Citation Nr: 22016649 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 10-38 584 DATE: March 22, 2022 ORDER Entitlement to service connection for headaches, on a secondary basis only, is granted. FINDINGS OF FACT 1. The Veteran's headaches are not proximately due to service-connected major depressive disorder and/or foot disorder. 2. The Veteran's headaches are aggravated beyond their natural progression by his service-connected major depressive disorder with sleep impairment. CONCLUSIONS OF LAW 1. The criteria for service connection for headaches due proximately due to service-connected disease or injury are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for headaches as secondary to service-connected major depressive disorder with sleep impairment are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from January 1970 to May 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The Veteran testified before a Veterans Law Judge (VLJ) at an October 2013 Travel Board hearing. A copy of the hearing transcript is associated with the claims file. This case was most recently before the Board in March 2021, when the claim of service connection for headaches was denied on a direct basis, but was remanded with regard to service connection on a secondary basis for further development. There was substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). 1. Entitlement to service connection for headaches as secondary to service-connected major depressive disorder with sleep impairment. The Veteran asserts that his headaches are related to his service-connected disabilities, to include major depressive disorder with sleep impairment. Service connection may be granted for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). Regarding the first element, the Board finds the Veteran has a current disability. Medical records show the Veteran has a current diagnosis of headaches. Regarding the second element, the Veteran is service-connected for major depressive disorder and multiple right and left foot disabilities. See Rating Decision Codesheet (May 2021). Regarding the third element of service connection, the Board finds that the current disability of headaches is aggravated by service-connected major depressive disorder with sleep impairment. In April 2021, a VA examiner opined that it is at least as likely as not that the Veteran's headaches are aggravated beyond natural progression by his service-connected major depression with sleep impairment. The VA examiner stated that in a November 2020 VA examination report, the Veteran was noted to have been officially diagnosed with tension headaches in 2010, and that this diagnosis was subsequent to a 2009 diagnosis of major depression. Additionally, the VA examiner explained that a review of medical literature reveals that tension headaches can be aggravated by sleep difficulties and depression. The VA examiner concluded that based on the body of current medical knowledge and the evidence of record, the Veteran's headaches are aggravated beyond natural progression due to his service-connected major depression with sleep impairment. The Board notes that the evidence of record demonstrates that the Veteran's headaches are not proximately caused by his major depressive disorder and right foot injury. As noted in a prior Board remand, the 2016 and 2020 VA examination opinions were inadequate and they are not considered herein. See BVA Decision (March 2021). In April 2021, a VA examiner laid out the relevant medical and lay evidence of record, to include prior VA examinations, and medical literature. See C&P Exam (April 2021). The examiner opined that the Veteran's claimed headaches are less likely than not proximately due to or the result of the service-connected major depressive disorder and multiple bilateral foot disabilities, reasoning that medical literature indicates that the cause of headaches is currently unknown and no evidence supports that foot pain or depressive disorder can cause tension headaches. See C&P Exam (April 2021). A June 2021 VA opinion was obtained. See C&P Exam (June 2021). The examiner opined that the Veteran's headaches is less likely than not caused by the service-connected major depressive disorder, noting both medical literature and the lack of headaches in the treatment records. See C&P Exam (June 2021). The Board finds these opinions probative. The examiners reviewed the relevant evidence of record, cited to specific medical literature, and provided supporting explanations. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). Thus, service connection on this basis is not warranted. Accordingly, the Board finds that service connection for headaches is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. K. MILLIKAN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Miller, 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.