Citation Nr: 21031961 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 17-16 405 DATE: May 25, 2021 ORDER Entitlement to service connection for a headache disability is denied. FINDING OF FACT A headache disability was not manifest in service and is not otherwise attributable to service. The Veteran does not have a medically unexplained multisystem illness. CONCLUSION OF LAW A headache disability was not incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1112, 1113, 1117, 1118; 38 C.F.R. §§ 3.303, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1989 to February 1993. This matter was previously before the Board in March 2019. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In a June 2020 memorandum decision, the Court remanded the case to the Board. The Board remanded for additional development in January 2021. The directives having been substantially complied with, the matter again is before the Board. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a headache disability The Veteran seeks service connection for a headache disability. To establish service connection a Veteran must generally show: "(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). Service connection may also 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). Service connection may be established for a chronic disability manifested by certain signs or symptoms which became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more not later than December 31, 2021, and which, by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a)(1). Consideration of a Veteran's claim under this regulation does not preclude consideration of entitlement to service connection on a direct basis. A qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): an undiagnosed illness; the following medically unexplained chronic multi symptom illnesses that are defined by a cluster of signs or symptoms: (1) Chronic fatigue syndrome; (2) Fibromyalgia; (3) Functional gastrointestinal disorders; or (4) Any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multi symptom illness; or any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service-connection. 38 C.F.R. § 3.317 (a). Medical records show that the Veteran has a current chronic headache disability. Service treatment records show complaints of headaches in March 1990 and May 1992. The Veteran denied frequent or severe headaches at separation. In November 2012, the Veteran received a VA examination. The examiner opined that the Veteran's headaches were less likely as not incurred in or caused by the in-service event on March 1990 and May 1992. The examiner noted the opinion was based on review of medical literature, medical records, and clinical experience. The examiner rationalized that the evidence does not provide any history of chronic headaches during active duty, and that the Veteran only complained of headaches twice in service and it was two years apart. The examiner further stated that the Veteran's separation examination was silent for any complaints of headaches. The examiner stated a nexus cannot be made. The Board notes that VA treatment records show the Veteran denied any headaches in July 2008. Further, during a May 2012 visit, the Veteran stated that his current headaches were from a head injury in March 2012. VA treatment records have consistently noted his headaches as due to his previous head injury since May 2012. Another VA opinion was obtained in March 2021. The examiner opined that the Veteran's headaches were less likely than not related to his service, to include exposures in Southwest Asia. The rationale for this was that the Veteran's separation examination, as well as post-service examinations, did not contain record of headaches. This indicates that the in-service headaches in 1990 were acute and self-limited. The headaches in 1992 were related to an ophthalmic condition, which was likewise acute and resolved. Further, the examiner indicated that the Veteran's current headaches are a single symptom with a partially explained etiology (tension headaches due to dysfunction at the neuromuscular junction). The Board finds that the preponderance of the evidence is against a finding that the Veteran has an undiagnosed illness or medically unexplained multisymptom illness. While he has reported headaches, there are no additional symptoms, and the headaches themselves are not unexplained. In reaching this finding, the Board gives greater probative weight to the competent medical evidence of record than to the Veteran's reports. While competent to attest to lay-observable symptomatology, he is not competent to diagnose this disorder. Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The issue is medically complex, as it requires specialized medical education and knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board acknowledges the Veteran's assertions that his headaches are related to service, specifically his in-service complaints of headaches in March 1990 and May 1992. The Board also recognizes that lay persons are competent to provide medical opinions on some medical issues. However, although the Veteran is competent to report his symptoms, any opinion regarding whether any headache disability is related to his service, to include his in-service complaints, requires medical expertise that the Veteran has not demonstrated since headaches can have many causes. Further, the Veteran's statements that his headaches are due to his active duty service are inconsistent with what the Veteran reported in May 2012, stating his headaches stem from an assault head injury in March 2012. In light of the foregoing, the Board concludes that the preponderance of evidence is against the claim and the benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). H. N. SCHWARTZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Creegan 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.