Citation Nr: 24001057 Decision Date: 01/05/24 Archive Date: 01/05/24 DOCKET NO. 20-25 176A DATE: January 5, 2024 REMANDED Entitlement to service connection for traumatic brain injury (TBI), to include headaches, is remanded. REASONS FOR REMAND The Veteran served in the U.S. Army from August 2005 to October 2006 and November 2008 to December 2009. The Veteran had a period of active duty for training from August 2003 to January 2004. The Veteran also had additional unverified service in the Army Reserves. This matter is before the Board of Veterans' Appeals (Board) on appeal of a January 2019 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). In a May 2020 substantive appeal, the Veteran has asserted that headaches are a symptom of residuals of head injury that the Veteran sustained during active service. Medical evidence associated with the claims file throughout the pendency of the claim, including copies of service treatment records (STRs), show the Veteran was treated for at least two instances of blast exposure during active service and complaints of headaches. Accordingly, the Board recharacterizes the claim for service connection to one of service connection for TBI, to include headaches. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). 1. Entitlement to service connection for headaches, to include as secondary to acquired psychiatric condition (OSTSD), is remanded. A March 2006 medical examination note indicated the Veteran was involved in a mortar attack in February 2006. While walking, a mortar landed approximately 30 to 40 feet from him resulting in a foreign body striking him on the occiput and causing subsequent headaches. It was noted that his injury was incurred in the line of duty. A February 2008 medical examination noted the Veteran requested a line of duty determination for, among other things, headaches. The examiner noted that his symptoms are consistent with depression and posttraumatic stress disorder (PTSD). In an October 2009 STR, the Veteran underwent an evaluation after a blast injury in October 2009. He stated he was going to living quarters when a rocket exploded 20 to 50 meters away. He stated he did not hit head, lose consciousness, or see stars/dazed/confused. There was no concussion, and he had no problems remembering event. The examiner found this is a negative screen. The Veteran, however, did report having headaches once or twice a month on and off at that time. A December 2018 VA TBI examiner found the Veteran did not have a diagnosis of TBI. The examiner found the Veteran's migraine headaches were not TBI related as they have not occurred contemporaneously to the claimed event. A March 2020 VA examiner also found there is no evidence of a TBI, or residuals related to a TBI. The Veteran reported headaches for about 3 to 4 weeks after his 2006 blast injury. He also reported occasional headaches since that time. The examiner noted he did not suffer any loss of consciousness and his current symptoms are related to his PTSD, depression, and anxiety. Although there is evidence against a current finding of TBI, the Board notes that the March 2020 VA examiner seemed to link the Veteran's headaches to his now service-connected other specified trauma and stressor-related disorder (OSTSD). As such, the Board finds a remand is necessary to determine the nature and etiology of the Veteran's claimed headaches, to include a potential secondary service connection. The causation standard for secondary service connection is "but-for causation." "The but-for causation standard is not limited to a single cause and effect, but rather contemplates multi-causal links, including action and inaction ... Stated otherwise, but-for causation is broad, undisputedly broader than proximate cause." Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) The matters are REMANDED for the following action: Schedule the Veteran for a VA examination for his claimed headaches. The claims file must be reviewed. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is the evidence at least in approximate balance that any headache disorder is related to service, including in-service blast injuries? Is the evidence at least in approximate balance that any headache disability is "but-for" due to service-connected OSTSD? Is the evidence at least in approximate balance that any headache disability was aggravated, i.e., worsened beyond its natural progression, by service-connected OSTSD? The examiner must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. Martin T. Mitchell Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. M. Donahue Boushehri 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.