Citation Nr: 21042289 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 18-33 357 DATE: July 12, 2021 ORDER Service connection for a headache disorder is denied. FINDINGS OF FACT 1. The Veteran had active duty from April 1968 to December 1969, and from November 1970 to November 1978; he has been 100 percent disabled since May 2017 plus in receipt of special monthly compensation. 2. The Veteran was diagnosed with headaches in service but symptoms were not chronic as they resolved prior to separation, were not continuous since service, and were not shown to a compensable degree within one year of service. A current headache disorder, diagnosed as a migraine disorder with variants, is not causally or etiologically related to service and was not caused by or permanently worsened in severity by a service-connected disability. CONCLUSION OF LAW A headache disorder is not proximately due to, aggravated by, or the result of a service-connected disability, is not presumed to have been caused in service and was not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION This appeal returns to the Board following a March 2021 remand to the Regional Office (RO) for a new medical opinion. The RO substantially complied with March 2021 remand instructions. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Turning to the evidence, the first element of service connection current disability is met, as his VA and medical treatment records show diagnoses for tension headaches and a migraine disorder. This was clarified in an April 2021 VA examination, in which the diagnosis of tension headaches was associated with high blood pressure in service, and his current diagnosis for the appeal period was migraine headaches. As such, the first element is met. Next, the second element an in-service incurrence is also met, as the service treatment records (STRs) show frequent complaints of headaches beginning in 1971 until 1977. However, the separation examination in August 1978 showed that the headaches had been asymptomatic for some amount of years as he was having headaches when his blood pressure was elevated. As such, the second element is met. However, the third element a medical nexus is not met, as no medical professional has connected the current headaches with those in service. A December 2014 VA examiner did not find a current diagnosis of a headache disorder, and the associated medical opinion was premised in part on that determination. However, the April 2021 VA examiner diagnosed migraines with migraine variants, and found it was less likely than not caused by service. The examiner reasoned that the Veteran claimed tension headaches had resolved, and current findings of migraine headache were shown more than 35-years after separation from service. The examiner continued that the reported episodes of headaches during service were clearly shown to be associated symptoms of the Veteran's elevated blood pressure. The symptoms resolved as expected and without residuals after adequate treatment/management of the hypertension. There were no findings in the Veteran's medical record indicating any interval medical history with service-related headaches for over 30 years. The examiner noted the new onset of headache following a neurological event as noted during a private neurology evaluation in January 2015. It was first noted as a chronic tension headache but most recently tension headaches were not apparent. At the time of the examination, the examiner stated, it was shown that the Veteran was adequately treated with an injectable abortive medication for a diagnosis of migraine, rather than tension, headaches. The examiner concluded that there were no entries in the medical record indicating that the current headache disorder was a result of or associated with the headache symptom shown during military service more than 30 years ago. The April 2021 VA examiner's rationale was well-reasoned and supported by the record as it discussed the different diagnoses of headaches and their separate etiology. In contrast, there is no contradictory medical evidence supporting a connection between the two disabilities. A January 2015 private medical record specified that headaches began since a possible stroke in November 2014. This evidence also weighs against the appeal as it attributed headaches to a neurological disorder many years after discharge. As such, the third element is not met, and service connection on a direct basis is not supported by the evidence. The issue of secondary service connection has been raised to the record, as the evidence has shown a relationship between headaches and the Veteran's now service-connected hypertension during service. The first element of service connection on a secondary basis a current disability as well as the second element a service-connected disability are met, as he has a diagnosed headache disorder and is service connected for hypertension. However, the third element a medical nexus between the two is not met, as no medical professional has connected his current diagnosis of a migraine disorder to hypertension. Additionally, the April 2021 VA examiner specifically associated the Veteran's high blood pressure and hypertension to tension headaches in service, but as specified above, distinguished his current diagnosis as a separate migraine disorder. Further, the VA examiner reference private medical records showing that the current headache disorder was precipitated by a likely stroke many years after separation from service and connected to that nonservice-connected occurrence rather than hypertension. As such, the evidence is insufficient to show that his current migraine headache disorder was either proximately due to or aggravated by service-connected hypertension. Next, a migraine headache disorder is an organic disease of the nervous system and as such, a chronic disease under 38 C.F.R. § 3.309 and may be subject to service connection on a presumptive basis. Although the Veteran was diagnosed with tension headaches during service, the April 2021 VA examiner specifically distinguished that his diagnosis of tension headaches resolved prior to the appeal period, and that his current diagnosis of a migraine headache disorder is a separate, and distinct disorder. Additionally, the December 2014 VA examiner found that while the Veteran still experienced occasional headaches, a headache disorder had resolved at that point. Similarly, a review of VA and private medical records failed to show that a chronic migraine headache disorder developed to a compensable degree in the year following separation from service. As to continuity of symptomatology, although the Veteran testified at the November 2020 Board hearing that headaches started again six months after separation from service, and his VA medical records in 2002 and 2003 show some come complaints of headaches, there is a gap in recorded symptoms until he filed a claim in 2014. Of note, the Veteran specifically denied headaches in March, July, October, and November VA treatment notes. Additionally, January 2015 private medical records reflect he told a neurologist he had started having headaches since a potential stroke in November 2014. As the headaches from that point forward have also been characterized as attributed to a different headache disorder, the medical evidence does not support continuity of symptomatology or service connection on a presumptive basis. The Board has considered the Veteran's lay statements that that his disorder was caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Brendan A. Evans, Associate 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.