Citation Nr: A25035372 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 240428-435125 DATE: April 16, 2025 ORDER Service connection for migraine headaches is granted. Service connection for an acquired psychiatric disability to include an adjustment disorder, generalized anxiety disorder, bipolar disorder, and intermittent explosive disorder ("acquired psychiatric disability") is granted. Service connection for a back condition is granted. Service connection for tinnitus is granted. Service connection for sleep disturbances to include sleep apnea and insomnia ("sleep disturbances") secondary to service-connected PTSD is granted. Service connection for cesarean section residuals to include scarring ("cesarean section residuals") is denied. Service connection for skin irritation is denied. REMANDED Service connection for bilateral hearing loss is remanded. FINDINGS OF FACT 1. The probative evidence of record supports a finding that the Veteran incurred headaches during service, which have persisted since exiting from service. 2. The probative evidence of record supports a finding that the Veteran experienced military sexual trauma, which led to the diagnosis of an acquired psychiatric disability. 3. The probative evidence of record supports a finding that the Veteran experienced lower back pain during service, which has persisted since exiting from service. 4. The probative evidence of record supports a finding that the Veteran experienced symptoms of tinnitus during service, which have persisted since exiting from service. 5. The probative evidence of record supports a finding that the Veteran's sleep disturbances are causally related to her service-connected PTSD. 6. The probative evidence of record does not support a finding that the Veteran's cesarean section residuals are casually related to service. 7. The probative evidence of record does not support a finding that the Veteran has a diagnosis of skin irritation. CONCLUSIONS OF LAW 1. The criteria for?service?connection?for migraine headaches are met.?38 U.S.C. §§ 1110, 1131, 5107;?38 C.F.R. §§ 3.102, 3.303. 2. The criteria for?service?connection?for an acquired psychiatric disability are met.?38 U.S.C. §§ 1110, 1131, 5107;?38 C.F.R. §§ 3.102, 3.303. 3. The criteria for?service?connection?for a back condition are met.?38 U.S.C. §§ 1110, 1131, 5107;?38 C.F.R. §§ 3.102, 3.303. 4. The criteria for?service?connection?for tinnitus are met.?38 U.S.C. §§ 1110, 1131, 5107;?38 C.F.R. §§ 3.102, 3.303. 5. The criteria for?service?connection?for sleep disturbances secondary to service-connected PTSD are met.?38 U.S.C. §§ 1110, 1131, 5107;?38 C.F.R. §§ 3.102, 3.303. 6. The criteria for?service?connection?for cesarean section residuals are not met.?38 U.S.C. §§ 1110, 1131, 5107;?38 C.F.R. §§ 3.102, 3.303. 7. The criteria for?service?connection?for skin irritation are not met.?38 U.S.C. §§ 1110, 1131, 5107;?38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty for training in the Air Force Reserves from November 2002, to March 2003, and from September 4, 2007, to September 21, 2007. This matter comes before the?Board of Veterans' Appeals?(Board) on appeal from an October 2023 and April 2024 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO).?? In April 2024, the Veteran submitted a VA Form 10182 Notice of Disagreement (NOD), seeking?direct?review by a Veterans Law Judge (VLJ) under the Appeals Modernization Act (AMA). Under?Direct?Review, all evidence available at the time of the decision on appeal is considered.?? 1. Service connection for migraine headaches is granted. Legal Criteria To prevail on the issue of?service?connection?there must be evidence of a current disability, in-service?incurrence or aggravation of a disease or injury; and a causal relationship between the present disability and the disease or injury incurred or aggravated during?service. See Shedden v. Principi,?381 F.3d 1163, 116667 (Fed. Cir. 2004).?Service?connection?may also be established under?38 C.F.R. § 3.303?(b) for a current disability on the basis of a presumption under the law that certain chronic diseases manifesting themselves to a certain degree within a certain time after?service?must have had their onset in?service; and?service?connection?may be established by evidence of continuity of symptomatology.?38 U.S.C. §§ 1101, 1110, 1112;?38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence persuasively favors the claim or is in approximate balance, with the Veteran prevailing in either event, or whether the evidence persuasively weighs against the claim, in which case the claim is denied. In other words, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (2021). "Active service" includes active duty, a period of active-duty training (ADT) in which the individual was disabled from a disease or injury incurred or aggravated in the line of duty, and a period of inactive duty training (IDT) in which the individual was disabled from injuries only incurred or aggravated during such periods. 38 U.S.C. § 101 (21-24); 38 C.F.R. § 3.6 (a); see McManaway v. West, 13 Vet. App. 60, 67 (1999) (quoting Brooks v. Brown, 5 Vet. App. 484, 485 (1993) (discussing 38 U.S.C. §§ 101 (24), 1131) (stating that the law "permits service connection for persons on inactive duty [training] only for injuries, not diseases, incurred or aggravated in line of duty."). ADT includes full-time duty performed for training purposes by members of the Reserve or National Guard. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c). IDT is generally duty (other than full-time duty) prescribed for Reserve or duty performed by a member of the National Guard of any State (other than full-time duty). 38 U.S.C. § 101 (23); 38 C.F.R. § 3.6 (d). Annual training is an example of ADT, while weekend drills are IDT. Factual Background The Veteran reported that she began to experience throbbing migraine headaches in 2003 while serving on Charleston, Air Force Base. The Veteran further reported that she experienced nausea, vomiting, and sensitivity to light. The Veteran stated that she was seen at a VA hospital in 2003 and that she had daily migraines for 3 months. The Veteran was diagnosed with migraine headaches at a December 2022 VA examination. The Veteran was afforded a May 2023 VA examination during which the conducting examiner opined that it was less likely that her migraine headaches were causally related to her service-connected PTSD. The examiner explained that they were unable to opine to determine the cause of headaches without mere speculation. The Veteran was afforded an October 2023 VA examination for dizziness where she reported that she was seen for headaches during service in 2003. Analysis The record indicates that the Veteran has a diagnosis of migraine headaches. See December 2022 VA examination. The Board assigns probative value to the Veteran's statements that she experienced migraine headaches during service which have persisted since exiting from service because she is competent and credible to report observable symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board does not assign probative value to the May 2023 VA examiner's negative opinion because they did not provide a rationale for their opinion and indicated that they could not determine the etiology of the Veteran's headaches without resorting to speculation. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Accordingly, the Board finds that the probative evidence of record supports a finding that the Veteran incurred headaches during service, which have persisted since exiting from service. As such, service connection for headaches is granted. 2. Service connection for an acquired psychiatric disability to include an adjustment disorder, generalized anxiety disorder, bipolar disorder, and intermittent explosive disorder ("acquired psychiatric disability") is granted. Factual Background The Veteran was diagnosed with an adjustment disorder at a September 2007 in-service treatment. The Veteran was afforded a November 2022 medical treatment during which the conducting physician noted that she has a history of generalized anxiety disorder and intermittent explosive disorder. The Veteran was afforded a December 2022 VA examination during which she explained that she was a victim of military sexual trauma while on required training during service in 2002. The examiner noted that there was marker evidence of record, including visits to a medical or counseling clinic or dispensary without a specific diagnosis or specific ailment, increased interest in tests for HIV or sexually transmitted diseases, and a breakup of a primary relationship. The conducting examiner diagnosed her with PTSD and major depressive disorder. The examiner indicated that the Veteran displayed symptoms of anxiety, depressed mood, and impaired impulse control, such as unprovoked irritability with periods of violence. The Veteran was afforded a June 2023 medical treatment during which the examiner explained that she has displayed increased levels of mental dissociation, depression, adjustment disorder, and night terrors. The examiner indicated that these symptoms are related to her military sexual trauma. Analysis As a preliminary matter, the Board has elected to recharacterize the Veteran's claims for service connection for an adjustment disorder, service connection for generalized anxiety disorder, service connection for bipolar disorder, and service connection for intermittent explosive disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The Board notes that the Veteran was diagnosed with an adjustment disorder during service. See September 2007 medical treatment. The Veteran has also been subsequently diagnosed with generalized anxiety disorder and intermittent explosive disorder. Accordingly, the first element of service connection has been met. Additionally, the Board finds the Veteran to be competent and credible to report the circumstances of her military sexual trauma. See Jandreau supra. Additionally, the Board notes that the December 2022 VA examiner indicated that there was marker evidence of record including visits to a medical or counseling clinic or dispensary without a specific diagnosis or specific ailment, increased interest in tests for HIV or sexually transmitted diseases, and a breakup of a primary relationship. The Board also assigns probative value to the findings of the June 2023 medical examiner who indicated that the Veteran's adjustment disorder is causally related to her military sexual trauma. The Board notes that the examiner supported their finding with a rationale. Accordingly, the Board finds that the probative evidence of record supports a finding that the Veteran experienced military sexual trauma, which led to a diagnosis of an acquired psychiatric disability during service. As such, service connection for an acquired psychiatric disability is granted. 3. Service connection for a back condition is granted. Factual Background The Veteran reported lower back pain at a September 2007 in-service treatment. The Veteran was afforded a December 2022 VA examination, during which she reported the onset of her back condition was in 2007 during physical training. The Veteran reported that her condition has worsened since then. In March 2023, a VA examiner indicated that the Veteran was diagnosed with degenerative arthritis of the spine in 2019. The examiner opined that it was less likely than not that the Veteran's back condition is causally related to service. As a rationale, the examiner explained that the Veteran had no chronic back condition demonstrated during active-duty service period. The examiner explained that the Veteran had a back injury while employed at Boeing and during a motor vehicle accident in August 2014, which caused recurring severe lower back pain. The examiner noted that that Veteran's IVDS and degenerative arthritis were not diagnosed during active-duty service period. Analysis The record indicates that the Veteran has a diagnosis of a lower back condition. See March 2023 VA examination. Accordingly, the first element of service connection has been met. The record also indicates that the Veteran reported lower back pain during service. See September 2007 in-service treatment. The Board also finds the Veteran competent and credible in reporting lower back pain during service that has persisted since exiting service because such symptoms are readily observable. See Jandreau supra. The Board does not assign probative value to the March 2023 VA examiner's negative opinion because they did not consider the Veteran's in-service reports of lower back pain. Accordingly, the Board finds that the probative evidence of record supports a finding that the Veteran experienced lower back pain during service, which has persisted since exiting from service. As such, service connection for a lower back condition is granted. 4. Service connection for tinnitus is granted. Factual Background The Veteran reported symptoms of tinnitus at a November 2022 medical treatment. The Veteran was afforded a December 2022 VA examination, during which she reported that she had an onset of tinnitus during service. The Veteran explained that she was exposed to military noise exposure from the flight line and gun range. The Veteran described the symptoms as a loud ringing in both ears, which occurs daily for 30 minutes at a time. The Veteran reported that her symptoms have remained the same since exiting service. The conducting examiner opined that it was less likely than not that the Veteran's tinnitus is causally related to service. As a rationale, the examiner explained that the Veteran had an MOS of health service management which had a low probability of hazardous noise exposure. The examiner further noted that there were no reports of tinnitus in the Veteran's service treatment records. Finally, the examiner indicated that the first report of the Veteran's tinnitus was in November 2022. Analysis The record indicates that the Veteran has a diagnosis of tinnitus. See December 2022 VA examination. Accordingly, the first element of service connection has been met. The Board finds the Veteran to be competent and credible to report that she was exposed to acoustic trauma during service from the flight line and gun range because it is readily observable. As such, the second element of service connection has been met. See Jandreau supra. Additionally, the Board finds the Veteran competent and credible to report that she experienced symptoms of tinnitus during service which has persisted since exiting from service because it is readily observable. Id. The Board does not assign probative value to the December 2022 VA examiner's negative opinion because they relied on an absence of reports in the service treatment records and did not account for the Veteran's statements. See Barr supra; Buchanan v. Nicholson, 451 F.3d 1331 (2006). Accordingly, the Board finds that the probative evidence of record supports a finding that the Veteran experienced symptoms of tinnitus during service which have persisted since exiting from service. As such, service connection for tinnitus is granted. 5. Service connection for sleep disturbances to include sleep apnea and insomnia ("sleep disturbances") to include as secondary to service-connected PTSD is granted. Legal Criteria Secondary service connection may also be established for a disability which is aggravated by a service-connected disability. To prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing that the service-connected disability caused or aggravated the nonservice-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). Factual Background The Veteran was afforded a December 2022 medical treatment during which she reported that she sleeps very poorly and experiences nightmares. The Veteran was prescribed medication for her sleep disorder. The Veteran was afforded a December 2022 VA examination during which the conducting examiner during indicated that her PTSD resulted in symptoms of chronic sleep impairment. The Veteran was afforded a July 2023 medical treatment during which she stated that she is unable to get adequate sleep has she is still having terrors about her military sexual trauma. Analysis As a preliminary matter, the Board has elected to recharacterize the Veteran's claims for service connection for sleep apnea and service connection for insomnia as one for sleep disturbances, to include to include sleep apnea and insomnia. See Clemons supra. The record indicates that the Veteran has a diagnosis of sleep disturbances. See December 2022 VA examination. Accordingly, the first element of service connection has been met. What remains for consideration is whether the Veteran's sleep disturbances are causally related to her service-connected PTSD. Here, the Board notes that the December 2022 VA examiner indicated that the Veteran's PTSD results in symptoms of chronic sleep impairment. Additionally, the Board finds the Veteran competent and credible to report that she has trouble sleeping at night due to recollections of her in-service trauma. Accordingly, the Board finds that the probative evidence of record supports a finding that the Veteran's sleep disturbances are causally related to her service-connected PTSD. 6. Service connection for cesarean section residuals to include scarring ("cesarean section residuals") is denied. Factual Background The Veteran received a cesarean section for her delivery in September 2017. The Veteran reported that she was not dilating after being induced and had to have a C-section. The conducting examiner identified a scar to the supra pubic area. See October 2023 VA examination. The conducting examiner opined that it was less likely than not that her cesarean scar residuals were related to contaminated water exposure during service. As a rationale, the examiner explained that there is no medical or scientific evidence available that provides any indication or a relationship between her cesarean section residuals and toxic exposure. Analysis The Veteran has a diagnosis of scarring as a result of her cesarean section in September 2017. See October 2023 VA examination. As such, the first element of service connection has been met. What remains for consideration is whether the Veteran's cesarean section residuals are related to service. Here, the Board notes that the Veteran's cesarean section took place in September 2017, over ten years after exiting from service. The Veteran has also not provided any medical opinions which indicate that her cesarean section residuals are causally related to service. Accordingly, the Board finds that the probative evidence of record does not support a finding that the Veteran's cesarean section residuals are casually related to service. As such, service connection is denied. 7. Service connection for skin irritation is denied. Factual Background The Veteran attended a September 2022 medical treatment during which the conducting examiner noted that she did not have any lesions or rashes. The Veteran was afforded an October 2023 VA examination during which the examiner indicated that the Veteran did not have a current skin condition or rashes. The Veteran reported that she had a breakout of rashes in her arms, thighs and legs during service. The Veteran reported that her rashes have come and gone since exiting from service. The conducting examiner opined that it is less likely than not that the Veteran's claimed condition is causally related to a toxic exposure risk activity. As a rationale, the examiner explained that there is no pathology to warrant a diagnosis or condition that can be related to the claimed toxic exposure. See October 2023 VA examination. Analysis The record indicates that the Veteran reports have a breakout of rashes during service. However, the Veteran's post-service treatment records are silent for a current diagnosis of a skin condition. Additionally, the October 2023 VA examiner indicated that the Veteran did not have a diagnosis of a skin condition. The Board acknowledges that the Veteran has expressed that she has a skin condition. However, while Veteran is competent to report the observable symptoms she experiences, she does not have the training or credentials to provide a competent (that is, medically qualified) opinion as to a medical diagnosis. See Jandreau, supra. In the absence of evidence of a current disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (Fed. Cir. 1992). Therefore, given that a skin condition has not been diagnosed, it is unnecessary to address the remaining elements of the claim for service connection. As such, service connection for skin irritation is denied. REASONS FOR REMAND Service connection for bilateral hearing loss is remanded. On the authorized audiological evaluation at a December 2022 VA examination, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 20 15 15 25 LEFT 20 20 20 20 20 The conducting examiner noted that the speech discrimination score was not available. Without the score, the Board is unable to determine whether the Veteran has hearing loss for VA compensation purposes. Accordingly, the Board finds that the December 2022 VA examination is inadequate and that remand is necessary to correct this pre-decisional duty to assist error. See Barr supra. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of any currently present bilateral hearing loss disability. The claims file must be made available to and reviewed by the examiner. Any indicated studies should be performed. 2. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any currently present bilateral hearing loss disability is etiologically related to hazardous noise exposure during the Veteran's active service. The examiner should provide a complete rationale for all opinions provided, which involves a detailed discussion of the reasoning behind each conclusion and does not rely on conclusory statements. After completing all indicated development, the Veteran's claims should be readjudicated based on the entirety of the evidence. Thomas L. English Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bahus, Alexander 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.