Citation Nr: 0003746 Decision Date: 02/14/00 Archive Date: 02/15/00 DOCKET NO. 94-36 991 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to service connection for headaches, to include as due to residuals of a head injury. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD A. C. Mackenzie, Associate Counsel INTRODUCTION The veteran has verified military service from March 1973 to April 1976, and his DD Form 214 indicates an additional one year, eleven months, and eighteen days of prior active service. This matter comes before the Board of Veterans' Appeals (Board or BVA) on appeal from an October 1993 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The Board remanded this case to the RO for further development in May 1997 and December 1998, and the case has since been returned to the Board. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of this appeal has been obtained by the RO. 2. The veteran's current headaches have not been shown to be causally related to service or to a service-connected disability. CONCLUSION OF LAW The veteran's headaches were not incurred in or aggravated in service nor are they due to or the result of a service- connected disability. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.310 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, the Board finds that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, the veteran is found to have presented a claim which is not inherently implausible. Furthermore, after examining the record, the Board is satisfied that all relevant facts have been properly developed in regard to the veteran's claim and that no further assistance to him is required to comply with the VA's duty to assist, as mandated by 38 U.S.C.A. § 5107(a). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303(a) (1999). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1999). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). Additionally, a disability which is proximately due to, or results from, another disease or injury for which service connection has been granted shall be considered a part of the original condition. 38 C.F.R. § 3.310(a) (1999). Specifically, when aggravation of a disease or injury for which service connection has not been granted is proximately due to, or the result of, a service-connected condition, the veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439, 448 (1995). During service, in September 1972, the veteran was injured in an automobile accident. He sustained multiple contusions and lacerations, including a scalp laceration. The records of his subsequent hospitalization, which lasted approximately three days, indicate that he was given medication for pain. Also, in October 1975, the veteran reported pain on the top of the head while wearing a steel helmet. However, a November 1975 physical examination revealed no evidence of headaches. Subsequent to service, in June 1976, the veteran underwent a VA examination, during which he did not complain of headaches. The first post-service medical evidence of headaches is a May 1993 VA treatment report. A June 1993 VA treatment record contains an impression of tension headaches (stress-related), which the veteran had described as lasting approximately six years. A July 1993 VA neurological consultation report indicates that the veteran complained of headaches and blurred vision for over five years; the pertinent impression was chronic headaches, of uncertain etiology. A July 1993 magnetic resonance imaging study (MRI) of the brain was normal. However, an April 1994 VA treatment record contains a diagnostic impression of "[r]ecurrent severe headache 20 years." Also, while a February 1995 VA treatment record indicates that the veteran's headaches were possibly of tension or polypharmacy etiology, a September 1995 record includes a diagnosis of post-traumatic headaches and contains a notation of the veteran's 1972 motor vehicle accident. Following the Board's May 1997 remand, the veteran underwent an examination with a VA psychologist in September 1997. Upon examination, the examiner noted that the veteran had interruptions of his stream of thought "which can be consistent with sequelae of head injury." The examiner further opined that the exact sequelae of the neurological effects was not clear from the record and that the veteran's headaches were at least as likely as not secondary to his motor vehicle accident as to other causes. In this regard, the examiner noted that the veteran's positive response to medication could indicate either a tension or medical basis for the headaches, and the examiner rendered no psychiatric diagnoses. The veteran also underwent a VA diseases and injuries of the brain examination in September 1997. The examining neurologist reviewed the veteran's claims file and, in the examination report, described the events surrounding the veteran's September 1972 injury and his post-service treatment. Following the examination, the examiner noted that the veteran had no tumor, motor or sensory impairment of the cranial nerves, or functional impairment of any peripheral structures. Also, the veteran did not meet the diagnostic criteria for migraine headaches; his headaches were most compatible with the type of headaches associated with a psychological disorder, otherwise known as "tension" headaches. The examiner noted that there was no way that an independent examiner could reconcile the prior medical opinions or record, but he also indicated that the veteran's headaches appeared to go back to 1987 or 1988 and that the current headaches had no relationship to the in-service motor accident. The examiner's rationale for this opinion was that there was only one minor complaint of headaches during the veteran's in-service hospitalization and that he was not regularly treated for headaches until 1993. In a November 1997 addendum, the VA psychologist who conducted the September 1997 examination noted that the veteran had "insufficient clear indication" of a mental disorder to warrant a diagnosis and that his VA neurological examination report contained the opinion that his current symptoms were not related to his motor vehicle accident. In view of this, the VA psychologist noted that he was inclined to defer to the VA neurologist's opinion and that, and, as such, the prior VA psychological examination report should be amended to reflect the conclusion that it was at least as likely as not that the veteran's claimed headache symptoms were due to factors other than his closed head injury. The Board also observes that, in November 1998, the veteran was seen at a VA facility for complaints of recurrent headaches, which he believed to be related to his in-service accident. The examiner rendered a diagnostic impression of "recurrent headaches which have gone on for years." However, radiologic studies of the skull were negative for a fracture. In reviewing the pertinent evidence in this case, the Board observes that the reports of the veteran's VA examinations from 1997 contain at least partially conflicting conclusions with regard to the etiology of his headaches. The VA psychologist who examined the veteran concluded initially that the headaches were at least as likely as not to have resulted from his in-service automobile accident. However, in a November 1997 addendum, this examiner modified that conclusion in view of subsequently developed evidence, namely the September 1997 VA neurological examination report, and stated that it was at least as likely as not that the veteran's headaches were due to factors other than his closed head injury. The Board finds that this revised opinion reflects a substantial abandonment of the earlier opinion linking the veteran's headaches to his in-service head injury, the residuals of which, specifically a right temporoparietal area scar, are service-connected. At a minimum, this revised opinion suggests that the prior opinion was, in effect, speculative in nature. By contrast, the opinion of the VA neurologist who examined the veteran in September 1997 is unambiguous. This examiner, after reviewing the claims file, found that the evidence of record did not support an onset date for the veteran's headaches prior to 1987 or 1988 and that the current headaches had no causal relationship with the in-service injury. The report of this examination contains a thorough description of the veteran's prior records of neurological treatment, and the examiner based his rationale in substantial part on the fact that the veteran was not treated for headaches on a regular basis prior to 1993. Given the unambiguous nature of this opinion as compared to that of the VA psychologist who examined the veteran in 1997, the thoroughness of the VA neurologist's analysis of the prior records, and the fact that veteran went for many years without treatment for headaches subsequent to his discharge from service, the Board finds the opinion of the VA neurologist to be of substantially greater probative value than that of the VA psychologist. See Hayes v. Brown, 5 Vet. App. 60, 69 (1993); Wood v. Derwinski, 1 Vet. App. 190, 192- 93 (1992) ("It is the responsibility of the BVA to assess the credibility and weight to be given the evidence"). See also Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Overall, the Board finds that the medical evidence of record does not support the conclusion that there is a causal relationship between the veteran's current headaches and either service or a service-connected disability. The only other evidence of record in support of the veteran's claim is his own lay opinion that his headaches were related to his in-service head injury, as set forth in the testimony from his March 1997 Board hearing. However, the veteran has not been shown to possess the medical expertise necessary to render a competent opinion regarding a current diagnosis or causation. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); see also LeShore v. Brown, 8 Vet. App. 406, 409 (1995) (evidence which is simply information recorded by a medical examiner and unenhanced by any additional medical commentary to that effect by the examiner does not constitute competent medical evidence). In short, the preponderance of the evidence of record is against the conclusion that the veteran's headaches were either incurred in service or incurred or aggravated as secondary to a service-connected disability. Therefore, the veteran's claim for service connection for headaches, to include as secondary to a service-connected disability must be denied. In reaching this determination, the Board has considered the doctrine of reasonable doubt, as set forth in 38 U.S.C.A. § 5107(b) (West 1991). However, as the preponderance of the evidence is against the veteran's claim, this doctrine is not for application in the present case. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). ORDER Service connection for headaches is denied. S. L. KENNEDY Member, Board of Veterans' Appeals