witnessed the Veteran's involvement in a military parachute accident in early February 1964. He saw two jumpers falling towards the ground suspended by a single parachute. He observed that the Veteran's nose was bleeding, and that the Veteran was complaining of head pain. In a September 2011 Notice of Disagreement, the Veteran noted that he was not treated in service for the condition. A May 2014 VA treatment note reflects that the Veteran reported to a VA staff internist that he had a parachuting accident in February 1964. At his April 2017 Board hearing, the Veteran described the parachute accident but noted that he did not seek treatment because there was a stigma associated with going to sick call, but that he believed the fall contributed to his strokes and that he had experienced headaches since service. He underwent a VA Central Nervous System (CNS) and Neuromuscular Disease examination in December 2017, and the examiner noted that the Veteran had experienced a cerebral vascular accident in 1982. The Veteran explained the in-service parachute accident to the examiner, and reported current symptoms of hearing impairment, right-sided paralysis, loss of mobility, difficulty swallowing, and occasional headaches. In a corresponding medical opinion, the VA examiner opined that it was less likely that the head injury sustained in service was connected to the 1982 stroke. The rationale was based on a review of the 1982 hospital records at the time of the stroke, which showed a normal CT of the brain with no acute or chronic finding, which, in the examiner's view, ruled out a chronic brain injury due to injury. The Veteran submitted a statement in February 2018 in which he noted that he told the treating doctors at the time of his stroke in 1982 about the parachute jumping injury, but they told him that there was no way the fall in service caused his strokes. The Veteran underwent additional examinations in August 2019. At another CNS examination, the examiner noted a diagnosis of right-sided weakness status post stroke. The Veteran underwent a cranial nerves diseases examination, but no cranial nerve conditions were identified or diagnosed. Similarly, he underwent a TBI examination, but the examiner noted that the Veteran did not suffer from a current TBI. In a corresponding medical opinion, a VA examiner wrote that it was very rare for head injuries to cause bleeding inside the skull days and weeks after the initial impact. The examiner further noted that the Veteran's contentions were not medically sound, insofar as he had several other risk factors for his stroke, and that it was very unlikely for mild TBIs to cause embolic strokes. The examiner wrote that there was no medical literature supporting a theory that a mild TBI would cause a stroke 18 years later. At an August 2019 scars examination, the examiner did not find any scars located anywhere on the Veteran's body, to include his head, face, or neck. The Veteran himself told the examiner that the claimed condition had not resulted in any scars. There were no findings, signs, or symptoms to support a diagnosis. The Veteran underwent a headaches examination after reporting that he experienced headaches at his TBI examination. The examiner noted a diagnosis of migraine headaches but did not offer a medical opinion. However, because the record showed that the Veteran had reported experiencing headaches after the parachute incident and prior to his 1982 stroke, the agency of original jurisdiction (AOJ) requested an addendum medical opinion, which was obtained in July 2020. The examiner noted a review of all the evidence to include the Veteran's contentions as to the onset of his headaches. The examiner noted that there was peer-reviewed medical evidence supporting causation between that of headaches post-head injury. The examiner opined that it was at least as likely as not that the Veteran's diagnosed headaches were caused by, or related to, the Veteran's reported in-service head injury. Despite receiving that opinion, the AOJ requested another opinion, based on conflicting evidencenamely, that the Veteran did not endorse headaches at his TBI examination. An addendum opinion was received in August 2020. The examiner reviewed the relevant evidence and opined that migraine headaches were less likely as not related to the reported in-service injury. The rationale was that there was no documented evidence of a head injury stemming from the parachute jump which could plausibly form a basis for chronic headaches, and that therefore, the prior, July 2020 VA opinion was insufficient as the basis for the rationale was not supported by any objective evidence of a head injury. The examiner added that headache was a common symptom associated with a stroke. 1. Service connection for migraine headaches. Initially, the Board notes that the Veteran's original claim was for a stroke, or residuals thereof. The Board, in this decision, has recharacterized the Veteran's claim as that of one for any residuals of an in-service head injury. After a review of the foregoing evidence, and after resolving all doubt in favor of the Veteran, the Board concludes that service connection for migraine headaches is warranted. Initially, the evidence shows a diagnosis of migraine headaches. The two nexus opinionsobtained in July 2020 and August 2020are in conflict because the July 2020 examiner accepted the Veteran's lay assertion of having sustained an injury after a parachute jump in service as true, and the August 2020 VA examiner based the opinion on the premise that the parachute accident did not occur because there was no documentation of such in service. The Board notes that the Veteran has explained that he did not seek medical treatment in service because there was some level of stigma attached with going to sick call. As noted in the Board's August 2017 Remand, it has accepted the Veteran's reports of his in-service injury as credible. It continues to do so. Given the foregoing, the Board finds that, in this case, the evidence both for and against an award of service connection for migraine headaches is at the very least in equipoise. Given that (1) the Board has accepted the Veteran's reports of his in-service injury as credible and has accepted the Veteran's statements that he did not seek medical treatment in service; (2) in August 2010 and in April 2017, the Veteran stated that after the accident, his headache lingered for several days and reoccurred for 18 years after the accident; and (3) a VA examiner has opined that, accepting the Veteran's reports of the in-service head injury as true, it is more likely than not that his migraine headaches are related to such injury, the Board will resolve all doubt in the Veteran's favor and find that the criteria for service connection for migraine headaches has been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The benefit sought is granted. 2. Service connection for residuals of an in-service head injury other than migraine headaches, to include a stroke, stroke residuals, or other head and/or facial injuries. Notwithstanding a finding that service connection is warranted for migraine headaches as due to the Veteran's claimed in-service injury, the Board must conclude that service connection for head injury residuals other than migraine headaches, to include a stroke, residuals of a stroke, or other head and facial injuries, is not warranted. Initially, to the extent the Veteran's claim included a claim for physical facial contusions, as he reported at his December 2017 VA examination that in crashing to the ground after the jump, the metal plate in his helmet slammed down on the top of his head leaving a deep scrape over his nose, the Board must conclude that the Veteran does not have any scars, contusions, or other head or facial injuries and has not had such at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Moreover, the evidence of record does not show that the Veteran has experienced any manifestations of the condition productive of a functional impairment in earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In this regard, it was noted at a July 2019 VA scars examination that the Veteran did have any findings, signs, or symptoms to support any diagnosis of head or face injuries or scars. The Board adds that in an August 2010 statement in support of his claim, the Veteran described in great detail the parachute jump in service and his explanation of why he believed it caused his later strokes. Notably, he did not describe any physical contusions or scars of the head or face. At his April 2017 Board hearing, the Veteran described why he believed his parachute jump contributed to his later strokes, but did not discuss any physical head or face contusions or injuries. As noted above, the July 2019 examiner found no scars located anywhere on the Veteran's body, to include his head, face, or neck, and the Veteran himself told the examiner that the claimed condition did not result in scars. There were no findings, signs, or symptoms to support a finding of disability. Thus, the evidence does not support a finding that the Veteran suffers from a physical head or facial injury, manifesting in scars, disfigurement or contusions. The Veteran's primary contention is that the parachute jump injury caused his later strokes, occurring in 1982 and 2015. The Board concludes that, while the Veteran has experienced strokes, in 1982 and in 2015, and while the Board has accepted as true the Veteran's reports of his in-service injury, the preponderance of the evidence weighs against finding that the Veteran's stroke conditions began during service or are otherwise related to an in-service injury. As noted above, two examiners have opined against a relationship between the Veteran's in-service injury and later strokes. Indeed, the December 2017 examiner noted that the presence of a normal CT brain scan in 1982 was evidence that ruled out a chronic brain injury due to injury. And an August 2019 examiner opined that the Veteran's contentions as to onset were not medically sound, as he had other risk factors for his stroke and that medical literature did not support a theory that a head injury would cause a stroke 18 years later. Taken together, the Board finds the December 2017 and August 2019 VA opinions to be probative, as they reflected consideration of the Veteran's assertions as to his injury, were based on an accurate medical history, and provided explanations containing clear conclusions and supporting rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Notably, there is no other medical opinion evidence of record. The Board has considered the article submitted by the Veteran which discusses the incidences of brain deterioration in football players. The Board finds the medical opinions described above to be more probative in answering the question of whether this Veteran's in-service head injury played a causative role in his post-service strokes, as they are based on the Veteran's own unique medical presentation and history. While the Veteran is competent to report his own observable symptoms, he is not competent to offer a medical nexus statement in this case, as attributing his 1982 stroke to a 1964 head injury is a medically complex issue requiring specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). While the Board acknowledges the Veteran's brother's observation that the Veteran appeared to be less "mentally sharp" upon his discharge and return home, to include exhibiting diminished short-term memory, the Board notes that the Veteran specifically denied experiencing any memory problems or amnesia, depression or excessive worry, trouble sleeping, or any other cognitive problem on his May 1965 Report of Medical History at the time of separation, although he reported several other physical problems at the time. The Board does not afford the statement probative weight, as it is contrary to the Veteran's own contemporaneous observations and report of history. (Continued on Next Page) For these reasons, the preponderance of the evidence is against the claim of entitlement to service connection for residuals of an in-service head injury other than migraine headaches, to include a stroke, stroke residuals, or head/facial contusions or scars. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Polly Johnson, 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.