Citation Nr: 22013487 Decision Date: 03/09/22 Archive Date: 03/09/22 DOCKET NO. 17-00 791 DATE: March 9, 2022 ORDER Service connection for migraine headaches is denied. Service connection for an acquired psychiatric disorder to include adjustment disorder with anxiety and depressed mood is denied. FINDINGS OF FACT 1. The evidence shows that it is less likely than not (less than 50 percent probably) that the Veteran's migraine headaches are etiologically related to her service. 2. The evidence shows that it is less likely than not (less than 50 percent probably) that the Veteran has an acquired psychiatric disability that began in or was otherwise caused by her military service. CONCLUSIONS OF LAW 1. The criteria for service connection for migraine headaches have not been met. 38 U.S.C. §§ 1131, 5107; 38C.F.R. §§3.102, 3.303, 3.304, 3.307, 3.309. 2. The criteria for service connection for an acquired psychiatric disability have not been met. 38 U.S.C. §§ 1131, 5107; 38C.F.R. §§3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June 1978 to July 1979. She is seeking service connection for headaches and depression, which she contends began during service. A September 2021 Board decision remanded the issues for further development, to include obtaining additional VA treatment records and conducting VA examinations to determine the current diagnoses of the Veteran's headaches and psychiatric disorder and their etiologies. Such developments have been completed. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38U.S.C. § 1131; 38C.F.R. § 3.303. 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 (nexus). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established with certain chronic diseases based upon a legal presumption by showing that the disease manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. 38U.S.C. §§ 1101, 1112, 1113, 1137; 38C.F.R. §§3.307, 3.309(a). In addition, service connection may also be established under 38 C.F.R. § 3.303(b), where a symptom of a chronic disease is noted in service without diagnosis in service or within one year from service, but chronicity is established by continuity of symptomatology after service. This is an alternative way to establish service connection for the specific chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). Migraine headaches Service treatment records (STRs) in April 1979 show that the Veteran was seen for headaches and running nose, and the assessment at that time was mild influenza. On her report of medical history at the time of separation, she denied frequent or severe headaches, but reported ENT problems and several other conditions. A VA examination in September 2021 indicated that the Veteran was diagnosed with migraine/sinus headache in 1978. The Veteran reported that her migraines started in around 1978, while she was in service, that she had both migraine and sinus issues, and that she continued to have headaches and took over-the-counter analgesics along with medications for sinusitis. (Of note, the Veteran is service connected for allergic rhinitis and sinusitis.) The examiner opined that it was less likely than not (less than 50 percent probability) that the Veteran's headaches were etiologically related to her service. The examiner explained that although STRs show that the Veteran complained of headaches in April 1979, she was diagnosed with mild influenza at that time, which was an acute viral illness. Given that such a viral illness caused the body's immune system to increase mucus production as part of the body's natural defense, sinus congestion and thus headache were common symptoms and complaints, but would resolve once the mild influenza event also resolved. The examiner indicated that the Veteran otherwise did not have other record of treatment or complaint of headaches during active duty period, that although VA treatment records in 2005 noted that she has a history of migraine, this was 26 some years following her military separation and thus a nexus between her current migraines and active duty could not be established. The Board gives great probative value to the September 2021 VA opinion, which is supported by medical records and sound rationales, and has not been contradicted or undermined by other medical opinions. While the Veteran reported in her September 2021 VA examination that her headaches began during service and continued after service, review of medical treatment records shows lack of treatment for her headaches as a stand-alone condition, and that her headaches are usually documented in the process of seeking treatment for other medical conditions. For example, STRs show that the Veteran's headaches were noted as symptoms of her influenza. VA treatment records show that in April 2005, she was seen for neck pain, and was noted that she had history of headaches. In November 2017, the Veteran complained of headaches associated with chest congestion and viral infection, in December 2018, she was seen for diabetes management and complained about medication which gave her headaches. In addition, evidence has shown that the Veteran repeatedly denied having experienced headaches during various time periods. For example, she denied having frequent or severe headaches at the time of separation, while reporting other medical conditions such as ENT problems. VA treatment records show that she denied having experienced headaches in November 2017, November 2018, November 2019, October 2020, and March 2021. As such, evidence does not show that the Veteran has a chronic condition of migraine headaches which began during service and continued since. Chronicity of headaches has not been established by continuity of symptomatology. Accordingly, service connection for headaches is denied. Acquired psychiatric disability The Veteran is seeking service connection for an acquired psychiatric disorder, to include depression which she contends began during service. STRs do not show any treatment for or diagnosis of depression. However, on her report of medical history at the time of separation, she reported having, or having experienced, depression. Nevertheless, VA treatment records in February 2003, March 2005, December 2015 and September 2016 showed negative depression screens. Moreover, the Veteran has denied seeking any mental health treatment for decades after separating from service. A VA examination in October 2021 diagnosed the Veteran with adjustment disorder with mixed anxiety and depressed mood. However, the examiner cautioned that even to the extent that a mental condition had been formally diagnosed, the symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. The Veteran reported that she had been sexually harassed during service. Specifically, she alleged that her supervisors' remarks had made her uncomfortable and she reported being physically touched but denied ever reporting it. She indicated that she had learned to stay away from them. There was no indication in the examination report that such incidents continued to bother the Veteran, and such incidents do not appear to have been described at any other time. The Veteran reported that she started going to VA mental health approximately three years earlier (about 2018). The examiner reviewed the Veteran's claims file and opined that the Veteran's psychiatric disorder was less likely than not (less than 50 percent probability) related to her service. The examiner explained that the medical records showed that the Veteran's current stressors were from her family, in that she was stressed and overwhelmed by being the primary care-giver for her family, that included her son and her grandchildren. None of the current stressors involve the military. VA treatment records in November 2018 showed that the Veteran was first diagnosed with adjustment disorder with depressed features by a social worker, who noted that the Veteran had mild depressive symptom related to situational distress and frustration of her children and family members. She reported at that time that her 39 year old son was as the source of distress, and that she took care of everyone except for herself. Records in December 2018 showed that the Veteran attended mental health group consulting. Records in October 2019 showed that the Veteran stated that she did not feel she need any further behavioral health treatment. The Veteran denied sexual assault/trauma in May 2018, July 2019 and November 2020. Here, the VA examination report makes it clear that the currently diagnosed acquired psychiatric disability is the result of the Veteran's life stressors, and not her military service. The opinion was well-reasoned and demonstrated a clear understanding of the facts surrounding the Veteran's case. The Veteran has testified that she thinks her condition might be the result of service, but she lacks the medical training or expertise to make such a link. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). For that reason, a VA examination was obtained to have an expert medical professional address the etiology of the Veteran's acquired psychiatric disability. As laid out above, the medical professional explained why it was less likely than not that the Veteran's acquired psychiatric disability either began in or was otherwise caused by the Veteran's active military service. This is the most probative evidence of record and when the evidence is weighed, it persuasively favors the conclusion that the Veteran's acquired psychiatric disability is not the result of her military service. Accordingly, the claim is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Wang, 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.