Citation Nr: 22018677 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 16-20 532 DATE: March 30, 2022 ORDER Entitlement to service connection for headaches is granted. FINDING OF FACT The Veteran's headache disability is proximately due to his service-connected hypertension. CONCLUSION OF LAW The criteria for service connection for headache disability as secondary to service-connected hypertension have been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from April 2003 to May 2003, and from July 2005 to May 2006. This matter is on appeal to the Board of Veterans' Appeals (Board) from a September 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. In September 2019, December 2020, and May 2021, the Board remanded the matter to the Agency of Original Jurisdiction (AOJ) for additional development, and it has since returned for final adjudication. In the May 2021 remand, the Board instructed the AOJ to obtain and provide the resume and curriculum vitae (CV) of the January 2021 VA examiner to the Veteran. As reported in the February 2022 final attempt letter, the Board finds that there was substantial compliance with the remand directives as adequate attempts were conducted to obtain the examiner's CV. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Service Connection for Headaches The Veteran contends that his headaches were caused by his active duty service. Alternatively, the Veteran asserts that his disability was secondary to a service connected condition. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. The Veteran has a current headache disability. For example, during the September 2015 and August 2020 VA examinations the Veteran was diagnosed with migraine including migraine variants. The remaining question concerns whether his current disability is related to service, or a service connected condition. The presumption of soundness applies only when a disease or injury not noted upon entry to service manifests in service, and a question arises as to whether it preexisted service. Gilbert v. Shinseki, 26 Vet. App. 48, 55 (2012), aff'd 749 F.3d 1370 (Fed. Cir. 2014). In this case, there is a question as to whether the Veteran's headaches preexisted his military service. During the September 2019 remand, the Board found that there was clear and unmistakable evidence that the Veteran's headache existed prior to his active duty service in 2003. This was based on the headache diagnosis in June 2000 and the service treatment record (STR) from April 2002 showing a prescription of Zomig, a medication specific for headaches. The Board also found that there was no clear and unmistakable evidence that the Veteran's headaches were not aggravated by service. Given these findings, the Board noted that the in-service element was met for the period of active duty in 2003 and the second period of service from July 2005 to May 2006. Therefore, the presumption of soundness has not been rebutted. When VA fails to carry its burden as to either preexistence or lack of aggravation, whether and to what extent the Veteran is entitled to compensation for the injury would be determined upon the assumption that the injury was incurred during service. It does not necessarily follow, however, that an unrebutted presumption of soundness will lead to service connection for the disease or injury. The Veteran must still demonstrate a current disability and a nexus between the current disability and the injury or disease in service. See Horn v. Shinseki, 25 Vet. App. 231, 233 (2012). To address the nexus question, the December 2019 remand directed the AOJ to obtain an addendum medical opinion to determine whether the Veteran's current disability was related to his active duty service. Since then, various medical opinions addressing direct and secondary service connection were obtained, as well as opinions addressing whether the Veteran's headaches preexisted service. Of note, during the appeal period, the Veteran was granted service connection for hypertension. The Board revisits the April 2019 private medical opinion by Dr. J.E., who had conducted an examination of the Veteran and reviewed the record. In the opinion, Dr. J.E. opined that the Veteran's hypertension caused the onset of the Veteran's migraine headache. While there are some issues in the opinion, it is still sound with respect to the connection between hypertension and headache. In that regard, Dr. J.E. had noted that during his service, the Veteran had experienced headaches and upon treatment by the base physician, it was noted that he had high blood pressure. The opinion is supported by the service treatment records. For example, during a June 2000 treatment, it was noted that the Veteran had a history of hypertension and headaches, and that that there was a relation between his hypertension and his headaches. The Veteran has continued to experience both conditions since service. The Board gives probative weight to this opinion as it was made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. There is no medical opinion or competent and credible evidence in significant conflict with the medical opinion. The opinion is also supported by other evidence of record, such as VA examinations. For instance, during a September 2015 VA hypertension examination, the examiner noted the recurrence between the symptoms of headache and hypertension. At his August 2020 VA hypertension examination, it was noted that when his blood pressure goes up, he has severe headaches. Upon review of the record, the Board finds the evidence to be evenly balanced as to whether the Veteran's current headaches is proximately due to his service-connected hypertension. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for headaches is warranted, and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Mathew 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.